Party Discovery: LOUIS CASTAGNA VS. ASBESTOS DEFENDANTS (B/P)AS REFLECTED ON EXHIBITS et al

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                                LANKFORD
CRAWFORD
MORENO LLP

ATTORNEYS AT LAW

PAUL V. LANKFORD (State Bar No. 181506)
PAUL LANNUS (State Bar No. 192551)
LANKFORD CRAWFORD MORENO LLP
1850 Mt. Diablo Bivd., Suite 600

Walnut Creek CA 94596

Telephone: 925.300.3520

Facsimile: 925.300.3386

Attorneys for Defendant
FORD MOTOR COMPANY

ELECTRONICALLY
FILED

Superior Court of California,
County of San Francisco

JAN 12 2011

Clerk of the Court
BY: ALISON AGBAY
Deputy Clerk

SUPERIOR COURT OF THE STATE OF CALIFORNIA

COUNTY OF SAN FRANCISCO

SAMUEL LEAL,
*Plaintiff,
v.
ASBESTOS DEFENDANTS (BP),

Defendants.

LOUIS CASTAGNA,
Plaintiff,
v.

ASBESTOS DEFENDANTS (B*P),

ASBESTOS
BRAYTON GROUP 536

CASE No, CGC-08-274807

Case No. CGC-07-274230

DECLARATION OF PAUL LANNUS IN
Supporr OF DEFENDANT FORD Motor
ComPANyY’s MOTION IN LIMINE TO
PRECLUDE ADMISSION OR ANY
REFERENCE TO UNFOUNDED

Defendants. ENVIRONMENTAL PROTECTION AGENCY
GuIpancrs [MIL #36]
* The use of the term “plaintiff” as used herein refers to the plaintiff in a personal injury action and the

decedent in a wrongful death action; and the use of “plaintiff” shall refer to both plaintiff in the singular and plural, as

appropriate.

-1-

ALANKFORD
CRAWFORD
MORENO LLP.

ATTORNEYS ATLAW

GARY COATES,
Plaintiff,
vy.
ASBESTOS DEFENDANTS (BP),

Defendants.

CLEM FITZHUGH,
Plaintiff,
v.
ASBESTOS DEFENDANTS (BP),
Defendants.

Case No. CGC-08-274784

CASE NO. CGC-08-274645

DECLARATION OF PAUL LANNUS EN SUPPORT OF DEFENDANT FORD MOTOR COMPANY'S
MOTION IN LIMINE TO PRECLUDE ADMISSION OR ANY REFERENCE TO UNFOUNDED
ENVIRONMENTAL PROTECTION AGENCY GUIMDANCES [MIL #36]

ANOD HA ow

28

LANKFORD

CRAWFORD
MORENO LLP
ATTORNEYS ATLAW

T, PAUL LANNUS, declare as follows:

i, lam a member of the State Bar of California and an attorney with LANKFORD
CRAWFORD MORENO LLP, counsel of record for Defendant in the above action. I have
personal knowledge of the facts sct forth in this declaration and, if called as a witness, could and
would testify competently to such facts under oath.

2. Attached hereto as Exhibit A is a true and correct copy of Environmental
Protection Agency (“EPA”) 1986 document titled “Guidance for Preventing Asbestos Disease
Among Auto Mechanics.”

3. Attached hereto as Exhibit B is a true and correct copy of EPA March 2007
document titled “Current Best Practices for Preventing Asbestos Exposure Among Brake and
Clutch Repair Workers.”

4. Attached hereto as Exhibit C is a true and correct copy of the Lorimer study, cited
in footnote 7 in the 1986 EPA document titled “Guidance for Preventing Asbestos Disease
Among Auto Mechanics.”

I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct.

Executed on this 2™ day of December, 2010, at Walnut Creek, California.

PAUL LANNUS

-2-

DECLARATION OF PAUL LANNUS IN SUPPORT OF MOTION IN LIMINE TO PRECLUDE ADMISSION OR ANY REFERENCE TO UNFOUNDED
ENVIRONMENTAL PROTECTION AGENCY GUIDANCES
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edjay UoHeUojur sty) UBD OUAAEXHIBIT CDLE

‘Tue Mower Stat Joumiun, of Numicosn
: Vol 43, No.3, May-June, 1876
iboratory to science, firm in our Printed in

ents sublimated compassion and
application of science thet we gain
others to live. and to. live more

‘ould-be unworthy ofthe name of

“Asbestos Exposure of Brak Repair Workers i in the
_ United States"

" wMtiaM V, LORIMER, M.D. ARTHUR N. ROHL, Pup. Aipuer nic, MD.
WILLIAM J. NICHOLSON, PED. 4x0 IRVING Q.. SELIKOFE, M.D.

éxaployed as‘auto mechanics
ercentage of these workers’

the asbestos worn aviay eens BO%-80%
the atmosphere...

The : wearing of asbestos Linings is complex and. for brief periods of time local
areas in the lining surface have temperatures exceeding 680°C, the tempera. -
ture at which chrysotile asbestos Joses the major portion, af its water of by-
droxylation and loses its” ‘chbraeteristic morphology. The bulk temporaturé
cannot exceed 350—400°C for any léngth of time ‘without decomposition of the
organic polymer’ binder material.

Several investigators (2-4) have’ " andlyzed’ bulk’, bréke-dram dust for. : |
chrysotile and have found weight perdéntages c of. ‘between 0.8% (2) to “eit most
1%” (3), Lynch (4)'reported Percentages of 16% and 16% free fiber in two of
fifleen samples. Mast of the rest were below 1%. * ;

Persenel and background simpling ‘of workers engaged i in ‘brake’ ‘midinte-
nance work at the job site. gives a snore direct estiméte of exposure.

Daring brake-lining’ ‘servicing ie wheel is removed. ‘and all loose dust ‘is
removed from the drams and backplates, Compressed ‘air jets are tisually used
(Fig. 1). In 2 two-city survey in the USA, ‘Castlemiin et al (6) found that 175
out of 220 establishments used this | procedure. Alternates include vacuuming ,
and .wel brushing. The brake lis ning itself may: require grinding to remove
irregularities or removal and replacement. The new lining may require
considerable manipulation to fit the brake shoe—beveling edges and punching
holes in the material, for example-As-dn alteniative, the brake shoe end lining

Prom the Department of Comiaunity Medicine and the Department. of Medicine, Mount Sinai
Schoo! of Medicine of The City University of New York, N.Y. 10025,

* Presented at the XVII International Congress on Occupational Health, Brighton, England,
September 16, 1975.

This work was supported by New York City ‘Health Research Council U-2329, NIEHS Grant
ES 00928, and NIH Research Training Fellowabip, National Heart and Eung Institute Grent HL
03591 (Dr, Lorimer) and by The Fard Motor Company.

Requests for reprints should be sent'to* Dr. Willism Lorimer, Environmental Sciences
Laboratery, Mount Sinai School of Medicine of The City University of New York, N. ¥; 10029,

207

drops, fo Ah ond or is emitted into2038 WILLIAM. V, LORIMER ET AL

Repos Eee

sponses

ey

Fis, 1. Auto worker cleaning brake drum with compressed oir jot, Note perconal sompleron the
right side of worker's chest,

may be replaced as e unit. A number of studies have measured exposure in
such work, and fiber counts reported ere summarized in Table I.

In addition, Boillat and Lob (8) reported values for various manipulations of
the brake-lining materiel including Punching holes for rivets, and gtinding.
Sampling interval is not given. Fiber counts ranged from 0.3 to 29.2 fibers/m);
four of the nine values were over 5 fibers/ml (5,000,000/m*),

Asbestos disease: Asbestosis in brake ners has been recognized and
compensated in Great Britain for many yeara (9), and instances of mesotheli-
oma in garage workers have also been identified (10-12). Boillat and Lob (8)
examined 39 vehicular maintenance workers who had performed brake-lining
service for about 4-2 hours a day for a mean of Bt years. They found two men
who may have had mild cases of asbestosis. The study. however, provided no
information as to the risk with longer exposures.

Present Investigation

In order to provide additional information on this subject, we have in-
vestigated asbestos exposure among brake repair maintenance workers in

New York City and have initiated a clinical survey of workers employed in
the workshops studied.

