unknown cause. There was no diabetes, and his

urinary sediment showed red cells, casts and
protein. The serum creatinine was 3.4 mg/dl. He
had chronic venousinsufficiency 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 known.
Subject No. 6. This 69-year-old man died on
Ebeye in 1989. His medical problems in March
1988 included diabetes (status post leg
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, He wasreferred
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
usuaily 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/dt) and recent weight loss. The mean
corpuscular volume was 98fl. 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

creatinine.

Nevertheless, she was

intramuscular B12. Mammography was
her Papanicolaou smear wasclass I.
relevant that her husband had died recegtly, andit
is possible that he had advanced tuberculosis.
Subject No. 10. This 59-year-old mdn died on
Ebeye in 1990. He had advanced diabetfs mellitus
with nephropathy, retinopathy, and
neuropathy.
When last seen in March 1990 his creafinine was
12.4 mg/dl and the hemoglobin level wag 10.4 g/dl.
A HbAIc level was 6.8%, only slightly elevated.
Flexible sigmoidoscopy was negative in 9987, and a
chest x-ray at that time showed no actife disease.
He was being followed by the Diabetid Clinic on
Ebeye. His death certificate listed renal Failure due
to diabetic nephropathy as the cause of Heath.
Subject No. 11. This 61-year-old mag, a former
heavy smoker, died on Majuro in 198@
He was
known to have chronic renal insufficiencythoughtto
be due to diabetes. He was referred
1987 for
evaluation of this problem.
An
examination by the Brookhaven team
calculi or hydronephrosis; renal siz
normal. He had gout, and the renal di

he had lost much weight and a hilar masf was noted

on chest x-ray. He was referred for fevaluation.
Carcinoma of the lung was indicated
certificate.

his death

Subject No. 12. This 73-year-old woman had
breast cancer diagnosed in 1985 afta@r
a breast
nodule was detected during her annial
medical

program physical examination. A mast#ctomy was

done that year. She died in 1991. Whdn last seen
by the medical team (March 1989)
thEre was no
evidence of metastatic disease, and tlfe

death is unknown.

cause of

Subject No. 13. This 64-year-old woman died on
Ebeye in 1988. Her last complete
examination was in 1986, when hej problems

included insulin-dependentdiabetes mel§tus, urinary

tract infection, and abnormal liver fugction tests.
Whenrepeated, the latter showed only minimally

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