- Email: [email protected]
Disability of Coal Mine Workers
COMMUNICATIONS TO THE EDITOR
according to VICC/Cincinnati classification.v These results are corn pared with ventilatory tests. Cases are classified in order according to x-ray evidence of their lesion size, starting from large opacities down to rounded opacities as, r, q, p, and irregular opacities as, u, t, and s. Extent of opacities are recorded along with other features noted on the chest x-ray filnl. Chest/heart ratios are expressed in centimeters, Ages, and years spent in soft or hard coal mines are also recorded. \Tentilatory function figures are expressed as percentages of predicted values.
Disability of Coal Mine Workers To the Editor: This preliminary study was planned after the passage of Public Law 91-713, 91st Congress, S. 2917 December 30, 1969.1 Title IV, Part B, Section 411, c- (3) of the law states in clause (A) "When diagnosed by chest roentgenogram, yields one or more large opacities (greater than one centimeter in diameter) . . ." and in clause (b), "When diagnosed by biopsy or autopsy, yields massive lesions in the lung, . . . , then there shall be an irrebuttable presumption that he is totally disabled due to pneumoconiosis ..." It is also stated in c- ( 1 ) that ten years or more work in the mines is required in order to qualify for disability. An attempt was made to investigate the relationship of chest radiologic changes with various ventilatory function tests which may be affected by respiratory disability. ~IATERIALS
RESULTS AND DISCUSSION
Only eight patients of the 19 may be eligible for total disability; according to the Public Law 91-173, these were classified as class A, B, and also worked in coal mines more than ten years. As seen in the table, none of the ventilatory test values correspond with x-ray evidence of the disease. Several coal miners without massive lesions had poorer function tests than those classified as having large opacities. The table also reveals that large opacities may appear in the chest films of miners with less than ten years of work in hard coal mines. There is no correlation between chest/heart ratio and pulmonary functions. An attempt was made to correlate gas-transferring capacity with chest x-ray findings in coal miners by Lyons et a1. 3 Single-breath carbon monoxide tests showed a difference between pin-head and micronodular types of pneumoconiosis. [ames?
AND ~IETHODS
Nineteen patients were chosen for study. They had worked in coal mines, were claiming disability, and had had pulmonary ventilatory studies done at Cleveland Metropolitan General Hospital. Their chest x-ray films were classified
Disability Years in
Patient
Agp
I
78 6B 6n 68 57 67 64 54
2 3 4 ,1 6 7 8
n
Hl
S-35 11-5 S-25 8-31 S-IH
71 67 77 69 fl6 68 67 78
8-34 8-33 S-16 8-32 H-4 8-34 S-25 S-30 S-30 H-33 S-24 S-43
fiS
H-:Ul
76
11-21
65
10 I1 12 13 14 15 16 17 18
Chest/
Classification
Coal X] inr- Heart r-rn 2~~/'12
36.·'IH 35/14 28/13 33lJ4 35/18 28/11 30/11 30/13 36/17 35/18 31 /14 29/12 32/14 30/14 31/17 31/18 2n 112 32/14
B,id,tb,lHl.
A,id,q,3/2,hi,hu. A,id,2/2,I>u,hi. A,id, p,2 ./3. A,id,t,2/3,hu,k. A,id,~,2/3,{"o.
A, \vd,s,2/2,<·o, tba. A,id,s,2/1, th,od. A,id,s,I/2,th. A,id,s,I/I,hu,hi. r,3/2,hi. r,3/2,hi. q,3/2. p,I/O. t,2/3,hi. t,2/2,{'o. 8,2/2,hi,co. s,I/2,hu. s, I /1,cn,tb.
All vent ilutorv function figures are expressed as S = Soft C·CHtl mine II = liard eonl mine FEV = Forcod Expiratory Volumet t) FEV-I = 1 sor-ond FEV FEV-3
~IEFI~
lj~.
01 Coal
Mine W orkers
FEV
FEV-l FEV-3
82 82 H5 82 100 77 80 86 122 95 60 III
84 88 96 62 79 66 105
fi5 61
87 88 97 72 80 79 129 100 33 118 72 111 93
eo
60
69 102
of predicted values
= 3 ser-ond FE\" =
~IVV-:\IV
~IVV
Mnximum Expiratory Flow Rate
7.5 72 87 85 103 77 89 91 135 105 45 III
75 100 94 60 70 72 100
l\IEFH
:35 :~4
72 121 87 70 51 73 1 1t5 89 II 112 72 129 115 32 32 49 107
l\1l\IEF C\IBC) 2H 27 40 71 73 47 ;:j7 54 133 78 12 35 27 130 49 34 2,l) 61 62
(if)
5H 84 78 102 81 6n 75 123 73
34 119 98 124 92 60 59 59 104
l\IV
BB 181 B4 IS5 246 94 H3 132 122 132 9n.5 126 108 157 127 125 96 130 118 116 12.5 82 104 134 126 143 107 136 119 126 could not perform 184 75 1]7 Ion 124 127
l\I~IEF = Maximum :\Iid-Expiratory Flow l\IVV = Maximum Volunt arv Ventilation l\IV = Minute Ventilation "2 mph. on level" l\IVV-l\fV :\IVV = Degree of Dyspnea "Predicted normal 0.65"
Sef' refr-renr-e (2, for r-lussifir-at ion figures
306
l\IVV
307
COMMUNICATIONS TO THE EDITOR
reported that a group of southern "lest Virginia coal miners with pulmonary disability had shown mild to moderate abnormality in the uniformity of intrapulmonary gas distribution. Unrecorded data in this study also showed that most of the cases have uneven distribution of ventilation by the single breath nitrogen test. This also does not correlate with chest x-ray film findings. I would like to point out that neither chest x-ray nor ventilatory tests alone should be used for the determination of disability of coal mine workers. Moreover, Reger and Morgan" showed that there is considerable difference in interpretations of chest xray films of coal miners by experienced readers. Vast research is needed to find a useful test for determination of disability in persons with pulmonary disease or pneumoconiosis, perhaps in the field of blood gases in rest and exercise.
were found. In a publication entitled "Calcification of the Tricuspid Annulus" (Amer J Roentgenol 106:550, 1969) Rogers et al report four new cases and in their references refer to several other case reports. In an article entitled "Atrial Septal Defect and Calcification of the Tricuspid \Talve" (Brit Heart J :32:409, 1970) Cooksey et al discussed the same subject. This literature review was conducted for us because we have seen two cases of calcification of the tricuspid valve associated with pulmonic stenosis in the last several years. '\T e can only agree with the authors' conclusions that it is a result of prolonged elevation of right ventricular pressure and merely want to call to the attention of your readers these other case reports. Lau-rence I. Bonchek, A/.D.o Portlarul, Oregon o Assistant
Sami Solu, M.D., F.C.C.P. o Cleceland °Staff physician, Sunny Acres Hospital and Tuberculosis Clinics of Cuyahoga County, Cleveland, Ohio. ACKNOWLEDG~IENT: The writer wishes to thank Dr. Joseph B. Stocklen, Controller of Tuberculosis for Cuyahoga County, and Dr. David G. Gillespie, Director of the Pulmonary Function Laboratories, Cleveland Metropolitan General Hospital, for helping to obtain and in making available the function records for this study.
REFERENCES
2
3
4
.5
Public Law 91-173, 91st Congress, S.2917, December 30, .51, 1969 V.I.C.C. Cincinnati classification of the radiographic appearances of pneumoconioses. Chest .58:.57, 1970 Lyons IP, et al: Transfer factor (diffusing capacity) for the lung in simple pneumoconiosis of coal workers. Brit Med J 4:772, 1967 james R~I: Distribution of pulmonary ventilation in disabled southwest Virginia coal miners, Amer Rev Resp Dis 101 :71.5, 1970 Reger, RB, Morgan \VKC: On the factors influencing consistency in the radiologic diagnosis of pneumoconiosis. Amer Rep Resp Dis 102: 90.5, 1970
Professor, Cardiopulmonary Surgery, University of Oregon Medical School.
