195 for evaluation of anemia and leukopenia. The wiagnosis of refractory anemia with excess blasts was made and subsequentlyconfirmedin Honolulu at the Straub Clinic (“*mvetodvyspiastic s\marome with an evolving acute nonivmpho- cvuc ieukemia”). She died in 1986. Subject No. 928. The cause of death in 1987 of this 73-vear-old woman is unknown. When last seen by the BNL medical team in Majuro in March 1986. no serious medicalillnesses were noted. She had been moderately anemic for sev- eral vears (hemoglobin level between 10.5 and 11.5 g. di). and a flexible sigmoidoscopic examination in 1985 was normal. No gastrointestinal blood loss was documentedin recent years. Subject No. 950. This 40-vear-old womandied in Kwajalein hospital in August 1985. The death certificate diagnoses were essential hvpertension and intracerebral hemorrhage. She had been known to be hypertensive for 13 vears and was followed in the hypertension program ofthe Trust Territories. Subject No. 969. The clinical diagnosis in this 69-vear-old man was either metastic tumor to the lung or pulmonary tuberculosis. However, the 1987 death certificate diagnoses were “congestive heart failure” and “~pneumonia.” Sputum cultures for M. tuberculosis were negative and there was no clinical response to antitubercu- lous therapy. Subject No. 975. When splenomegaly and thrombocytopenia were detected in March 1984. this 65-vear-old man was referred for further evaiuation. A lymph node biopsy in October 1984 showed “atypical lymphoepithelicid cell proliferation of uncertain etiology,” possibly a lymphoma. He died in 1985 and details of the _ terminal illness could not be obtained. Subject No. 991. This 78-year-old womandied in January 1986. Death certificate diagnoses included “septicemia. diabetes mellitus. and chronic renal failure from diabetic nephropathv.” She had a mid-calf amputation of the right leg some six years earlier and was being followed at the Ebeye hospital. Her most recent BNL medical examination was in 1981. Subject No. 1050. Colon carcinoma with hepatic metastases is the death certificate diagnosis in March 1985 for this 50-year-old woman. 9008101 This diagnosis was madeafter she was referred to Majurofor evaluation of a possible abdominal mass detected in June of 1984. Laboratory Findings: A review of average blood cell counts of the different exposure groups during the three-year reporting period does not reveal any systematic differences among groups.Figure 2 is a continuation graph in which the exposed groups are portrayed in relation to the Comparison group. Table 1 gives the actual meancountsof formed blood elementsofthe different groups and identifies counts which differed significantly from those of the Comparison group. Biochemicaltest results are listed by individual identification number in Appendix B. Neoplasms: Thyroid nodules Surgery for palpable thyroid nodules was performed on five persons in 1985 and one person in 1986. No new lesions were detected in 1987. The specific diagnoses, determined by an expert panel of pathologists, are listed in Table 2, and Table 3 gives a summary ofall nodules diagnosed throughout the medical program. The benign thyroid nodules include adenomas. adenomatous nodules, and occult papillary carcinomas. The adenomatousnodulesare included in the tabulation even thoughit is highly debatable that they are true neoplasms. The occult papillary carcinomas are, with rare exceptions, “harmiess tumors” (Sampson. 1976). A recently reported autopsy series from the Federal Republic of Germany found occult papillary carcinomas in 6.2% of 1020 thyroid glands. Almost half of the tumors were multicentric and 14% had regional lymph node metastases (Lang et al., 1988). Since there was no predilection for age it was concluded, as in earlier studies, that occult papillary carcinomas have no propensity to cause clinically apparent thyroid disease. However, controversy continues on how the clinical diagnosis of occult papillary carcinomais to be made (Schneider et al.. 1980), and some authorities would accept that diagnosis onlyif the tumor were anincidentalfinding at surgery. Since some of the purported occult papillary carcinomas removed from the Marshallese patients presumably were palpable before surgery, there maybydiffering opinions on their clinical. if not histologic, classification.