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Dow Migration

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 What Dow Corning Corporate documents have to say about the migration of silicone.

Document #63
10/27/65
ACKNOWLEDGEMENT OF NEED FOR TESTING
COHESIVENESS - LIQUID COMPONENT OF GEL
GEL MIGRATION
SHELL DEGRADATION
SHELL STRENGTH - THICKNESS
TESTING
TISSUE REACTION

Burdick, Dow Corning, memo to Don McGhan, Weiler, VerVoort, and Pellikka regarding "Mammary Implants." He states:

"There are still a number of questions concerning our breast units that have not been answered. We know that a quantity of low molecular weigh material is exuding from the bag, but that is all.

He suggests a test to extract the material and analyze it. Burdick states:

"This test should tell us how the gel is affecting the rubber bag. Adhesion and tear strength should also
be related to swell. The extractables may be of low enough molecular weigh to migrate throughout the body. If so, what quantity are we talking about?

CITE: OOM 321439 - 321449, Exhibit to Bennett Deposition and Exhibit to D. McGhan
Deposition. Dow Corning Trial Exhibit List Abstracts

Document #109
09/20/76
Hobbs, Dow Corning, memo to Hinsch with a copy to Lentz regarding information concerning migration of silicone gels. Hobbs states that experimentation had not demonstrated migration of Dow Corning mammary gel but this factor does not appear to be true for all silicone gels. Hobbs further states that gels having a low consistency due to low levels of cross-linker appear to migrate along tissue planes in much the same manner as large injected doses of silicone fluid.

CITE: M 170104, Exhibit 130 to Burda Deposition; Exhibit 91 to Braley Deposition.  DUPLICATE: M 570060. NOTE: The document was listed as 00/00/70 on Plaintiff's Trial Exhibit List. Dow Corning Trial Exhibit List Abstracts

Document #151
06/00/73
COHESIVENESS - LIQUID COMPONENT OF GEL
ACKNOWLEDGEMENT OF NEED FOR TESTING
GEL MIGRATION

Dow Corning Bioscience Research Laboratory "Research Project Description: entitled "Bioscience Research Support Project - Systemic Migration Of Prosthetic Gel In The Rhesus Monkey." This cooperative project between Dow Corning's Medical Products Business and Dr. Gerow will "to examine the efficacy of using the gel as an injection or implantation for mammary augmentation. This project is designed to examine the potential of gel components to migrate systemically from the site of instillation." (DCC 16001066) "The gel is a complex mixture of which the low molecular weight fraction (up to 1% w/w of the gel; 330 Fluid) is assumed to offer the greatest potential for migration.

Present data acquired in rats indicate that such low molecular weight components tend to appear in depot fat and lymph nodes and that maximum tissue concentrations are attained shortly after instillation.... The relative contribution of the various routes of elimination may include the lung,  kidneys and liver based on the elimination of orally administered permethylated cyclic tetramer...."
(DCC 16001066)

None of the data to be gathered will allow definition of the structural types that may migrate. The  330 Fluid fraction components of the gel "are the most likely candidates ... (so) it may be advisable to repeat the study with a gel formulation containing a minimum of low molecular weight linear and cyclic siloxanes."

CITE: DCC 16001066 - 16001068, Exhibit to Bennett Deposition. WITNESS: Bennett
(Authenticated in Bennett, Vol. II, p. 546: 12-23). DISPOSITION: Admitted in Toole (II) v.
Baxter Healthcare. Dow Corning Trial Exhibit List Abstracts

Document #224
03/22/76KNOWLEDGE OF GEL BLEED
GEL MIGRATION

Handwritten note to Milt Hinsch from Greg Bicket, both of Dow Corning, discussing the bleed question and Dr. Terino's presentation. Bicket notes that many persons are asking questions about, "What is that stuff on the outside of DC's implant.... Do you want that bleeding into your patient's body ... will it cause capsule contracture. We say they all do it; McGhan must be cleaning their implant very carefully." He lists 8 questions including whether the gel migrates and, if so, to what parts of the body and with what effects. Bicket feels "uncomfortable" since he can't answer all of the questions. He notes that McGhan is raising these questions with doctors.

