| | . PRIVACY ACT MATERIAL REMOVED | Report e 401488 [eration During the period June 11-23, 1978 the Marshall Islands and Honolulu were visited in order to carry out thyroid surgery as part of the on-going thyroid study of unexposed Marshallese. On June 13 Drs. Brown Dobyns, surgeon and Dave Reid, pathologist from the Cleveland Metropolitan General Hospital and I went from Honolulu to Majuro for purposes of examinations of certain Marshallese for possible thyroid surgery. Dr. William Grant, Resident Physician from Kwigalein met us in Majuro. During the March-April survey we had selected a number of cases with either frank nodules of the thyroid or suspicious cases among the unexposed Rongelap and Utinik people including one case of an exposed Utifik man. One lady had been brought from Utinik Island and one man from Majuro for.this purpose. Of twelve people examined at Majuro surgery was indicated in four and on June 15 they were flown to Kwigalein with us. On June 15, 20 people living at Ebeye were examined. A . .. Of these thyroid surgery was indicated in 4. In a fifth older woman it was decided that the risk of surgery was too great because of her health status. On June 16 the group, including the Marshallese nurse (under our employee) flew to Honolulu. Earlier that day Dr. Hugh Pratt, who had arrived in Honolulu the previous day, had arranged for admission of the patients to Tripler Army Medical Center. On June 17 and 19 thyroid scans and general work up were done on all patients. Dr. Dobyns with assistance of surgical residents from Tripler carried out .thyroid surgery on 7 of the 8 patients. The 8th patient, an older woman, due to cardiac findings was not operated on. Dr. Reid read the frozen section of tissues removed at the time of surgery and advised Dr. Dobyns of his findings. Preliminary findings indicated that two of the patients had cancer of the gland, one with. cervical node metastasis requiring total thyroidectomy and extensive neck dissection. The one exposed man from Utirik had a benign adenoma. The patients when last seen on June 24 appeared to be recovering satisfactorily, though the last case requiring more extensive surgery needs fu-r4«+ follow-up before such a statement can be made. The following table lists the patients brought to Tripler with results: Name , ‘Age 50 50 50 30 _ Sex F F F M 35 .™M 27 M 50 66 F F Exposure status-Islands Results of Surgery Unexposed, Utirik _ Unexposed, Rongelap Unexposed, Utirik Benign adenoma, Lt. " " Rt. ; Cancer with cervical metastasis Exposed, Utirik Benign adenoma, Rt. Unexposed, Watje Unexposed, Rongelap Unexposed, Rongelap Unexposed Rongelap Small focus cancer,no metastasi§ " " " Lt. i. 4 Not operated, medical complica~ tions Further follow-up will undoubtedly be necessary at Tripler on the two cancer cases in the future. A letter of instructions was sent by Dr. Dobyns to Sne. Grant and Riklon regarding follow up care in the Islands. This will be particularly. important in the case of who may not develop parathyroid function due to the extensiveness ofher cancer and necessary surgery. While at Tripler the thyroid scans and tumor sections were also examined on > an unexposed Utirik man, who had thryoid surgery for cancer two years agowith pulmonary metastasis. Continued follow-up at Tripler will also be necessary in his case. PRIVACY ACT MATERIAL REMOVED WN 50 0850 15.965 = : y e ) rcO