ASBESTOS EXPOSURE
Materials and methods

Personal air samples were taken during brake-lining maintenance work both
on automobiles and trucks, These were peak samples taken over 2-10 minutes

TABLE 1
Asbestos Fiber Measurements in Brake Maintenance Service

Coraments

Sampling method

Operation

Reference

ASBESTOS EXPI

TWAT Four brake blowouts

1.25

atatlesaraples by elde of

3
3
7
3
:
3
2

during this time

ear-2
static samples, in dunt

Eight hour shift
Wark on hraleo

80 2.65

cloud during blowing-2
personal sampling (2 men)

TWA

0.68
100

ABO
to

‘on heal cleanin

mechenic employed209

ASBESTOS EXPOSURE OF BRAKE REPAIR, WORKERS

aSvaoay, payysjon oo, ~ Vite

aro . .
ag'o 09 60q quaanipy sojdures auj0
2 :
auoz dngyvaiq u dund nag 8 “woaag {uamz) saucer Buytwaaq way
Suop ato aqazq Gays veo : - (epee
‘Sutinp ano J6a0 way, 929 09 {our 017) potiomad , ymp Supaojq ‘pus qusuy
: : ‘spnojp
4genp way rajdined 4 9290 . :
daind pray-puogy yoga er spaosog aay ‘nay sano saidwuwa 3v0d | tanp joo Buyao1g (@ we
wo oat. : goa -
ero ost sayuao ofesna—
. iro oat Aussi 9609 Z—
1 woowogyn . . wo oat {noonsayo pur Sujusoc) ug, quopofpo—
Hupumennyunolg ew VAAL BO" oat vajauevone7o id puna
anjn2g uo piace yopy— . 80° t woe hawoap Suysors
eres eT oo . a (uo g) auydaius pouosiod hcaydaze ojungoats
angi ~ ft 890 s
a“ al wae ‘g-Buyooyg Zupnp paoje
- , 96° 06 qonp ty ‘eajdames anya oe
jap ayysupnp gag “oa Os
Gnowoqoxeqmeg = VAL * 08 Jeapedg saydareasyeo | wipanoduaoig PUT YaLHeY
TT anunaeg ako coy naa + poujoas 2uydusog uogacd aauasnyey

Fapalag aupunniayy aia uy suBuamsvapy soquy FO1—qsy
1 aTavi .

a 8
is
1B

2
i a8
i; Ge
283
z ai

z
3.8

dues for various manipulations of
g holes for rivets, and grindi:
sanged from 0.3 to 20.2 fibers/;

mil;

who had performed brake-lining
of 8a: years. They found two men

The study. however, provided no

(6,000,000/*). .
. ners has been recognized and

1(9), and instances of mesotheli-

fied (10-12). Boilfat and Lob (8)

gas a
oF® 33
gts a8
aes 5.4
ase 2a
BEER aa
gee Z5
Bas. 83
BEE 2
4 a
gas Eg
33 23
gaa. #6
gee $6210 : WILLIAM V. LORIMER BT AL
during which the workers were Petforming certain tasks, such as blowing dust

. fom drum brakes, renewing. used linings by grinding, and beveling new

linings. Background samples were also taken at varying distances and times,
‘The stendard techniques for filter procedsing and ‘fiber counting which have
been adopted by the Occupational Safety and Health Adkhinigtration of the
US Department of Labor were, used (13): Samples of dust collected in the

standard manner were examined both by- dtandard optical techniques (fi- .

bers/ml > 5p) and by eléctron microscopy to give pe/m? of air, and the results
compared, Bulk samples of brake-drum dust were collected and analyzed by
electron microscopy. One hundred fibers were sized in each sample; Qualita-

» tive-morphologic comparisons of the fibers with standard'chrysotile morphol- |

ogy were made,
Results se,

Fiber concentrations for. personit-and backgroimd saraples during blowing
dust from drum brakeé on automobiles are.presented in Table IL. The values
show extensive variation, but the valves at 8-5 Teet are by far the highest, with
a mean of 15,9 fibers/ml. . : .