To the Editor: Dr. Bonchek's statement concerning our article is correct. The article by Rogers et al appeared at the same time our paper was being prepared and had not been listed in the Index Medicus. In the case of Cooksey et aI, which was published following submission of our paper, calcification seemed to be valvular rather than annular, as were the other isolated cases referred to by Dr. Bonchek. Cooksey et al likewise were not aware of any such cases reported previously. We thank Dr. Bonchek, however, for bringing attention to the above articles and his own cases, confirming further our contention that calcified tricuspid annulus provides a valuable fluoroscopic clue to longstanding right ventricular hypertension most likely due to pulmonary valvular or right ventricular infundibular obstruction. Ali R. Chahramani, AI.D. o Miami o Assistant
Professor of Medicine, University of Miami School of Medicine.
Calcification of the Annulus of the Tricuspid Valve
Serum Alpha1-Antitrypsin Deficiency
To the Editor: In the recent article on "Calcification of Annulus of Tricuspid Valve" (Chest, September, 1971), by Arnold et aI, the authors note that "calcification of a tricuspid annulus has not been previously reported." Your readers may be interested to know that in a recent search of the medical literature from 1968 to 1971 conducted for us by the National Institutes of Health NIEDLARS Service, several reported cases
To the Editor: Deficiency of serum alphai-antitrypsin (AI-A) is not only associated with degenerative pulmonary disease, but also with other conditions, such as hepatic fibrosis.' As yet, a connection between lack of A1-A and central nervous system disease has not been made. We studied a 57-year-old caucasian woman for progressive dyspnea of several years' duration. Her
CHEST, VOL. 61, NO.3, MARCH, 1972
according to VICC/Cincinnati classification.v These results are corn pared with ventilatory tests. Cases are classified in order according to x-ray evidence of their lesion size, starting from large opacities down to rounded opacities as, r, q, p, and irregular opacities as, u, t, and s. Extent of opacities are recorded along with other features noted on the chest x-ray filnl. Chest/heart ratios are expressed in centimeters, Ages, and years spent in soft or hard coal mines are also recorded. \Tentilatory function figures are expressed as percentages of predicted values.
Disability of Coal Mine Workers To the Editor: This preliminary study was planned after the passage of Public Law 91-713, 91st Congress, S. 2917 December 30, 1969.1 Title IV, Part B, Section 411, c- (3) of the law states in clause (A) "When diagnosed by chest roentgenogram, yields one or more large opacities (greater than one centimeter in diameter) . . ." and in clause (b), "When diagnosed by biopsy or autopsy, yields massive lesions in the lung, . . . , then there shall be an irrebuttable presumption that he is totally disabled due to pneumoconiosis ..." It is also stated in c- ( 1 ) that ten years or more work in the mines is required in order to qualify for disability. An attempt was made to investigate the relationship of chest radiologic changes with various ventilatory function tests which may be affected by respiratory disability. ~IATERIALS
RESULTS AND DISCUSSION
Only eight patients of the 19 may be eligible for total disability; according to the Public Law 91-173, these were classified as class A, B, and also worked in coal mines more than ten years. As seen in the table, none of the ventilatory test values correspond with x-ray evidence of the disease. Several coal miners without massive lesions had poorer function tests than those classified as having large opacities. The table also reveals that large opacities may appear in the chest films of miners with less than ten years of work in hard coal mines. There is no correlation between chest/heart ratio and pulmonary functions. An attempt was made to correlate gas-transferring capacity with chest x-ray findings in coal miners by Lyons et a1. 3 Single-breath carbon monoxide tests showed a difference between pin-head and micronodular types of pneumoconiosis. [ames?
AND ~IETHODS
Nineteen patients were chosen for study. They had worked in coal mines, were claiming disability, and had had pulmonary ventilatory studies done at Cleveland Metropolitan General Hospital. Their chest x-ray films were classified
Disability Years in
Patient
Agp
I
78 6B 6n 68 57 67 64 54
2 3 4 ,1 6 7 8
n
Hl
S-35 11-5 S-25 8-31 S-IH
71 67 77 69 fl6 68 67 78
8-34 8-33 S-16 8-32 H-4 8-34 S-25 S-30 S-30 H-33 S-24 S-43
fiS
H-:Ul
76
11-21
65
10 I1 12 13 14 15 16 17 18
Chest/
Classification
Coal X] inr- Heart r-rn 2~~/'12
36.·'IH 35/14 28/13 33lJ4 35/18 28/11 30/11 30/13 36/17 35/18 31 /14 29/12 32/14 30/14 31/17 31/18 2n 112 32/14
B,id,tb,lHl.
A,id,q,3/2,hi,hu. A,id,2/2,I>u,hi. A,id, p,2 ./3. A,id,t,2/3,hu,k. A,id,~,2/3,{"o.
A, \vd,s,2/2,<·o, tba. A,id,s,2/1, th,od. A,id,s,I/2,th. A,id,s,I/I,hu,hi. r,3/2,hi. r,3/2,hi. q,3/2. p,I/O. t,2/3,hi. t,2/2,{'o. 8,2/2,hi,co. s,I/2,hu. s, I /1,cn,tb.
All vent ilutorv function figures are expressed as S = Soft C·CHtl mine II = liard eonl mine FEV = Forcod Expiratory Volumet t) FEV-I = 1 sor-ond FEV FEV-3
~IEFI~
lj~.
01 Coal
Mine W orkers
FEV
FEV-l FEV-3
82 82 H5 82 100 77 80 86 122 95 60 III
84 88 96 62 79 66 105
fi5 61
87 88 97 72 80 79 129 100 33 118 72 111 93
eo
60
69 102
of predicted values
= 3 ser-ond FE\" =
~IVV-:\IV
~IVV
Mnximum Expiratory Flow Rate
7.5 72 87 85 103 77 89 91 135 105 45 III
75 100 94 60 70 72 100
l\IEFH
:35 :~4
72 121 87 70 51 73 1 1t5 89 II 112 72 129 115 32 32 49 107
l\1l\IEF C\IBC) 2H 27 40 71 73 47 ;:j7 54 133 78 12 35 27 130 49 34 2,l) 61 62
(if)
5H 84 78 102 81 6n 75 123 73
34 119 98 124 92 60 59 59 104
l\IV
BB 181 B4 IS5 246 94 H3 132 122 132 9n.5 126 108 157 127 125 96 130 118 116 12.5 82 104 134 126 143 107 136 119 126 could not perform 184 75 1]7 Ion 124 127
l\I~IEF = Maximum :\Iid-Expiratory Flow l\IVV = Maximum Volunt arv Ventilation l\IV = Minute Ventilation "2 mph. on level" l\IVV-l\fV :\IVV = Degree of Dyspnea "Predicted normal 0.65"
Sef' refr-renr-e (2, for r-lussifir-at ion figures
306
l\IVV
307
COMMUNICATIONS TO THE EDITOR
reported that a group of southern "lest Virginia coal miners with pulmonary disability had shown mild to moderate abnormality in the uniformity of intrapulmonary gas distribution. Unrecorded data in this study also showed that most of the cases have uneven distribution of ventilation by the single breath nitrogen test. This also does not correlate with chest x-ray film findings. I would like to point out that neither chest x-ray nor ventilatory tests alone should be used for the determination of disability of coal mine workers. Moreover, Reger and Morgan" showed that there is considerable difference in interpretations of chest xray films of coal miners by experienced readers. Vast research is needed to find a useful test for determination of disability in persons with pulmonary disease or pneumoconiosis, perhaps in the field of blood gases in rest and exercise.
were found. In a publication entitled "Calcification of the Tricuspid Annulus" (Amer J Roentgenol 106:550, 1969) Rogers et al report four new cases and in their references refer to several other case reports. In an article entitled "Atrial Septal Defect and Calcification of the Tricuspid \Talve" (Brit Heart J :32:409, 1970) Cooksey et al discussed the same subject. This literature review was conducted for us because we have seen two cases of calcification of the tricuspid valve associated with pulmonic stenosis in the last several years. '\T e can only agree with the authors' conclusions that it is a result of prolonged elevation of right ventricular pressure and merely want to call to the attention of your readers these other case reports. Lau-rence I. Bonchek, A/.D.o Portlarul, Oregon o Assistant
Sami Solu, M.D., F.C.C.P. o Cleceland °Staff physician, Sunny Acres Hospital and Tuberculosis Clinics of Cuyahoga County, Cleveland, Ohio. ACKNOWLEDG~IENT: The writer wishes to thank Dr. Joseph B. Stocklen, Controller of Tuberculosis for Cuyahoga County, and Dr. David G. Gillespie, Director of the Pulmonary Function Laboratories, Cleveland Metropolitan General Hospital, for helping to obtain and in making available the function records for this study.
REFERENCES
2
3
4
.5
Public Law 91-173, 91st Congress, S.2917, December 30, .51, 1969 V.I.C.C. Cincinnati classification of the radiographic appearances of pneumoconioses. Chest .58:.57, 1970 Lyons IP, et al: Transfer factor (diffusing capacity) for the lung in simple pneumoconiosis of coal workers. Brit Med J 4:772, 1967 james R~I: Distribution of pulmonary ventilation in disabled southwest Virginia coal miners, Amer Rev Resp Dis 101 :71.5, 1970 Reger, RB, Morgan \VKC: On the factors influencing consistency in the radiologic diagnosis of pneumoconiosis. Amer Rep Resp Dis 102: 90.5, 1970
Professor, Cardiopulmonary Surgery, University of Oregon Medical School.
To the Editor: Dr. Bonchek's statement concerning our article is correct. The article by Rogers et al appeared at the same time our paper was being prepared and had not been listed in the Index Medicus. In the case of Cooksey et aI, which was published following submission of our paper, calcification seemed to be valvular rather than annular, as were the other isolated cases referred to by Dr. Bonchek. Cooksey et al likewise were not aware of any such cases reported previously. We thank Dr. Bonchek, however, for bringing attention to the above articles and his own cases, confirming further our contention that calcified tricuspid annulus provides a valuable fluoroscopic clue to longstanding right ventricular hypertension most likely due to pulmonary valvular or right ventricular infundibular obstruction. Ali R. Chahramani, AI.D. o Miami o Assistant
Professor of Medicine, University of Miami School of Medicine.
Calcification of the Annulus of the Tricuspid Valve
Serum Alpha1-Antitrypsin Deficiency
To the Editor: In the recent article on "Calcification of Annulus of Tricuspid Valve" (Chest, September, 1971), by Arnold et aI, the authors note that "calcification of a tricuspid annulus has not been previously reported." Your readers may be interested to know that in a recent search of the medical literature from 1968 to 1971 conducted for us by the National Institutes of Health NIEDLARS Service, several reported cases
To the Editor: Deficiency of serum alphai-antitrypsin (AI-A) is not only associated with degenerative pulmonary disease, but also with other conditions, such as hepatic fibrosis.' As yet, a connection between lack of A1-A and central nervous system disease has not been made. We studied a 57-year-old caucasian woman for progressive dyspnea of several years' duration. Her
CHEST, VOL. 61, NO.3, MARCH, 1972