Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5...
Transcript of Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5...
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Item ID Number °0671
Author
Corporate Author
Report/Article Title RePort on Survey MDL/2: Prospective LongitudinalEpidemiological Survey of Clean-Up Workers at Workfrom 1980 in High-Contaminated A Zone
Journal/Book Title
Ysar °°00
Month/Day
Color D
Number of Images 112
DOSOriptOn Notes Alvin ^- Young filed this item under the category"Human Exposure to Phenoxy Herbicides and TCDD"
Tuesday, February 20, 2001 Page 671 of 680
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SURVEY frDL/2
PROSPECTIVE LONGITUDINAL EPIDBMIOLOGICAL SURVEY OF
CLEAN-UP WORKERS AT WORK FROM 1980 IN HIGH-CONTAMINATED
A ZONE
Research team:
I .Gilessi (coordinator}
G.AsseimatoP.BraaibillaP.CanziateiliL.MeaszaF.Merlo?.MocarelIiF.Sicarello
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SSPOST ON STT2VEY MDL/2
PROSPECTIVE LONGITUDINAL EPIDEMIOLOGICAL SZJ2VBY OF ..CLEAN-UP
WORKERS AT WORK FROM 1980 IN HIGH-CONTAMINATED A ZONE.
INTRODUCTION
In A zone contaminated by high level of TCDD following the ICMESA
accident the clean-up operations started in the stammer
of 1980. The existence of a real risk for clean-up workers is
demonstrated by the experience accumulated in the last years
as a result of similar operations at various European industrial
plants in Europe.
Four years after the contamination episode at the Badische und
Soda Fabrik (3A5F) ( two years after the reopening of the plant
a new case of poisoning occurred in a worker who had been repair-
ing an autoclave; during the operation he had several tines lift-
ed his protective mask to wipe off the sweat. Four days later1
dermatological manifestations and neurological symptoms appeared;
six months later he was admitted to hospital for pancreatitis ind
hepatomegaly; nine months later he died; pancreatic necrosis,
liver abscesses and chloracne on the trunk were found at necropsy
The Clean-up procedures at the Coalite plant in England were
inadequate: after the clean-up,79 cases of chloracne occurred
in workers not e:eposed at the time of the accident.
Numerous cases of chloracne developed among workers engaged 021 t±
initial clean-up at the Philips plant in Holland. In the subse-
quent dismantling of the plant strict personal protection was
enforced among the workers, who had to wear ventilated overalls,
and * clinical surveill.ar.ce program was set up centered on the ova
lutation of biochemical parameters before the event and subsequently.at re-ju
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iar intervals. Wo major deviations from normal values were ob-
served in the ten workers who complied consistently with the
prevention procedures. In two other workers who had been sent
to the contaminated zone to dilute the contents of some tanks
with water and who had worn on the overalls correctly one
or more liver function parameters were found to be abnormal
eleven weeks later; the values slowly normalised in the weeks
that followed. In no case were there dermatological manifes-
tations. The Philips researchers concluded that the working
methods were effective in preventing exposure to TCDD.
Notwithstanding the vast quantity of data on TCDD that has accu-
lated since the Philips episode, a public health surveillance
program still has to be based on the observation of biological
parameters whose behavior may indirectly reveal exposure to the
poison by showing its early effects (early effect indicators).
Direct monitoring of the intake of the poison (dose indicator),
up to now imply the biopsy of adipose tissue and it is not proposa
ble as a continuous nonitoring of groups of active workers in a
plan of public health surveillance.
2 - M3TEGDS
2.1 Objectives
The general objective of the survey 7;as to gauge the effi-
ciency of tlie safety sieasrares taken during the clean-u? of
areas A*-A3. Tlie safety measures rere taken, to prevent any
significant exposure to the poison but, going by previous
experience, possible e::posure could not be excluded.
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2.2 General desicn of the study
The design v/as that of a prospective controlled study (almost
lilce a trial) comparing clean-up -workers and reference groups.
The parameters of interest (essentially clinical signs and
symptoms, biochemical parameters) were measured before, during
and after the period of potential exposure, in both groups
(Fig. 1).
2.3 Population under study
The groups under study vere selected at the .^replacement
examination. The subjects vere sent by the firm handling :.hs
clean-up to Desio Hospital. None had previously been engaged
en clean-up operations.
The preplacement examination took place in trsro stages: first
35 clean-up workers vere selected and then a month later
another 37 subjects rere chosen, 36" as controls and 1 as a
clean-up worker.
2.4 Preplacement examination. Data collection.
For every subject the preplacement examination included:
2.4.1 In t ervi ev-cuest ionary
2.4.2 History and physical examination
2.4.3 Laboratory tests
2.4.4 Lung function test
2.4.5 Neurological examination, nerve conduction velocityaad Electromyography (EMG)
2.4.6 Electrocardiogram (ECG)
2.4.7 Chest X-ray
2.4.1 Int ervi e -ques t.ionary
The main purpose was to obtain informations for the
comparision of the clean-up workers with the controls.
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The interviesz-questionary was administered, by two trained
interviewers at the time o£ the medical examination. The
questions included:universal variables(like years of
schooling, marital status, telephone, working history),
habit (drinking, smoking-), drugs intake,
family history and personal history with special reference
to liver disease and skin diseases.
A copy of the questionary form is attached in Appendix A.
2.4.2 The history was taken and the physical examination done by
occupational health specialists of the Occupational Health
Service of Desio Hospital.
A copy of the case record form used is attached in Appen<Sc B
2.4.3 Laboratory tests
The following tests were done:
1 - Glutamic oxalacetic transaminase (SGOT or AST)
2 - Glutamic pyruvic transaminase (SGFT'or ALT)
3 - Alkaline phosphatase-(AP)
4 - Gamma glutamyl transpeptidase (GGT)5 - Bilirubin
£ _ Cholesterol
7 _ Triglycerides
o „ Surface antigen of hepatitis B Virus (HBsA.g)
9 - Electrophoresis of serum proteins
10 _ Blood cells count plus platelets and differential
11 - Total urinary porphyrins
12 - Urinary dejta-aninolevulinic acid (ALA-U)
Most of the parameters were chosen because TCDD is hepa
totoxic and affects the lipid metabolism. An increase
in SGOT-SGPT is to be regarded., as an indicator of cyto-
lysis-, an increase in GGT as an indicator of enzyme in
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duction and an increase in AP as an indicator
of biliary stasis.