CITE: M 160026 - 160027, Exhibit to Petraitis Deposition, and Exhibit to MDL Rathjen Deposition. DUPLICATE: GEG 4026 - 4027; M 190255 - 190256, KMM 3831 - 3832.  NOTE: This date is approximate and is based on the date on the top of the page from the ASPRS meeting on 03/22/76. Dow Corning Trial Exhibit List Abstracts

Document #230
04/14/76
KNOWLEDGE OF GEL BLEED
ACKNOWLEDGEMENT OF NEED FOR TESTING

Eldon Frisch, Dow Corning, responds to Milt Hinsch's memo on Greg Bicket's questions on gel
bleed.

"The material which bleed from a mammary implant is a polydimethylsiloxane, or more appropriately a silicone fluid. It comes from within the gel.... Since the gel starts as a fluid, these materials are also fluids, and they tend to migrate about in the gel, eventually dissolving in the envelope and passing through it.... We have no scientific data to indicate whether or not the presence of the fluid polydimethylsiloxane which bleeds through the envelope increases or decreases the problems of capsular contracture." He questions whether Dow Corning's field inventories are getting too old, allowing "the bleed (to become) more evident." Frisch also talks about injected silicone fluid studies which showed absorption of the silicone fluid into the body. "We have no scientific evidence to indicate whether or not the presence of the fluid polydimethylsiloxane which bleeds through the envelope increases or decreases the problems of capsular contracture."

CITE: M 190259 - 190261, Exhibit 13 to California Braley Deposition (used by Dow Corning), Exhibit to Petraitis Deposition, Exhibit to MDL Rathjen Deposition.  DUPLICATE: KKH 1561 - 1565; GEG 4023 -4025; M5700445 - 570047, KMM 3828 -3830; GEG 4246 - 4250. Dow Corning Trial Exhibit List Abstracts

Document #236
05/17/76
ACKNOWLEDGEMENT OF NEED FOR TESTING

Art Rathjen, Dow Corning, memo to Bey and C. Lentz regarding a capsular contracture study proposed by Dr. James Penoff. "We are engulfed in qualified speculation - nothing to date is truly quantitative or qualitative; therefore, Dr. Penoff's suggestions for a course of action merit some serious consideration." (emphasis added).

Phase I of the proposed study includes:

A.        Is there something in the implant that migrates out or off the mammary prosthesis?  yes or no!

B.         Does it continue for the life of the implant or is it limited or controlled for a period of time?

C.        Does it come from the gel or envelope or both?

D.        What is it?

E.         Considering the evolution of the mammary prosthesis, have changes in both the gel and envelope altered the degree or changed what might migrate through or off the prosthesis?

Phase II would be pre-clinical implant testing to determine whether components of the envelope and
gel migrate.

Phase III is human implantation.

CITE: F 715 - 716, Exhibit to MDL Rathjen Deposition, and Exhibit 78 to Harris County
Rathjen Deposition DUPLICATE: FDA 31438 - 31439; M 210001 - 210002. Dow Corning
Trial Exhibit List Abstracts

Document #252
08/23/76
GEL MIGRATION
KNOWLEDGE OF SYSTEMIC DISEASE
RUPTURE

Jim Rudy, President of Heyer-Schulte sends a "Dear Doctor" letter regarding "the possible and known problems and complications" of breast implants. It is noted that subtle processes of degradation should be expected to occur, and that the knowledge associated with long-term implantation is imperfect. If the implant is torn the gel will migrate and that is why Heyer-Schulte placed warnings in data sheets in May 1975. Doctors and patients should expect some patients to exhibit adverse response to silicone implants.

CITE: M 190413 - 190417, Exhibit 159 to Harris County Powell Deposition, Exhibit to Harris County LeVier Deposition, Exhibit to Nawash Deposition, and Exhibit 140 to Harris County Rathjen Deposition.   DUPLICATE: GEG 004050 - 004054; KMM 262028 - 262032; BAX 36899 - 36903.  WITNESS: Rudy Exhibit 34; Hyans Exhibit 24.  DISPOSITION: Admitted in Toole (II) v. Baxter Healthcare. Dow Corning Trial Exhibit List Abstracts

Document #254
09/20/76
GEL MIGRATION

E. Hobbs, Dow Corning, Memo to Milt Hinsch and Charles Lentz providing information on the migration of silicone gels. Experimentation utilizing various animals has not demonstrated migration of Dow Corning mammary gel. However, "Gels having a low consistency due to low levels of cross-linker appear to migrate along tissue planes in much the same manner as large injected doses of silicone fluid." One gel, in a test situation having a low cross-linker material, moved from its original implant site apparently along tissue planes aided by gravity.