Fiber concentrations for personal and background samples during renewing
‘used linings by grinding track brakes are presented in Table WI. The mean
concentration for the personal sampler was 3.8 fibers/ml. Fiber concentrations

TABLE I-
Personal Samples— Automobile Brake Service
Operation. . co Distance Coaesution
Blowing dust out of drum brakes ~ aft. 19.8
Blowing dust out of drum brakes Son - 204
Blowing dust out of diuz brakes 3-54t . BE
Blowing dustoutof drum brakes OBE 186
‘Blowing dustout of drum brakes 10 ~ 38
Blowing dustautofdrum brakes 5-10 20
‘Blowing dustout of drum brakes : Bld : 42
Blowing dustout of drum brakes “10-20%, od
Blowiiig dust out of drum brakes 10-20 ft, 48

Background Samptes—Automobile Brake Servite

Distancs

> Time
onan tame Uae
Blowing dust out of rota brakes ror. Oni, a3
~Blowing dust out of drum brakes 20 Omin. 0.8
Blowing dust out of drum brakes lft. min. 0,2
Blowing dust out of dram brakes On. _ Sxin, a1
Blowing dust out of dram brakes, Sf. . Trin. O41
Blowing dust outof drum braken 76M. Mmii, On

* Only fibers longer than 5. were counted by phase microscopy af 400%.

ASBESTOS EXPO

Personal £

Operation

. Renewing used linings by grind
Renewing used linings by grind!
Renewing used linings by grindi
Renewirig ved linings by grind{
Renewing used liningo-by.grindi
‘Renewliig used linings by grind
‘Renewing vised linings by grindi
Renewing used linings by grindi

+ Renewing used linings by grindt
Renewing used Jinings by grind

Boehground
em
Operatian

Se
Beckgraund to grinding used lin
Background 6 grinding used lin
Background to grinding used lin
Bodkgraund to grinding uséd lin
Background to grinding used lin

for persdnal and background +
ere given in Table IV. The me

To determine the correlati:
chrysotile, sections of filters ci

‘ contrast optical microscopy an

are given in Table V. Tew sam

. determine the percentage of ab

A mean’of 83% of all chrysotil-
20% of the total mess of" 4
diffraction.. Throughout the «&

. Waa given to the-morphology c

alteration in the typical ehry
granular patticles, when analy:
techniques, had structural and
alteration product of chrysotile
silicate composition was. also fi

CLINICAL STUDY

Materials and methads

104 inén, member of a ur
examined in a preliminary stu
City, All were volunteers. The
and environméntal history, »

,re

ASBESTOS EXPOSURE OF BRAKE. REPARR SVOFKERS 2u
RET AL :
. TABLET. - :
ertain tasks, such as blowing dust Peigonal Sompler- p > .02.

Effect of smoking: Significantly more smokers and ex-smokers than
non-smokers were obstructed (Table IX X? = 8.48 .01 > P > 001). (See note
at end of the Table.) There was no significant difference, however, amang
smokers, non-smokers, and ex-smokers with respect to restriction (X? = 01,
not significant).

ASBESTOS EXFOS

Classification of Pulmonary

A

PVC
———____—__™
FVCNG pred > 80 Norma
FVCNNG pred’s .70-.79 Restric
PYCIVC pred ¢ .69 Restrie

—
“Note: all those with FEV/PVG <

Pulmonary Function Abnormalities ir

Any ebnormatities
ee

Restriction of Pulmonary Function 6
restricti 1956-65

ive
and combined © ————

25 1
(62)

_—_
For before 1956 compared with 1855

Relationship.between Obstraction.or
ee

Number of
Subjects
Normal 31
Obstructive 3a
Restrictive “
Combined n
Total 87
a
For restriction X* = .01. N.S. (emoker
For obstruction X? = 8.28 .O1 > Pp

‘Those in the combined group counterle ters om brake-drua dust.

nics did brake lining more than
shad a menn age of 48 + 12 years

aary examination were minimal,
astaiices in which fine rales were
& performed on.a Systems
aents used were FVC/VC predict-
neasure of-obstruction in small
forced expiratory flow rate with
tired), The results were classified
ed, or notmal according to the
detailed in Table VIL. 29% had
increasing with age and most
ork (Teble VIII), The differences

smokers and ex-smokers than ~

+ 8,48 01 > p > .001): (See note
tant difference, however, among
respect to restriction (X* = .01,

ASHESTOS, EXPOSURE OF BRAKE REPAIR WORKERS 216

TABLE VI.
“Classification of Pulmonary Functiottin Vehicular Maintenance Workers
FEV, FVG 2 75
oie RSE SREY
FvC2 80, .