The urinary porphyrins vere determined because TCDD
is known to exert a porphyrogenic effect.
2.4.4 Lung function test
2.4.5. Neurological examination, nerve conduction velocity,
EMG2.4.5 Slectrocardiographic examination
2.4.7 Cliest X-ray examination
2.5 Selection of groups of clean-up workers and controls
The criterium of eligibility was the fitness of the followingparameters:
1 Males between 18 and 55 years old
2 JTo clinical signs of acute or chronic diseases such as
viral hepatitis, diabetes, chronic liver disease, skin dis
ease, etc.,
3 Results within the normal range for the following laboratory
tests: SGOT,SGPT,GGT,AP,Serum bilirubin,RBC,hematocritfher--i
globin,WBC and differential counts,platelets,urinary porphjyr
4 Ho clinical or instrumental signs of peripheral hervous~sys
5 Normal ventilatory function test.Out of 112 candidates only 72 were found eligible for
the clean-up work and entered the study.Grounds for exclusion <jrere medical problems (Irver disease( a
normal values in laboratory tests), problems relating to the
nature of the u'ork (abnormalities of ventilatory function -/it!
reduced tolerance to the wearing of a mask).
2.5 periodic examinations
According to the protocol, svery subject had to be examined
every 6 months. Moreover, b~ regional lav the clean-up vor^e
had to be examined every 3C working days un~il the end cf the
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job. The periodic examinations included physical examination
and laboratory test as required for the preplacement exami-
nation. '
2.7 Final tests
The final tests were done 6 and 12 months after completion
of the clean-up job.
2.8 Data analysis
Given the sample size the power of the tests used was estima-
ted and proved to be adequate for the design of the study.
The frequency distribution for the demographic and other
variables (Table 1) was reported. For comparing this distri-
bution the chi-squared test for independent samples was used.
For the comparison of the continuous variates (Figs. 3-26) one-
and two-way variance analysis was used, by group (clean-up and
reference workers) and by, test (tests done at successive exami-
nations), using the SPSS program. All tests were rated signif-
icant if the probability depending on chance was less than
0.05* (with two tails).
Discriminant analysis was done with a program developed by Da-
vies. The logic of the discrimisnt approach lies in the fact
tjiat significant differences could be identified for the entire
battery of -rests used, where for a single test no significant
difference emerges.
HS3ULTS
The results of the replacement examination and of the firs- 4
periodic examinations are reported here. The results will also
be shOwT. for the subset of incividvials wich underwent all the
periodic tests.
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The data are also presented according to the number of hours
worked. The time trend of six selected parameters for each
worker is also indicated.
3.1 Response
The outline of the study design and follow-up response aresho\..i in Fig. 1 .During the follow-up two of the exposed workers died in aroad accident. One missed out after the first follow-upand yet anotherone after the second Another four failed to
attend for the fourth follow-up.
In the reference group the response rate was low: five failedto attend for the first follow-up, seven for the second andthird and another six for the last (response rate « 65%).Among the clean-up workers the response rate was 100% of thosepresent on the job, who needed to comply with periodical controland to be passed fit to continue working;.
_ The fail in the response" rate at the last follow-upwas due to ex clean-up workers (those who had for various r-s*sons given up working- in the zone) . In tha reference croupthe low response rate was due to distance from tha place cfresidence or to emigration to other areas. One control subjeafter the first follow-up was included among the clean-up "/or!ers and from that date ha was s:ccludec from the data analysis
2.2 Base data
3.2.1 Int erview-cues t ior.ary
One of the clean-up workers and four -of the controls were
not interviewed, tnter-croup comparability in respec" cf
certain characteristics is indicated in Table 1 . Age, sc
ucation, marital status, smoking, drinking, previous ex-
posure to heparotcxic substances and liistorv of skin cis-
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ease presented fairly similar distributions in the two
groups. Significant differences were found in respect
of history of liver disease and possession of a telephone
at home, which proved to be more frequent in the reference
group.
3.2.2 Laboratory data
Of the laboratory tests done those most relevant for sta-
tistical analysis are the ones that, according to the sci-
entific literature, seem to be correlated with exposxire to
TCDD, viz.'urinary porphyrins, liver enzymes, serum cho-
lesterol and triglycerides. The results of the WBC, plate-
let, serum protein, albumin and gamma globulin tests are
also presented. At the preplacernent examination no sig-
nificant difference was found in the variables studied,
except for alkaline phosphatase, the mean value of which
was higher in the reference group.
3.3 Follow-up results
kDuring the follow-up period nine workers left the job for reasons
unrelated to health. Five workers were rated no longer fit and
r/ere dismissed. The grounds for unfitness were:
1 - in siibject 12 abnormal SCOT (42 mU/ml) and SCOT (75 aU/ial}
values in t /o tests, in October and December 193*!: tiiese
values returned to normal in subsequent tests.
2 - in subject 13 severe hypertension (135-125 rnmKc).
3 - in subject 14 a slight increase in GGT.
4 - in subject 15 persistent presence of H3sAg.
5 - in subject 27 use cf antiepiieptic drugs.
These subjects continued to attend for follor-up examinations
according -c the program for ex clean-up workers. Another sub-
ject cave up tl:e job a fev; days after starting because he cculc
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not stand the mask and was lost to follow-up.
3.3.2 Clinical evaluation
No case of skin or neurological disease occurred. Clinical
examination revealed nothing noteworthy. The percentage
of subjects with hepatomegaly did not differ significantl
in the two groups; the higher percentage among the clean-
up workers might be due to the fact that the doctors were
not "blind" (Fig. 2). Mo significant difference emerged
in respect of weight variations.
3..3.3 Laboratory data
The analysis was dene separately for all the cases in the
follow-up period and for a subset of subjects whose data
were available for all the periodic examinations (except
the last).
Dispersion charts for 10 out of 14 laboratory tests in th;
first four examinations are shown in Figs. 3-26 together
with the means and standard deviations.
