unknown cause. There was no diabetes, and his
creatinine.
Nevertheless, she was started on
urinary sediment showed red cells, casts and
protein. The serum creatinine was 3.4 mg/dl. He
had chronic venous insufficiency in the legs and a
left hydrocele. A serologic test for filaria was
negative. There was also a mild macrocytosis; a
serum B12 level was low normal. The cause of
death is not knowa.
intramuscular B12. Mammography was normal and
Subject No. 6. This 69-year-old man died on
Ebeye in 1989. His medical problems in March
1988 included diabetes (status post leg
Ebeye in 1990. He had advanced diabetes mellitus
with nephropathy, retinopathy, and neuropathy.
Whenlast seen in March 1990 his creatinine was
12.4 mg/dl and the hemoglobin level was 10.4 g/dl.
A HbAic level was 6.8%, only slightly elevated.
Flexible sigmoidoscopy was negative in 1987, and a
chest x-ray at that time showed noactive disease.
He was being followed by the Diabetic Clinic on
Ebeye. His deathcertificate listed renal failure due
to diabetic nephropathy as the cause of death.
amputation) with chronic renal failure, severe
neuropathy, and eye infection from recent cataract
extraction, for which he was referred.
He was
moderately anemic with a Hb of 9.6 g/dl. The
cause of death is unknown.
Subject No. 7. This 42-year-old man died on
Majuro in 1989. He had diabetes, extremely
carious teeth, a cataract, and a disabling
arthrogryposis. When last seen in 1989 his only
medication was glyburide. His blood count and
serum creatinine were normal. Hewas referred
for cataract surgery. The death certificate lists
overwhelming sepsis and severe pneumonia as the
cause of death.
Subject No. 8. This 89-year-old woman died
on Ebeye in 1990.
No important medical
problems were noted when patient was last seen
in March 1988.
She had severe kyphosis,
cataracts, and perhaps a mild dementia, but in
general annual examinations indicate she was
usually in quite good health. Her blood count was
normal and a Papanicolaou smear was Class I in
1988. Medications included only acetaminophen
and a skin antifungal agent. The cause of deathis
unknown,
Subject No. 9. This 76-year-old woman died
on Ebeye on December 31, 1987. The death
certificate diagnoses were cardiac failure and
bronchitis. At the time of her last complete
medical examination by the Brookhaven team she
had a moderately severe anemia (hemoglobin
level: 8.8 g/dl) and recent weight loss. The mean
corpuscular volume was 98 fl. and there was some
hypersegmentation. A serum B12 level was
somewhat low (170 pg/ml), but the urine
methylmalonic acid level was normal at 0.8 ug/mg
her Papanicolaou smear was class I. When seen
several months later in follow-up, she felt well. A
flexible sigmoidoscopy was normal. It may be
relevant that her husband had died recently, andit
is possible that he had advanced tuberculosis.
Subject No. 10. This 59-year-old man died on
Subject No. 11. This 61-year-old man, a former
heavy smoker, died on Majuro in 1989. He was
known to have chronic renal insufficiency thought to
be due to diabetes. He was referred in 1987 for
evaluation of this problem.
An_ ultrasound
examination by the Brookhaven team revealed no
calculi or hydronephrosis; renal size appeared
normal. He had gout, and the renal disease could
have represented uric acid nephropathy. There was
a suggestion of pleural effusions on chest x-ray in
1988 when he was referred for further evaluation.
Whennext seen by the medical team in March 1989
he had lost much weight and a hilar mass was noted
on chest x-ray. He was referred for evaluation.
Carcinomaof the lung was indicated on his death
certificate.
Subject No. 12. This 73-year-old woman had
breast cancer diagnosed in 1985 after a breast
nodule was detected during het annual medical
program physical examination. A mastectomy was
done that year. She died in 1991. Whenlast seen
by the medical team (March 1989) there was no
evidence of metastatic disease, and the cause of
death is unknown.
Subject No. 13. This 64-year-old woman died on
Ebeye in 1988. Her last complete Brookhaven
examination was in 1986, when her problems
included insulin-dependentdiabetes mellitus, urinary
tract infection, and abnormal liver function tests.
When repeated, the latter showed only a minimally