FVOVC pred & .80 Nomel =. fe” Obstructive *  Obotrudtive
FVCNC prea = 10-19 Restrictive d ‘Combined O¥otructive
FveNe pred < <9 Restrictive Combined . Gombined x

émbined

al those with rEvreve <..16 old bod FEPMMYE <0 -

TABLEVI* sos
Pulmonary Funclion Abnotmolitier in 87-Vehicular, Maintendrice Workers with over J0 Years
: . ___Baperience :
. Mumbar Percent.
Realsietive 1s . 16%
Obstructive a2 7%
Combined 1 . 13%
Any abnormalities . 6%
TABLE Vill
Restriction of Pulmonary Function by Year of Onset of Work in 90 Vehicle. Mointenance
Workers.
: ‘Abnormal
aah ‘1856-65 . 1946-65 ‘Before 1946
and comblaed > =
"Yee. + No. Yes "Na Yeo" No
25 Soa 18 1 2B 10 19
(6%) (335) (84%)

For before 1956 compared with 1956 ond after: X¥ = 4184 05 > p> .02
TABLE IX .
Relationship between Obstruction or.Restriction und Smoking in Vehicular Maintenance
Workers
. ‘ames . Never Smoked Ex.Smokers
-Nommel © ‘a to - B 8

Obstructive « 31 15 6 n
Restrictive ua a 6
Combined ue, 5 74 6
Toul 8 33 25 2

For wstsictioa X? » 01 aN. 5. (amoler ond ex-amobers compared with ever smoked)
.. Por obstruction X* = 828 .01 > p > .001
‘Those in the combined group counted, ns being both obstructive mid reatsiativea

216 WILLIAM V. LORIMER ET-AL ASBESTOS EXPO
_ The relationship between pulmonary functios sigas of restriction: and ‘
‘abnormal x-rays was investigated. No significant associativnwas found (Table
X). ct

The amount of axbéstos bie
Chest x-ray: The chest x-rays were read twice by conéensus reading, using

‘and. even if only 3 small pe

at least three experienced readers, and categorized according to the ILO/U/C. ~huhdreds of thousands of kilog:
classification. An x-ray was- read -as ‘abnormal, if fine or moderately thin, . cit’brake mainteriance work sho
irregular linear opacities werg-present (a‘or.¢.>- 1/0) and/or pleural thickening these operations need maré ey:
was present (a-1 or more), The ‘prevalence of shnormal readings is given in weighted values. Peak values £
: Table XT; Parenchyinal ‘abnormalities wete present in 18 inetinges, nine i/o, beak veluerin the United Stat
six 1/1, two 1/2 and two’ 2/2: X-rdy firidings consistent with asbestosis :, _ Much of the chrysotile ip alt
increased with time; stich @ trend is evident in’ Table XY. This: trend ig grenuler, |
statistically significant, - a . sae Detailed clai ‘
TABLE X . reported. Hojwever, even the int

+ - Hlélationship between X-Roy Reading and Pulmonary Punetion Teste in 67 Vehicular
Maintenance Workers

. . . . exposure in brake repair
Pulmouary function, Number of Subjecls ‘Xray handing Percent Me of the vee et
* Restriction” s. ~Abnanmole 6 20% asbestos The prevalence both
Normal 1 2% . ak results.was bignificantly higher

Obstruction a - mnernaal* a ed afte ional é:
Aoorma 3s a expected fs occupatioial én

Normal . . 2 * Abnarmel* = 6 2% : . .

2 . Bh

Le Sumn
Measurements were made by
brake repair and maintenance
averages ‘and peak levels show
fifths of the total number of ch.

+ parenchymal Gibrpsle and/or pleural thickening

For overall pattern X* = 1.78.60 > p > 30

Foi restrictida clone X?.m 1.21 20> p> 20

For obstruction alone X* = 150 80 > p > 20

For obstruction and restriction compared to normal: X? = 08 80> jp > 70

TABLE Xt Ode in lengtli-and not visible
X-Ray Changes in 90 Vehicular Maintenance Workers with over 10 Yeara' Espériente + Broup of experienced vehicular
— is s — of x-ray’ abnormalities. consia
we oe ‘erent restrictive pulmanery function ¢
Parenchymal fibrosis . . 8 20% limited in scope and- was resi
Pleural thickening or caltificatinn -, 6 . SR therefore readily -be- generalize
Both pefonchymal and plenral chonges 2 Me. United States, the ‘Sadings-«
y changes . among such workers and that aE
instituted.
sos TABLE XID
X-Roy of Vehicular Maintenance Workirs by Year of Oniet of Wark
Abnormal” " 4
1956-65. 146-55 Before 1845 We are indebted to the United Ant
vo. No Yee No Yer No Automobile Dealers Industrial Relati:
* = —; s eo cooperation inthe conduct ofthe fil
I. . with to acknc assistan,
ay ay hy fe acknowledge the

tan, and Dr. 8. Alf Fischbein for their c

wish to express our appreciation for {
Warshaw in our Isborotory studies and
Mrs. Dinne Monahon in oor field invest

“Parenchymal fibrosis (LO/UC », { > 1/0) and/or pleural thickening
X? for before 1856 compared with 2956 and after: X? = 5.86 02> p> O1RET AL

‘unction. signs of restriction: and
icant associatitn‘was'found (‘Table

fwice by consendus reading, using
gorized according to the ILO/U/C
mal if fine or moderately thin,
t 2-4/0) and/or pleural-thickening
of abnormal readings is given in
i présentcin 19 instdnees, nine 1/0,
idings’ consistent with asbestosis
lent in-Table XIL- This: trend is

inary Funetion Teste tr. 87 Vehicular
thers :

X-ray reading: ~Pereent
—

BaBaba
g

1g by Yeur-of Onset-of Work.

‘Bolare 146
. “Yee * Ne
wot et
47%)

dleural thickening
4 95 02> p> OL

- ‘The amount of agbéstos brake material worn away each year is

" granular.

_ avbrages-end peak levels showed significant’ asbestos.

ASBESTOS EXPOSURE OF BRAKE REPAIR, WORKERS . 27

+ Discussion

I FmOUs,
and. even if only q small.percéntage is morphologically unaltered, then
hundreds of thousands of kilograms remain, Fibér cownts.in varions operations
brake-rhainterlance work show wide variations. Certainly, they indicate that
these operations need moré systematic‘evaluation, both-as.to peak and time-
weighted values. Peak values frequently exceed the 10 Aber/ml legal limit. for
peak values in-the United States. . ~ 77 ° .
Much of the chrysotile is altered to other phases, which may be fibrous or
: e. biologic activity ‘of these materials ‘hag ‘not been studied.
Detailed cliisification and quantificition of these changes has. not been
reported. Haivever, even the.incomplete correlations presented above between
opticel fibér.counts and electron microscopic volumes of morphologically
intact ‘chrysotile is evidence thet fiber counts dré useful measures of dsbestos
éxposure in brake repair work. vo . oo :
Man the’ vehicular ‘mainténance, workers examined showed signs of
‘The prevalence both.of chest x-ray changes and restrictive function
results was kignificantly higher after 20 years of exposure than before, a result

expectéd' after occupations] éxpasure to asbestos, (74,15).

hee Summaty asd Conclusion! oF

Méssuyements were made by optical microseépy'of ‘asbestos Jevelé during
breke' repair and: maintenence work-in New York City, Both time-weighted
exposure, Over four-
fifths of the total number of chtysotile fibers in, brake-dram dtist were below
0.4u in length and not visible by optical microscopy. Over one-quarter of a
group of experienced vehicular maintenance workers examined had evidence
of x-ray abnormalitiés consistent with asbestosis; one-quarter -also had
restrictive pulmonary function test findings. While this preliminary study was
limited in seope and was restricted to volunteers, and its sesults cannot,
therefore readily be generalized to all brake roaintenance workers in the
United States; the findings suggest that asbestos disease will be present
among such workers and that appropriate control measures should be urgently

instituted.

Acknowledgments |

We are indebled to the United Autorcbile Workers, Lacal 250, New York City and-to the
Automobile Dealers Industrial Relations ion of New York City for their valusble
cooperation in the conduct of the field studies in this resentch.

We with lo acknowledge the acsiétance of Br. Ruth Lilis, Dr. Suson Daur, Dr. Henry Ander-
son, and Dr, 8, Alf Fischbein far their coopetation in the clinical and radiologic shidies We also
with to express our appreciation for the valunble assistance af Ann ‘TeiteThoum and Raplisel
Warshaw in our lsboratory etudie# end to Mrs, Frances Perez, Mrs. Marcin Lorimer, RLN., and
Mrs, Disne Monahan in aur field investigations.

>. . . ‘THe Motor Six Journ, or igoIciNe:
218 WILLIAM V: LORIMER ET AL Vel 48, No.3; Mayne 1575
References’ : “om

1. Department of Commercé, Buren of Gensws: 1972 Ceneus of Manufacturers, 1972 County

Business Patterns, Cencur of Population: 1810 Occupation by Industry (adopted Portal Surgery and
by J. Willan Loyd), : : , : : an
2/dacko, M, G. aod DuCharine, H.'2 Biko Eniabons Emiclon Measurements from Brake :

_and Clutch Linings frim Selected Mobile Scurens, EPA Repdrt 68-04:0020, 1978,

+N, GALAMBDS, M:D., §¥. 3
bestor during Brake Maintentnes, Ann JORN #: 08, MD.

The treatment of portal ©
esophageal varices is a surgica
devised which predictably dec
other than an effective and p
nonoperative therapy have no

- frequency of recurrent upper BE

‘There ere-only two types of
bleeding esophagaal varices ce
pression (totel shunt); and 2)

jccup Hyg 18:98-29,

+ Tivestigetfong and Allerative Form of Control far Dust
Generated during the Clesing of Brake Arsemblies and Drums, Ann Occup Hyg
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8. Boillet, M, A. and Lob, M.: Risk of Asbestasis in Workors Employed sn-Re;

6. Hintch, D.: Pocotile Alternatives to Asbeitos an « Feletion Matesil, Ann

placing Automobile
Broke Livings, Scheveiz"Med-Wochr 105 (89):1954-1359, 1972, “ There are only two types.of
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10. Newhouse, M. L. and Thompson, H.: Mesothelioma of

: Plegra and Peritoneum- following.
Brpomure‘to Asbéstos in thé London Area, Brit J Ind Med 22:251-269; 1565,
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- Malignant Mesothelis) Tumors in Canada, Cancer 26:934-19, 1870. .
12. Greenberg, M, and Lloyd Davies, T. A.: Mesothelioma Register 1962-2968, Brit J Ind Med
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1B. National institute for Occupations) Bafety and Heelth: Occupational Expouure.to Ashestos,
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44. Bader, M. E., Bader, R.A., Teiratein, A. 8. Milles, A, ond Selikoff, I. J.: Pulmonary
© Funedfon and Radiographic Changes in $88 Workers sith Verying Duratlon of
+ ‘Exposure to Asbestos, Moiint Sinai J Med 38:482-600, 1970, .
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Received for publication January 29, 1976

gastric vein), One is decompr
‘This is the And-to-side portace
the intra. and the extrahepatic
ide portacaval shunt, Ther
side portacaval sliunt. The only
various portal decompressive j
size of the anastomosis, or ‘gra:
and, therefore, the effectivent
emaller is the frequency of its,
more common is recurrent, 0
versely, the smaller the shunt;
recurrent hemorrhage-but Jess i

In contrast to total shunts 1
the portal vein, aselective shut
two truly selective shints: On
which consists of two procedure
sis. This directs blood flow’ fro:
numerdus collateral veins v:
Portial-azygos disconnection: A
Portal vein-are ligated to preva:
created shunt (Fig. 1),

Atlante, Go. 50303, .,
"Presented December 11," 1975.05
Surgery, Méunt Sinai Schoal of Medi
for reprints should be éx:
Medicine, 69 Butlér Street, SE, Atlar

From the Depasiments of Medici