3.3.3.1 Urinary porphyrins (Figs. 3 and 4)
ITo significant difference was found between the t
groups at successive tests but a significant c:-/f
ence was found for both croxips between tests dens
successive times. But the values were within r:.or
limits, well below threshold values. The same re
suits appeared for the subset of subjects air/ays
present.
3 1 1 o <;r'i",r^ CPS*** f V-t~s *. £. *? o ^* J . J • £. i Urvj A. — a«jr"i \ ~ - CS . 3 , O f / f O , '
Mo significant difference was found, except fcr 3
at third follow-up, when the mean value cf t«s *:••:
posed (17.75 iBC/ml) was higher than in the r.cr. e:-:;
posed (14.28): this difference ~-as also sicr.ifica
within the subgroup of ever-present subjects.
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3.3.3.3 Alkaline phosphatase (Figs. 9-10)
The significant difference observed in the baseline
test disappeared in subsequent tests.
3.3.3.4 Gamma GT (Figs. 11-12)
No significant difference was found between the two
groups in the successive tests but a significant
difference did emerge for both groups between suc-
cessive tests.
3.3.3.5 Bilirubin (Figs. 13-14)
Serum total bilirubin behaved in the same way as GGT.
3.3.3.5 ALA-U (Figs. 15-16)
The same applies to ALA-U.
3.3.3.7 Cholesterol and triglycerides (Figs.17-18-19-20)
Ho difference was observed.
3.3.3.8 Other laboratory tests* !
A significantly lower vTBC count was found in the
clean-up workers at first follow-up (Figs. 21 and 22)
and the same applies to platelets (Fig. 23). -The
serum total protein value was higher than in the con-
trols (Fig. 24) and a lower mean serum albumin (Fig.
25^ in the .clean-up workers in the.preplacemeat exam-
ination only in the subgroup of the ever-present.
A significantly higher gamma globulin value (Fie.26)
was found in the clean-up workers at second follow-
up.
3.3.3.9 Analysis of the biliary data
In order to identify deviations from the normal val-
ues, some variables were converted into binary data,
above or below the threshold used at tl:e ^replacement
examination. The frequency of ovitside range values
was too low'for statistical analysis: r.o r.orercrt.v-<$•' 6 ••
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3.3.3.10 Discriminant analysis
The dispersion chart of the scores obtained by
discriminant analysis of the values of eleven
laboratory tests is show, in Fig. 37. Mo sig-
nificant discriminant function was identified.
3.4 On-job hours and laboratory tests
The clean-up workers were divided into three subgroups by the
number of hours worked in zone A at the time of the second
follow-up. Seven had worked less than 200 h, nine from 201 *o
400 h and twenty more than 400 h. JTo significant difference i-
in the mean values of the lab tests was found at the first and
second follow-up (Table 2N-.
3.5 Individual assessment of the clean-up workers
It must be stressed that, while the program of tests for the
reference group envisaged an examination every six months, the
clean-up workers und'ertrent medical checks every 30 days as lor
they continued on the job. The number of examinations of th:« •-
group was between 2 and 20 (mean 12.41). In the foregoing*'•'-, *analysis we have considered only the five for which the controdata are also available. Figs. 38 to 73 show the time trer;-*-.of six selected parameters (porphyrins, 5GCT, A?, GGT, cholest-erol and triglycerid.es) for each worker.
The analysis of the test shows that in ten cases (nos. 4,10,1620,22,23,27,37,32 and 35) 210 variables increased by more than100% of the baseline value curing the follow-up period; in thiteen cases (nos. 1 ,2 ,3 ,3 ,6 ,14,15,13,19,25,29,30 ar.d 33) f:erewas an increase of more than iCCf. in at least one parameter bvialways within the normal rar.ee. In another thir-eer. cases ''-i3 ,3 ,11 ,1 2,: 3,17, 21,24, 26, 2S, 34,36) there was an increase of .,-,cthan 1 CC'= in at laast ons sarsnister wi~h values bevond the ?.c~*
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range: in six cases the increase was in the triglycerides, in
three in alkaline phosphatase, in one the urinary porpliyrins
and triglycerides, in one case transaminase and triglycerides
and in one case GGT.
CONCLUSIONS
The program of surveillance for the clean-up workers in area Al-
A5 of Seveso was undertaken to check the efficiency of the safety
measures taken during the clean-up operation started in May 1930.
The principal conclusions are:
1. During the follow-up period no case of clear clinical disease
that, could be attributed to TCDD (chloracne, peripheral neurop-
athy, liver disease, etc.) occurred.
2. Of the five workers rated unfit after the commencement of the
job one had abnormal liver enzyme values in two tests, which
subsequently normalised. There was no known cause of the in-
crease and so a transient effect of TCDD exposure cannot be ex-
cluded, 'although the contemporaneous weight gain (more than 15
kg) may suggest nutritional causes.
3. Mo definite difference between clean-up workers and controls
was found in respect of the laboratory tests. The .same con-
clusion was reached when the data were treated as binary data
and discriminant analysis was applied to i3 lab test variables.
4. The analysis of the time trends of six variables in the clean-
up workers shows that some variations occurred in the trigly-
cerides: these are, however, :r.ore likely to be due to biologi-
cal variability or to insufficient precision in analysis.
In sum, the survey failed to show biologically significant features
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such as to suggest that the workers engaged on the clean-up
operations in the highly contaminated zones can have absorbed
TCDJ5. The safety measures adopted seeni to have provided
effective protection for the v/orkers.
Desio, 30 July 1983.
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TABLE 1. Distribution of Detaographic and Other Variablesin Clean-up and Reference Groups
Characteristics
Mean Age
Education(Tears completed)0-56-910+
Marital Status
Never MarriedMarriedSeparated, DivorcedWidowed
*
Smoking Habit(Cigarettes /day)
Non-smokerEx-smokerLess than 2020 or more
Alcohol Consumption(cc./day)0Less than 4040 or more
Previous Exposure to
Clean-upWorkers
31.2C-.74
13157
Ch£ s<? j|'59
13-152
Chi sq.-j3.54£u£
11
2.1111
Chi sq.-2.56
7919
Chi sq.-l.13
ReferenceWorkers
32.. 7
19103
-19100.
35712
61214
Hepatotoxic Substances
YesNo
332
725
Chi sqf-|.33
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•i TA3LZ 1. Distribution of Desographic and Other Variables, ' (Continued) in Clean-up and Reference Groups
Characteristics Clean-up ReferenceWorkers Workers
Telephone at Horns
Yes ' 13 21No 22 . 11
History of Dermatitis
Yes 6 9No 29 23
Chi .
History of LiverEnlargement
Yes 4- 12No '29 23"
Chi sq,-$.25~
Past ?hysician*sWarning on Liver Disease
Yes 4 4No 32 28
Chi s
' Significant at ? less than .05
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f 1
!-..i? »esulls of various laboratory tests (mean and afrwJW (tt\»latio») at the ^re-employment examination, after 3 and !) monllts inuorkorSt^lvidetl according to the number oMiours spent in AT, A2 zones"
Number ofhours
Total urinaryporphyrlne(^icj/cj.crcat.)
SCOT (U/l.)
SGPI (U/ l )
Alka l ine|»hosfaUse(U/L)
Uaiiima-GI (U/l.)
TotalD i l l nib ln(Mj/dl)
I'M (sue)
llciuoijlouin (y/dl)
HIC (xl03/«»u3)
I'laltilcts(xlO3/™3)
Al lHMln(g/d l )
(i.iiiiua-GlobuUne(<|/dl)
Cholesterol Scrumlevel (my/Mllt
I t lij]y«:«!r idc^f HHI/j l l )
pre-uN|>l.ex.
71.17(24. 19)
20.71(LSI)
23.71III. 32 )
23.06(&.03)
30.00(10.07)
.73(.13)
27.25(2.43)
15.1)0(.ifl).»
6.46(1.60)
216.14(47.34)
4.00(.220
1.021.12)
242.43(60.30)
1-U5.43, .....
less than 2003"1 mnrith ex.
09.20(47, 26)
10.03(6.06)
20.33(3.67)
34.03(a. la)
31.67 '(J2.14)
.50(.16)
27, 511(3.22)
. 15.93j (.34)
7.15 /p5.4fi)
230.17(43.06)
4.97(.45)
.96(.12) .
223.50ft 7. 60 j
155.17
9l" month ex.
60.43(IG.67)
10.29(4. |»fl)
19.14(fi. ?2)
27,71(5.02;
26.29(fO.97)
.67(.IB)
29.67(3.2?)
16.31f . f i f f )
6.06(I.flfi)
222.00(40. 0fi)
4.9U(.3C J
.94(.11)
215.71(63.&0)
131.1)0
fp|re-eiM|il.ex,
93.57(S4.&&)
15.66(2, 70)
16.70(&.V3)
34.67(IJ.2B)
10,70(12,36)
.66(,ie)
27.06((. ?D
16.06(.00)
6.73(1.30)
200. U9(42. If)
4.62(.33)
1.22(.17)
ID4.7U(33.2fc)
i?2 .G6jJ /.1/J.H.SI
m 201 to 4003rd month ex.
75.09(3f.$*j
14.67(2.J2)
14.09(3. 10)
37.11(6.4&)
23.11(12.00)
.62(,J7)
26.29(2.2r;
16.01(.02)
6.67(3.2SJ
209.56(44. U)
4.96(.«)
1.17(.22)
J92.70(30. 00)
109.66
/40.&£<;
9ln month ex.
01.00(2T.O&)
12.67(3.24)
12.00(2.00)
33.56(7.04)
20.56( 7.62)
.69(.16)
29.59(2.57)
16.51(.9.1)
6.ni(I. 72)
200.71)(36.77)
4.29(.16)
1.15(.12)
192.09(20.55)
r U C . S f c "
•; * ±..42*
(iru-cutpl.ex.
96.44(44.20)
15.20(3.02)
17.70(4.07)
27.20(fi. 71)
17.95(0.0 J )
.66(.13)
25.55(2.33)
15.64(.73)
6.09(1. 10)
193.25(34. GO)
4.70(.33)
1.21(.20J
174.11( 25.22)
101.37
( 42.3fi)
more than 400
3 Mionlh ex.
70.55(38.01)
14.75(*.,'.«)
19.35(ii.Oi.)
32.15(7.61)
20.115(7.2J);
.65(.12)
26. GU(2.00)
15.65(.7G)
6.'J/(J.lrt)
206.20f<i7.3&)
.4.70(•36)
I .H)(.20)
179.60^23. 61)
'b.y
Ulii.Zll)
9 ' HKHitl
C6.9f>(2/.
13.60(3.D.
16.110(a. ;
2U.70(/.
in. us(x./
.67(.7;
20.77(/-
lu.16( . 1*
6 . i r >('•'
I'Jfi.ifO(3«
5.05(-1
1.16<"-J
ID3. no( 2'
134.30
(•'••
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'IG. 1 OUTLINE OF TEE STUDY DESIGN AND r'OLLOW-Oi'CLEAN-U? AND REFERENCE GROUPS
List o Workers
Eligible (n-72)
Clean-up Workers (n«36)
Non-Eligible (n*41)
Controls (n*36)
PreplacsmenrExamination
lesDoncents Non-ResVxondents Pvescondents Non-Respondents
1s u Follow-un
•* _ , i2 Fbllow-un
3rd FoUow-UD
4 Follow-ID
![Page 20: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/20.jpg)
FIG.2 PROPORTION OF LIVER ENLARGEMENTAMONG CLEAN-UP AND CONTROLS.
CLEAN-UPYORKERS
CONTROLS
X Llvor F.nlnrrjniiiQntG cm. orO.
