,, *

DOHEH-0593

—-. . .,’ --..,. BNL-5254~- ““”l“

Formal Report_— -_ ..—. .—...- -—-—

FIVE YEAR REPORT ION THEIMEDKXL FCLUXV’ W OF

MARSHALLESE RECEIVING SPECIALIMEDICAL CARE RELATED TO

1954 BRAVO FALLOUT RADIATIONI@MWMFW 3992- 1996)

June 1999

U.S. Department of EnergyOffice of Environment, Safety and Health

Office of International Health Studies

DISCLAIMER

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United States Government. Neither the United States Government nor any agency.L---_x --- ---- -r .L-:- -—-1 -..--,.UIC1 CU1, llU1 dHy U1 UIC1l C1llplUy CC>, ~l& ~-1~ ‘w~ii~-l~y”, CApl CXiCd U1 lllLpllCU, CIi--------- -- ;-_l:,..-l.

assumes any legal liability or responsibility for the accuracy, completeness, or..,.,. c..l ----U> C1U111C33 of aiiy ‘-r-— -+:--U1lU1 llMLIU1l,

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represents that its use would not infringe privately owned rights. Reference herein.- ---- ----- .- --- —-- ,.:-1LU dUy >pCL; ~lb tAM.UICIQ1dI ~i~&~~, ~io~~~~, ~i ~~rvi~e by ii~dC Uct UIC, U cIUCLILCI1 K,

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manufacturer, or otherwise does not necessarily constitute or imply its endorsement,.-,.,. --.-A .+:,... A. C,-..,;..;..m k., *LO1T..;*-A c+., -. 17,1., ------ n. .,.,, .mo..,..,1 U~U1lllllU1lU,~ LIU1l U1 lavui 1115 Uy UIC U1il LGU L7La LL3 VUV LILU1lLLIL U1 clliJ a~L1lLwV

thereof. The views and opinions of authors expressed herein do not necessarily state-. vafla,-+~1.mo--f ihrmI Tm;t,d C+. +,ac P.n.,a--c.n, n. . . . . .-o-,.,, ,ha.a.-. fUL 1 LILLLL UL,UD& U. U.b ULLILLU tiLLILL.1 ~“ V L’,U,,L,’L “L W,J Cl&jt,, &~ ULL’ ~“, .

This report has been reproduced directly from the best available copy.

Available to’DOE and DOE Contractors from the Office of Scientific and TechnicalTnfnm.tinn P f) