Procedures:
Medical Histories and Physical examinations will be recorded on the special sheets
(Enclosure IV) which will be furnished later. Available will be a copy of the
previous years' exams and a brief summary of past medical findings.
The examining
doctors should review the medical history and, with the T.T. medics, expand on it
if necessary. The summary of significant positive. findings should be completed on
the last page of the exam forms. The examining physician should initial the routing
sheet. The examining physician should personally confer with each subject, giving
them briefly the results of the exams and proposed treatment. He should initial
the checkoff list for this on the routing sheet. In addition to routine physical
exams, more detailed or special exams of certain organ systems will be emphasized:
Cancer Detection
This is the most important aspect of the exams with particular emphasis placed
on screening for possible malignancies that are recognized.as being associated with
radiation exposure.
Since cancer statistics are sparse for the Marshall Islands,
documentation of these findings is of particular importance.
Thyroid Examinations
Routine inspection and palpation of the thyroid and neck with drawings of the
thyroid are indicated. Note clinical evidence of thyroid function. A sheet with
a thyroid drawing is attached to the physical exam forms. Plasma will be collected
for TSH on designated Rongelap and Utirik people. As referred to above, additional
thyroid exams will be carried out on unexposed Rongelap and Utirik people living at
Majuro and Ebeye. Those with thyroid nodules will be evaluated for surgery and if
needed referred to the U.S. for surgery. These control studies are needed to establish a better basis for the incidence of thyroid cancer in the Marshallese people.
Leukemia
In addition to hematological evaluation, careful exam of the lymphatic system
including liver and spleen will be done.
Lungs
An x-ray machine will be available for routine chest plates. Such x-rays will
be evaluated on all patients with abnormal findings on physical exam.
Breasts
Referral is possible for biopsy or possible surgery of any cases with suspic-
ious findings in the breast.
be done.
Honolulu is the nearest place where mammography can
.
Stomach and GI Tract
Rectal exam should be done on all subjects > 40 years of age with test of feces
on glove for occult blood ("Hematest').
Flat plates of the abdomen may be done.
Proctoscopic exam can be done if indicated.
Genitourinary
Pelvic exams on all mature females (greater than 14) with two Pap smears to be
fixed (Cell-Guard for later staining and reading).
If indicated biopsy of the
cervix and uterine washings will be performed as indicated.
Gram-stained smears
for GC may be done.
Serology for syphilis will be done on those not previously
tested and repeats on certain people with positive titers to determine if the dis-
ease is quiescent or progressive.
In older people (greater than about 30) previous
yaws infections may cause false positive syphilis reactions.
(lab-stix) and microscopic if indicated will be done.
IUSTabzZ
Urine exam, routine
(See Enclosure V).