5
1 1-
JAM1 1 1 1
JAM JAN
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F i g. 3 • URINARY PORPHYRINS VALUESIn cloan-up and refGrQnco groups
(mcg/1) C R U 11 R
10
o0
,,.*"•J
i-i
i-i
* *•i
Tf i*M-
i•i-
••*-r
-i-tt+-H-
if,*
EXAM
.,1 I
^ i
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; . - ,'•• 1 ' i j r
qmx* icloan-up
\zzz\GKflMP 2
rufarancQ
KXX)
F i g./4 .URI NARY PORPHYRINS (mean' sd)in cloan-up and reference groups
EXAH | EXAH 2 EXAH 3 ,!ii|Mii If leant betwucii-bxautt mena d
HXAH 4 EXAH 'J
![Page 23: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/23.jpg)
VCllUQSFig. 5 S G Uin clean-up and reference groups
1.U./B.1 'C* -f K R R R
0
10
in
o
.,.(09)
titt
(51)
i i
i
\
EXAM• i • •
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: i
CROUP IctiCHT-ynIZZZ3GROUP 2reference[XXX]
Fig, 6 S, G, 0, L GnQan+sd)in clean-up and referenca groups
EXAM I
i: Hcnut
EXAM 2 EXAM 3
a inetm
EXAH 4 EXAH 5
m
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0l .U./ml
V'* .•'*:
Fig.7 S G P T valuesin clean-up and reference groups ,'
— ,'/••,
a /. ((64)
0
V
)0
10
t
r||-
Hl
* trf
fc
I1 1
t*V v• -1- :t
o0
EXAM• i • »
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:?&••Fig.S ALKAL PHOSPHATASE valuQ
in clean-Up and reference groups
o1.U./1 K R R C H
iO
10
II-
I-
ft;,
»
11+
+
I:
t
i
tt1
+n4
titrI-K
*4
**
•h,(53)
+ I
> f*: >«• 't,.+H
00
EXAM
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L . i I j u ..i
CROW* icJuorruv)
^67eWF 2
rafanmcQ1XXX)
W
0
S. G. P, T,ir» clean~up and refer once groups
EXAM 1 EXAM EXAH3 EXAM 4 L'XAH 5
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.WJP Iaon-Mp
ZZJ-2
foroncQ
''10
0
F i g:10ALKAL, PHOSPHATASE (mean+sa;in cjQan-up and reference groups
l.tk/1
EXAM 1.- EXAM 2 EXAM 3
Hi|;nt.fleant l>etuceu~^&-o|i|ia |iiona*difference.
EXAH 4 EXAH 5
-..-•** «•-
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•pi
n
Fig.tl G G T P vciluQsin clQcnvup and rQfQrQncQ groups
LU./I c R c ' n-1 1 (55) +(51)
1 . 1 +•l- -f -I- -|-
-1-
•I- 1-•1- •!•.•-,. .•.,.
•1- -1-
** ;: •* f"1** *l* "1* *•*
h t -H- -1^II. 1. fl- If
1 i1! ' r"1 't I *
i 1- •!• -f- T*H-.'I fo tt.- *+| J t „
•1- T
-|-|.
1 1
1
*
C ft . 'C R
H+(b7)-l-(b1) +(52)
' t4
-II--1-+ *'"T i•1-
•|* 'K.1. " 1
1 '., +f.,. ., f ^ r .,. ,.
1 t \-II 4- ^ 114- -I-
A w \ If
V + • +1 tit+ + *]> i
H-'I,•1-
i i
EXAM• • I •
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cJucuruo
CROUP 2rafaranoBfXXX)
I.U./l
40
0
Fig. 12 G,G.T,P. (rnean+sd)in claan-up and rcfGrenco groups
EXAM S
,n if Scant
EXAM 2 EXAM 3 EXAM 4 EXAH
![Page 31: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/31.jpg)
vu i
in cloan-up and rGforence groups
.4
1.2
1.0
.0
.0
MCJ R R R
.2
0.0
l
•il-l
•I-H-
•H-f
l-l-
•I-
III
II
III-
h
II-
I
•i-i-
•n-
1 1
•in-
•H-l-
f +
•i-
•n-
tH-
-ni-•n-i-
•i-i-i-•in-
h I
•n-i-
i
ii
i
n>
ii h
EXAM
. .*&,S//7V/-
• V-Vt
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J t *.— J tiH .
IcJorrt/)t//)
Z)
KXX1
o
Fig.14BILlRUBIN (moan+sd)in clean-up and PQfaronce groups
L-XAH 1 EXAM 2
inn 3 f leant l>ctwcun-exjuii«0
EXAM 3 EXAH
(Ufterejice.
EXAM 5
![Page 33: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/33.jpg)
Fig. 15 U - ALA valuesin clQan-up and rQfQrQncQ groups
•g/1 R 11 (t
G I
t
ll-l-
f|
II
*•*
•It
f14t\ -II-
-I-
*
'tf*
4t++t
ft
0
EXAM• i » i
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-). i: i I J :*- 3 -
cjaorrwiIZZZ1
2rafarancaIXXX1
o
Fig. 16 U - A L A dnean^sd)in clQarrup and rcfenQncQ groups
EXAM I
8 i I'M i. if leant
EXAM 2 EXAH 3
mean
EXAH 4 EXAM 5
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Fig.,17 CHOLESTEROL valuesin clean-up and reference groups
A
t»•t
**
*+*Tt*
»
t
K+ •
nEXAM
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i = ! t- J L.:. j u i «- 1 L. I' i. 1 l.
IZZCROUP 2
IXXX1
F i g, 16 CHOLESTEROL (inean-«-sd)in clQQn~up and raferonco groups
300ng
200
100
0CXAH I EXAM 2 CXAH 3 EXAM
\
CXAH 5
![Page 37: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/37.jpg)
0
F i g. 19 TRIGLYCERIDES valuesin clQan-up and refQrQncQ groups
U it R K
•I" «. -f-
I ... +*' *
1
... *+ t'1= + 1
+ t** «... t *1 + 1- Til t.i. "•"<"•i.1 4
i ! *, -*? tit / ft-J-. -j'H' -f . '.|:|-:j: J :|'+ I] -|-.|;|.:' M ,;|; ^ *1, ':| +*+ tl*t * **
1 1
^.(6/0) ^.( 329) 4. (300)
•I-
1
H '+ '' 1t
*i **f t + t*
a. * *I I*iL'l* J'l fc *
- .. *4.r-(- -t+tr 4:|- I-* *!• aL « * 1_*/ l '; '»
. ; . + '<t •« ' •
i i
EXAM
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GliOUP IcluarvpI7-771
GROUP 2referanctiKXX]
Fig;2QTRIGt¥GERIDES (niQan+sd)in clQarrup and reference groups
300
wo -
0HXAM 1 EXAM 3 EXAM 4 EXAM S
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> Fig.21 LEUKOCYTES valuesin clean-up and reference groups
/ MtttQ K \\ H R
•i-i+
H:|:i::
\ *.