CITE: D 972, Exhibit 141 to Harris Country Rathjen Deposition, and Exhibit 2D to Harris County Talcott Deposition. DUPLICATE: M 170104; M 570060; DCC 8200611. Dow Corning Trial Exhibit List Abstracts

Document #256
09/22/76
GEL MIGRATION
TISSUE REACTION

Milt Hinsch memo to the Dow Corning sales force concerning Dow Corning's response to Heyer-Schulte's "Dear Doctor" letter discussing problems and complications of gel-filled mammary prosthesis. Hinsch claims that Dow Corning's implants are considered "non-active in the body" and he "would not expect shape or softness to change appreciably." Also, Dow Continues "to test 100% for cohesive gel during production" and "their gel offers the softest possible feel while retaining cohesiveness." Hinsch states that, "there are no cases of Dow Corning gel migration. Conversely, in documented cases where the envelope was ruptured, the gel did not migrate." He claims that all materials are subjected to "extremely sensitive" tests for tissue reaction and must show no tissue reaction to be accepted. Hinsch states that Dow Corning does not plan a written response to the ""Dear Doctor" letter.

CITE: M 240432 - 240433, Exhibit 8 to Hinsch Deposition (plaintiffs), Exhibit 44 to Hinsch Deposition (Dow Corning), Exhibit to Peters Deposition, Exhibit to Harris County Rudy Deposition, Exhibit 97 to Harris County Rathjen Deposition, Exhibit 2D to Harris County Talcott Deposition, Exhibit 113 to Burda Deposition, and Exhibit to MDL Rathjen Deposition.
DUPLICATE: GEG 4048 - 4049; M 880029 - 880030; OOM 880029 -880030.
Dow Corning Trial Exhibit List Abstracts

Document #261
10/23/76
GEL MIGRATION

Art Rathjen, Senior Clinical Research Specialist for Dow Corning, writes to Kurt Wagner, M.D. about a problem with gel migration, "Obviously, whether it is a Dow Corning implant or a competitors' the fact that this phenomenon would exist is disturbing enough. We have always been conscious of this possibility: therefore, you certainly caught me off guard when you first reported that the gel from one of our implants had indeed migrated to the groin." Rathjen claims that Dow Corning
did not supply any materials to competitors for the manufacture of mammary implants until the first quarter of 1976. General Electric supplied the materials. (emphasis added).

CITE: KKH1719. DUPLICATE: GEG 4009. Dow Corning Trial Exhibit List Abstracts

Document #310
02/27/79
GEL MIGRATION
KNOWLEDGE OF GEL BLEED
RUPTURE
SHELL STRENGTH - THICKNESS

Del Petraitis memo to Bill Oppelt, both of whom are former Dow Corning employees who are now at McGhan Medical. Petraitis is critical of Dow Corning's inflatable shells because of their method of dipping which results in significant differences in thickness, making the shells "very susceptible to aneurysm formation."

With gel-filled implants, the shell thicknesses are less. Also, he states that Dow Corning's gel "achieves its responsiveness by utilizing a large quantity of non-functional polymer in the gel formation.... This free polymer is not chemically cross-linked and is only mechanically trapped in the gel matrix. As a result, it is free to migrate through the shell and makes the entire implant much more prone to the 'bleed' phenomenon."

CITE: MCG 8487 -8489, Exhibit to Coyne Deposition, Exhibit to Grosh Deposition, Exhibit to Oppelt Deposition, Exhibit to Schreiber Deposition, and Exhibit to Petraitis Deposition. Dow Corning Trial Exhibit List Abstracts 

Document #315
11/07/79
SHELL STRENGTH - THICKNESS
RUPTURE
COHESIVENESS - LIQUID COMPONENT OF GEL
GEL MIGRATION
TISSUE REACTION

Operative report from Dr. Vinnik's patient. Patient reported being involved in a "very trivial accident, when she struck her right breast against the 'monkey bars' while playing with her child in a playground." During explantation for the ruptured prostheses, Dr. Vinnik noted that the gel ran "down the patient's chest, onto the operating table and onto the floor.... This procedure is performed because of medical necessity as a ruptured breast implant can produce serious medical problems....Free silicone gel, particularly when it is non-cohesive as (sic - has) been known to migrate through the local area, and produces severe granulomatous response." (emphasis added).

CITE: KMM 423161. NOTE: See KMM 423155 - 423156. Dow Corning Trial Exhibit List Abstracts

Document #332
02/09/81
KNOWLEDGE OF SYSTEMIC DISEASE
GEL MIGRATION

Boley, Dow Corning, memo to Frisch, LeVier, Spielvogel, Cooper, Rylee, and Wessel regarding

"Baboon Study To Evaluate the Fate of Silicone Wear Particles." Boley notes that:

"Silicone particles have been found in the axillary lymph nodes of patients with Silastic finger joints. These particles have been detected as a consequence of biopsy of nodes that have become painful and enlarged.... Of concern to the surgeon is whether these particles will continue to migrate beyond the regional nodes into the thoracic or abdominal cavities. Since concerns about malignancies requires that any chronic swelling of lymph nodes be biopsied or excised, wear particles could create the need for a surgeon to breach the body cavities.

CITE: KMM 328166 - 328167. DUPLICATE: KMM319434 - 319435. Dow Corning Trial Exhibit List Abstracts

Document #353
05/14/82
TISSUE REACTION
KNOWLEDGE OF SYSTEMIC DISEASE

Dr. Robert Parsons, Professor of Surgery at the University of Chicago, writes a letter to Gene Jakubczak at Dow Corning informing them of their research on implanted silicone prostheses. "our data suggest strongly that the fibrosis and capsular contracture seen clinically maybe (sic) an immunologically mediated phenomenon." (emphasis added). Dr. Parsons states that macrophages aggregate and adhere to the surface and actively erode the silicone envelope after implantation: macrophages ingest and process silicone; macrophag-lymphocyte communication occurs by intracellular bridging in the lymph nodes and have identified silicone containing microvacuoles in both the macrophages and lymphocyte ends of the bridges; and significant inhibition of macrophage migration by silicone sensitized lymphocytes in vitro has been shown. Dr. Parsons, Dr. Heggers and
their research assistant, Nir Kossovsky, suggest that their work may enable them to develop a method of screening patients for "hypersensitivity to silicone" before they are implanted.

The research team found that the body's reaction to silicone created giant cells called macrophages that erode the silicone envelope and can migrate to the lymph nodes. Dr. Parsons believes that the body's immune reaction could be causing such problems as capsular contracture. Requests for finding from Dow Corning for further research to better understand this immune response were denied by the company.

CITE: F 748 - 749. DUPLICATE: FDA 19612 - 19613: KMM 447084 - 447085; Staff
Report prepared by the Human Resources and Intergovernmental Subcommittee of the Committee on Government Operations, December, 1992, p. 15. Dow Corning Trial Exhibit List Abstracts

Document #358
06/11/82
GEL MIGRATION

Burda, Dow Corning, reports on Complaint Report WM2570 in which the left implant ruptured and "silicone gel migrated down the patient's arm."

CITE: CO 1417 - 1429. Dow Corning Trial Exhibit List Abstracts

Document #393
04/18/84
TESTING
GEL MIGRATION

Linda Veresh, Dow Corning, "Final Report on Dow Corning 382 Elastomer, skin sensitization test; the original report is dated 1982. Two of the guinea pigs died with no cause determined but the implants had migrated and whitish lesions and granular particles were found on the lung, ventricles of the heart, spleen and liver. In addition, hemorrhagic spots were found on the cerebrum.

CITE: T 11768 - 11817 Dow Corning Trial Exhibit List Abstracts

Document #416
03/12/85
TESTING
GEL MIGRATION

Dow Corning Health Care Group Research Report 150 by Boley and Bejarano entitled "Fate of  Q7-2159A Gel Injected Sub-dermally In Rats: Macro Observations." Fibrous tissue can infiltrate Q7-2159A gel and partition it into many smaller masses. The disappearance of 50% of the gel from the injection site is of concern. Whether the gel migrated or was trapped in capsular tissue is unknown.

CITE: DCC 800311717 - 800311729, Exhibit 9 to Bejarano Deposition, Exhibit to Frisch Deposition, and Exhibit 32 to Zimmer Deposition. DUPLICATE: F 160 - 175; KMM 297691 - 297705. Dow Corning Trial Exhibit List Abstracts

Document #428
09/23/85
ACKNOWLEDGEMENT OF NEED FOR TESTING
GEL MIGRATION

D. Weyenberg memo to J. Cooper, Dow Corning, regarding an "immunomodulation Study." Weyenberg outlines the objective of the study:

What is the potential for silicone gels and fluids intended for disposition in the body, and which migrate and persist indefinitely in the body, to cause or contribute to clinically significant disorders? Where does the material accumulate: Where would theory predict it to accumulate? What might be the impact of certain accumulations? Are there elimination mechanism? Does it migrate from any initially deposited site? The phenomenon of silicone migration within the body is very central to any of these questions, and I am bothered by our apparent lack of knowledge of this phenomenon and the low emphasis on phenomenon in our potential program.

CITE: KMM 369357, Exhibit to Weyenberg Deposition. Dow Corning Trial Exhibit List Abstracts

Document #432
10/17/85
SHELL STRENGTH - THICKNESS
SHELL DEGRADATION

Clauss, Dow Corning Valbonne, memo to Frisch regarding Dr. Muller. Dr. Muller complained that the envelope has disappeared and suggests that there was a chemical dissolution of the envelope by the gel, that the body metabolized the envelope, or that the envelope migrated. Clauss states that the first and second hypothesis "seems for me, according to our silicone behavior knowledge, the most credible."

CITE: M 460185. Dow Corning Trial Exhibit List Abstracts

Document #453
02/23/87
ACKNOWLEDGEMENT OF NEED FOR TESTING
COHESIVENESS - LIQUID COMPONENT OF GEL
CONCEALING FROM FDA
FRAUD/MISREPRESENTATION
GEL MIGRATION
KNOWLEDGE OF SYSTEMIC DISEASE
MISCELLANEOUS - RECKLESS/CONSCIOUS DISREGARD
SHELL DEGRADATION
TESTING
TISSUE REACTION

Robert LeVier, Dow Corning, memo to Hayes, Rylee, Stark, Thiess, Weyenberg, and Yerrick regarding the "Medtox Project Final Report." Seven numbered copies of the Medtox Report were issued to the seven individuals listed above. The final report replaces the 12/31/86 interim report.

Levier asks each of the recipients to "Please discard the interim report dated December 31, 1986. (KMM 298339). 

The purpose of the Medtox project was to formulate a consolidated understanding of all internally funded safety studies of silicone material relevant to the Health Care Business and to relate the findings to current safety issues as presented in the literature, by the physician community and in litigation. LeVier reviewed four sources of information: the Corporate Toxicology File 1949 - present, the DC 360 Fluid NDA 2702 file 1974, the Medical Research Report File 1980 - present, and the Corporate Mainframe Reference List 1957 - present. The report will generate a database for Dow Corning to search and will be available to the Legal Department. The first and earliest report LeVier noted was a 1949 publication. He also located and identified in the appendix 110 reports. The studies through 1963 were primarily related to antifoam compounds and emulsions used in antigas formulations. Thereafter, the studies were conducted to qualify materials. "Studies in the 1980 - 1986 period are primarily directed toward requalification of materials that have been in use for some time."

Levier concludes that the reaction at the implantation site is an acute inflammation progressing to chronic inflammation characteristic of a mild foreign body response and that there is no evidence of systemic toxicity. LeVier does note, however, that:

Two studies indicate that PDMS injected S.Q. or I.P. in very large quantities (5 to 62 ml/animal) in mice and rats is disseminated broadly and polymer is microscopically visible as deposits in tissue. It is likely that these deposits are the end-stage result of phagocytic transport and aggregation of polymer.

Several teratology studies in rats and rabbits have shown a positive but low incidence of skeletal defects and increased fetal resorptions.

LeVier acknowledges that silicone fluid and silicone elastomers can be found in macrophages and multinucleated giant cells. "The greater incidence of macrophages and giant cells is more characteristic of a chronic inflammatory state than usually seen around elastomer implants in the absence of abrasion particles." He notes that the silicone fluid migrates and is transported to regional lymph nodes. Further, LeVier concludes that:

The implantation site reaction to silicone gel, particularly in the form of a fabricated mammary prosthesis, is similar to that produced by fluid polymer. In the case of free silicone gel the distribution compared to fluid polymer resides in the cohesiveness of the gel.... In the case of free gel, progressive gel subdivision by connective tissue septa is superimposed on encapsulation of the entire gel mass.

The analyses of the internal studies indicates that there are notable deficiencies among the reports.

LeVier classifies these as "Nuisance Issues" and "Substantive Issues." The nuisance issues include that the study designs are outdated, the studies are of limited utility, the variety of systemic histopathologic findings is broad, and the majority of the studies were conducted by IBT and FDRL. "Both of these companies are known to have falsified data in the time period relevant to the studies conducted for Dow Corning." He does not think it likely that any of Dow Corning's studies were falsified, but he does not state the basis for this belief.

Regarding the substantive issues, LeVier states:

There are two specific deficiencies of importance that tend to limit the utility of the long-term studies in particular.

1. The histopathology of the reticuleondothelial system (RES) including liver, spleen, lungs, lymph nodes and bone marrow was not examined carefully or systematically in any long-term study. Therefore, little information is available from these studies with regard to migration of implanted materials nor with regard to target tissue effects. Such an examination is rarely part of a formal toxicity study but the absence of such an evaluation is often cited as a criticism.

2. None of the studies incorporate a critical assessment of physiologic effects induced by the local inflammatory reaction. Nor is the nature of the local reaction assessed in detail. Thus, no information is available with regard to effects on the immune system, for example. In discussing the limitations of the prior studies, LeVier admits that there are no studies in which the inflammatory reactions were described and classified according to "criteria employed by researchers expert in the study of inflammation nor have any studies been designed to detect the range of systemic effects that could attend a chronic inflammatory state.... Presently, there are insufficient data to effectively understand cause and effect relationships or to defend silicones against the broadening claims of HAD stimulation. 

In discussing what corrective measures should be taken. LeVier recommends that Dow Corning should not replicate any of the studies that were flawed and outdated. He states:

Replication of existing studies for the sole purpose of correcting nuisance problems would be very costly and would consume several years before results could be available. Some problems such as too few animal per group and too many implants per animal could be corrected but it is improbable that the spectrum of unrelated pathologic events could be materially influenced. It is such pathologic events that are used to claim systemic toxicity caused by silicone implants. The course of action (corrective measure) that is recommended is to develop sound arguments in support of the validity of existing studies. (emphasis added).  

LeVier also discusses the immunopotentiation of silicone and notes that "if immunopotentiation is prolonged in response to PDMS, then the probability may be increased that silicone has an adjuvant like effect of sufficient duration to promote development of auto-antibodies in susceptible individuals."

CITE: KMM 298296 - 298339. NOTE? The interim Medtox report is dated 12/31/86. NOTE: Includes LeVier memo sending attached Medtox report to D. Hayes, R. Rylee, F. Stark, G. Thiess, D. Weyenberg and K. Yerrick. Dow Corning Trial Exhibit List Abstracts

Document #483
07/25/88
GEL MIGRATION
TESTING
TISSUE REACTION

FDA: An internal FDA review of the epidemiological study involving 3,000 women in California by Dr. Dennis Deapen and his colleagues, Pike, Casagrande, and Brody, to determine if breast implants increase the chance of developing cancer, concludes there were "numerous sources of errors, biases and methodological limitations." Also:

"this study has not contributed greatly to our understanding of the relationshp between breast implants and the risk of breast cancer. Furthermore, it is known that silicone can migrate to other body sites away from the site of implantation. Even with all the biases inherent in the study design, the authors did note a higher number of observed cases of cancers at other sites than expected (24 observed versus 15.8 expected). Based on these results and the fact that silicone can migrate to other sites, the authors should have addressed this issue by including cancers at other sites, instead of limiting their study to only breast cancer.

CITE: M 780066 - 780069; Attachment 3 to Staff Report prepared by the Human Resources and Intergovernmental Relations Subcommittee on Government Operations, December, 1992, p. 9. NOTE: See 05/10/89 ENTRY. See 00/00/00 (M 780074 - 780078), 00/00/87 (M780070 - 780073), 08/17/89 (M 780079 - 780090) and 08/03/88 (M 780056 -780063 entries; possible attachments to this document. DUPLICATE: M790025 - 790029. Dow Corning Trial Exhibit List Abstracts

 

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