*
•it
ti '•it
*h
+1-
*.t
•I*
V
4*;.
o oEXAM
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i £~:.; « -. j ;
CROUP I
zz
IXXX1
/«rao
o
F i g.22 LEUKOCYTES (mean'sd)in c)Qan~up and. reference groups
EXAM f EXAH ^
Hi I'.ni ficnuL iiel:wccii-Biioui>B
EXAM 3 EXAM 4 EXAH 5
![Page 41: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/41.jpg)
CTrtJW* IcJanrrt/p
177712
rtiforoncQIxxxi
400/•mo
200
0
F i g.23 PLATELETS (meon+ed)in cloan-up and roferonce groups
EXAM i EXAM 2 EXAM 3 EXAM 4 EXAMS
" SI I mi If tcnnt liQ|.wiicn~exaroa menu difference,
![Page 42: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/42.jpg)
, . 1.. .. . ; - ' - • t""J .-- .; L. , .
CROUP 2roller oncafXXXI
o
Fig..24 SERUM PROTEINS (mean+sd)in clean-up and rofo^QncQ groups
EXAM 1 F-XAH ^ EXAM 3 EXAM 4 EXAM 5
![Page 43: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/43.jpg)
GROUP ic hum-up
EZZJGROUP 2
rnfnronca
100
00
20
0EXAM 1
Fig.25 ALBUMIN (mean+sd>in clecm-up and reference groups
EXAH2 EXAM 3 EXAM 4 EXAM S
![Page 44: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/44.jpg)
1. i
GROUP 2rnfttrflncoV77777A
F i g. 26 -GLOBULINS (mean-'-sd)in cloan-up and pQferencu grou|i9
i
l-XAH i EXAM 2 EXAH 9
. '«i i>nifleant j>ct:wecn-ftroupa nieiuf (Difference.
l-XAH 4 EXAM 5
![Page 45: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/45.jpg)
Fig,27 PORPIIYRIN PATTERN IN CLEANUP ANDCONTROLS, DY EXAM (CUT-OFF=250)
CUE/UNI'HOUHAI.
ci r.AN-in»AIJNOKMAI.
NURHAI.
IZZZJ
ADMOHMM
50NllMHiR «: SUBJECTS
30
20
10
0EXAM I EXAM 2 EXAM 3 EXAM 4
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I "3 f I . I I
CMIAN-lf*NMIMAL
AN II'
MOfvHAL
CONIROLSM1HOHHM.
fiq.28 SCOT PATTERN IN CLEAN-UP ANDCONTROLS, BY EXAM (CUT-OFFMO)
50NUMUBl OF SUUI£CTr>
30
20
10
KXXX sxxx
CXAM I EXAM 2 EXAM 3 I-XAM 4
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in*mm[IIIZlCLEAN UPADMOIIMM.
CONIHOLSNURHAL
\ZZZ\
CQMIROL8ADIJOHMM.
fig.29.SGPT PATTERN IN CLEAN-UP ANDCONTROLS, BY EXAM (CUT-OFFM2)
50NUMBER (H:
40
30
10
0 l-EXAH 1 EXAM 2 EXAM 3 EXAM 4
![Page 48: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/48.jpg)
J . 1 . I v'~1
Cf£AN-U>NORMAL
IZZZICLFAN Ul»AI1NOUMAI.
CONIKOI.SNURHAI.
\ZZ73
COHntOLSADIIOHHAI.
50
30
20
10
0
Fig.30 A.P. PATTERN IN CLEANUPAND CONTROLS, BY EXAM(CUT-QFF=50)
mm OF
IIXAM 1
• [7
EXAM 2
IXXXXl
EXAM 3 EXAM 4
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QJNJFJUHJPHW.
CI.KANUI'ADNOUMAL
CONIROISNORMAL
IZZZJCl)WIU)L!>AONOiiMAI.
Fig:3t GGTP-PATTERN IN CLEANUPAND COMTROLSrOY EXAM(CUT-OFF-50)
50NUHOtlt OF SUBJECT?}
30
10
/ 0
JXXXX
EXAM 1
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APPENDIX A
FACSIMILE OF INTERVIEW QUESTIONARY
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Study en the surveillance of the cLean-up workers in the TCDD/decontamination/ Seveso, Italy.
Date of the interview
Starting time
Interviewer's number
Interview number
A - Personal Data
Al - "What is- your full name?"
A2 -"When were you born?" (Specify day, month and year)
A3 - "Where were you born?" (Specify Town and Province)
A4 -"What is your address?" (Specify street., number. Town,, nrov. , •<postal code)
AS- "Do you have a telephone?"
Yes ..... /___/
No /__/
I don11 Know / /
JTo answers / /
If YES, go to A6else, go to A7
A6- "What is your telephone number?"
I den11 knew / /
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A7 - "Vfhat is your present civil status?"
Single ............... . /__/
Married ..... .......... / _ /
Separated ............. / _ /
Divorced .............. / /
Widow/er ........ . ..... /_/
Other (specify) ...........
answers ............ / _ /
A8 - "What is the highest educational record you have got?"
University degree ............. . . / _ /
High School ..................... / _ /m-
Secondary School .......... ^ ..... / _ /
Primary School ............. ..... / _ /
Other ( specify). ..... ............. / _ /
No records ..... ^ ................ / _ /
I don ' t know ...... ......... .'„... / _ /
No answers ....... ............... / _ /
A9 - "Did you do the military service?"
NO .. .......... . ---- /_ _/
I DON'T KNOW ....... '/ _ /
NO ANSWEHS ......... / _ /
OTHER (Specify) ---- / _ /
If NO, go to A10
else, go to A12
A10 -"Why did you net do the military service?"
Health reasons / /
Family reasons / /
Other (Soecifv) / /
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All - "In the last month, have you been smoking cigarettes?"
YES /__/
I. CANNOT REMEMBER / /
NO ANSWERS / /
OTHER / /
If YES, go to A12
else, go to A17
A12 - "How many a day?"
A13 - "At what age did you start smoking?
I cannot remember . ... / /
No answers ........... / _ /
A14 - "How long have you been smoking?"
YEARS ............... /__/_/
1 CANNOT REMEMBER . /. / _ /
A15. - "Over the last five years, the number of cigarettes you
smoke- a day hast
INCREASED -.. .............. / _ /
DECREASED ............... / _ /
THE SAMS ............... / _ /
I DON ' T KNOW .... ......... / _ /
OTHER (Specify) ....... . .......
In case of increase or
decrease, go to A16, ej.
Se, co to A17.
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A16 - "Why?" (Specify)
Go to A21
A17 - "Have you ever smoked in the past?"
If yes, go to 1£else, go to A21
A18 - "How old were you when you smoked the first cigarette?"
AGE /__/I CANNOT REMEMBER / /
AlSbis - "Have you smoked more than 5 packets of cigarettes inyour life?"
If yes, go to Al9 YES .,, . . / /fc „, NO I. .. / /
else, go to Dl ' —
A19 - "For how many years have' you been smoking?" / / /
A20 - "Kow many cigarettes a day were you smoking in that period?"
NUMBER OF CIGARETTES . . ..... / _ /^I CANNOT REMEMBER .......... / _ /"
ALCOHOL
31 - "Have you ever drunk alcoholic drinks like wine, licuors, beer?
YES ................... / _ .NO .................... /__I DON ' T KNOW .......... / _OTHER (Specify) ........
NO ANSWERS ............ /
If YES, go to 32else, ao co Cl
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32 - "At what age did you start drinking aLcohcLic beverages?"
YEARS ...... .............I DON ' T. KNOW ............NO ANSWERS .............. /OTHER (Specify) .......... .
S3 - "At present, are you drinking alcoholic beverages?
YES .................... /__,NO .....................I DON ' T KNOW ...........NO ANSWERS .............
YES, go to B6
else, go to 34
34 - "At what age did you. give:, up drinking alcoholic beverages:
YEARS /I DON'T KNOW /NO ANSWERS v . . /__
\BS - "Why did, you give- up drinking alcoholic beverages?"
I DON' T KNOW /mNO ANSWERS -''
Note for the interviewer: —•"*- read DRINKS if yes at D2, else read DRINKEO
/
26 - "Could you specify what kind of alcoholic beverages you usual"
WINE ..... .............. /BEER ................... /OTHER (Specify)
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REGULARLY DURING MEALS /_REGULARLY DURING AMDBETWEEN1 MEALS . . .* /_REGULARLY BETWEEN MEALS /_I DON <T KNO:; /~NO ANSWERS /_
20 - "On these occasions, how much do you drink?" i•
WINE /__/1-2 glasses a day / /Two fflaases to half a liter a day / /Half a liter to one liter a day / /More than one liter a day / /I don' t know / /No answers / /
BEER /__/1-2 glasses a day ~ / /Two classes to half a liter a day / /Half a liter to one liter a day / /More than one liter a day / /I don' t know ..*».., /• /No answers * / /
32 - "Have you been drinking these drinks in the last week?:vrh i sky t Br andy, Bitt er s, et c. ? "
YES / /NO /_/I DON'T.IOTO:: / /HO ANSWERS ... / /
If YES, go to 310else go to Cl
BIO - "What kind of hard liquors have you
ALCOHOLIC APERITIFS /_BITTERS-DIGESTIVES /"KAU-DS-VI2. . /"COGNAC /"WIIISKY /COFFFT: WITH LIQUEUR /OTHER.' "
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7)
•311 - "You usually drink these drinks:
OGCASIOKALLY / /REGULARLY BEFORE . OR AFTER MEALS / /RSGULARLY BETWEEN MEALS / /REGULARLY DOTH ON AND BETWEEN MEALS / /
I?-12 - "On these occasions, how Tiuch do you drink?"
ONE TO TWO LIQUEUR GLASSES A DAY / /THREE TO FuUIl LIQUEUR GLASSES A DAY /__/MORE THAiT FOUR LIQUEUR GLASSES A -DAY /_/
Cl - "In the last two months from today, have you been taking medipills, suppositories, syrups., etc.
YES .,,....NO /__/I DON'T Ktfow / /NO ANSWERS / /
If YES, go to C2t
else/ go to Dl.\ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ • • • • •• •• •I M BI MB MB M MI ™ ™™ *
\\
12 - "Would you please tell the names of the medicines you have
1)2) ; .3)4) .
Eor. each medicine at C2,
go to the cuestions C3,C4,C5
C3 - "Have you been taking I) ,.2), 3), 41 for more than one week?"
YES 1} /__/ 2 /__/ 3 /_/ ^ /"NO /___/ /__/ /__/ /I DON' T KNOW /__/ / / / / /.\T0 ANSWERS / / / / / / /
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8)
C4 - "What troubles caused you to take 1), 2), 3), 4)?"Note: Specify the type of trouble for each medicine
CS
1}2)3) iA] '
- "Did the physician prescribe the mpriicine 1), 2), 3), 1)?"
1) /_/ 2) /__/ 2) /__/
Y E S / / / / / /
I DON'T KNOW1TO ANSWERS ..
CS - "For how long have you been taking the medicine i), 2), 3), 4)?'
1) YEARS / / / MONTHS / / /
2) /_/_/ /— /— /3)- /_/__/ /__/__/
Dl - MEDICAL HISTORY
"Have you ever suffered frotn any of the following trou'-.las ordiseases?"
YES NO I DON'T REM. I DON'T KHO'.: VTAll OF 3
Acne /__/ /__/ /__/ /_/ /__/Soils /__/ /__/ /_/ /_/ /_/Viral hepatitis /__/ / / / / / /• / /Chronic hepatitis /__/ / / / / /__/ / /Hepatic cirrhosis / / / / / / / / / /Epilepsy /___/ /__/ /__/ /_/ /___/Gail-bladder and/orbiliary ducts stones / / / / / / / / / /Diabetes /__/ /___/ /__/ /'___/ /__/
For each YZ3 at Dl, ask for D2 and fill in the above cclu~n, elsec:o to D3
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D2 - "When dirt it start ...... (read the disease)?",
D3 - "Have you ever been hospital -zed?"
YES .......................... /__/NO ............ ............... /_/i DON ' T KNO;; ................. / _ /NO ANSWERS ................... /__/
If YES go to D4, else go to D9
D4 - "liow -nany ti-aes have you been l-ospitaLized?"
Number of ti-ru?s / /
D5 - For each time, write th<? disease, tlie year, t'.ie Hospital name and the town where it is.
"For what disease have you been hospitalized t'-te (1st,2nd, 3rd) time?
D6 - "When did it happen?" (year)
D7 - ' "What is the na-.e of the Hospital?"
D8 - "Where is the Hospital?" (town)Number of Year of
Disease _ cIoapita^izationa-.HoapitaJLization nosrital £Ta-*r~ "
D9 - "Please/ tell us the name and the address of your physician1
DlO - "Have your physician ever told you that your liver is iconditions?"
YES /_/NO /__/i DON'T :-:sow / /I DC17' T XEMEM2E?. / /
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10)
Dll - "In th •» last two years, have you ever lost Tiore* than 5 :'ilos1 without being on a special diet?"
YES .: /__/NO /__/I DOT' T KNOW /_/I DON'T REMEMBER / /
If YES go to 012, else go to D13
D13 - "Why did you lose weight?
D13 - "In the last t\ o years have you rvrr been under treatment againanaemia?"
*.
YES /__/NO /__/I DON'T KKO»: / /I DON-T REMEMBER / /NO ANSWERS / /
If YES specify* tee treatment
D14 - "Have you ever suffered from skin troubles because of exposuresunbeams?"
YES /__/NO /__/I DON * T KNOW / / •NO AN5:vEi1S / /
If YES go to D15 else go to El
D15 - "Please describe these troubles"
Dlo - "Do these troubles reappear after each exposure to sun1"cans "
YES .... .................. /__/NO .... ................... /___/I DON • T KNOW ............. / /
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ENDING TI::E OF T"nr QUESTIONNAIRE / / / / /
El - " la the interviewed hard of hearing?"
YES /__/NO /__/I DON ' T KNOW / /
E2T - "Can the interviewed speak and understand Italian correctly?"
VES /__/NO /__/I DON'T . K2JOW ./ /
E3 - "In which day of the week was the interview made?"*
Monday / / _Tuesday / /Wednecday / /Thursday / /Friday / /
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APPENDIX 3
CASE SHEET USED F02 MEDICAL EXAMINATION"
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DE3IO HOSPITAL
OCCUPATIONAL HEALTH SS2VICS
Chief Physician: Prof. I.Gaessi
CLINICO-SPIDEMIOLOGICAL SURVEY
MDL - 1 ICM3SAMDL - 2 CLSAN-U? "C25C
Desio Hospital
Surname and name
place of birth date
Registered residence tel.
Usual address
Marital status
married unmarried nridower separated divorced
Occupation
Exposed control
Treating physician
Examining physician
f iW^T V *-~ O'rAi'iiijI .~_o_
FatherMotherC T 7 -' v> (»<;
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PHYSIOLOGICAL HISTORY
Birth at tern premature
Delivery normal dystocic twin
Development normal precocious late
Schooling1 compulsory high school university
Military service:
yes force
no health reasons :
yes
no
•
Marriage: no
yes at ... years
no. children
no. abortions
Present occupation
Previous "
'for risks see cuesticnarv^• «» '
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smoking (see questionary) } only
drinking (see cv.estionary) C
drugs (see questionary • )
Diet
poor • normal plentiful
Digestion: normal yes
no why
Bowel movements: normal constipated loose
Urine output: normal yes
no
Sex life:
reported normal
reported abnormal since which year
why
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PAST HISTORY: (supplemented by cuestionary)
Diseases:
Hospital admissions
Accidents
Allergies
*
PSBSEHT HIS.TOKY: (past year)
Visual apparatus
disturbances
diseases
Auditory apparatus
disturbances
diseases
Respiratory system
disturbances
diseases
Heart
disturbances
diseases
Digestive tract
disturbances
diseases
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Urinary system
disturbances
diseases
Limbs
disturbances
diseases
Masculosksletal systemdisturbances
diseases
Skin
disturbances
diseases
Nervous 33/31 em
disturbances
diseases
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PHYSICAL EXAMINATION
Height Weight kg Usual veight
Constitution:
longilineal normal brevilineal athletic
thin medium fat obese
3P max min Heart rate
Slcin: normal
abnormal
specialist examination
Subcutaneo\is tissue. Abnormal findings
no •
yes wh
Lymph nodes. Abnormal findings
no
yes specify
i-tisculature. Abnormal findings
no
ves specify
Skeletal system. Abnormal findings
no
yes specify
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Head: mobility ache yes
no
eyes abnormal findings no
yes
ears: abnormal findings nonose: yes
mouth: oropharynx abnormal findings no
yes
teeth abnormal findings no
yes
Neck: abnormal findings no
yes
Respiratory System: abnormal findings no
yes
if yes: chest deformity
"F.V.T. (fremitus - vocal - tactile)
: percussion
auscultation
Mammary Glands: abnormal findings no
yes
Heart: abnormal findins no es
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Abdomen: abnormal findings no
yes
Liver: normal findings yes no
in any case: :
- upper limit on the right midclavicular line:
intercostal space or rib
- lower limit (cm from tlie costal arch on rightmidclavicular line):
. at end of normal inspiration
palpation
percussion
. in max forced inspiration
palpation
percussion
- margin and surface
- consistency
- tenderness
Spleen: normal findings yes no
Other Findings Abdominal Organs
Genitourinary System
Sidneys: abnormal findings no
Bladder: abnormal findincs no
yes
•res
3xterr.al gsnitalia: abnormal findings r.o -es
![Page 113: Journal/Book Title Ysar °° Month/Day Color Number …...2.4.4 Lung function test 2.4.5 Neurological examination, nerve conduction velocity aad Electromyography (EMG) 2.4.6 Electrocardiogram](https://reader036.fdocuments.us/reader036/viewer/2022071004/5fc0b81c85752b7177281052/html5/thumbnails/113.jpg)
Limbs: abnormal findings no 753
upper•
lower
varices no yes
peripheral pulses (radial, posterior tibial, dorsal arteryof foot)
abnormal findings
no yes
if yes:
Nervous System And Psyche
abnormal findings no yes
Remarks: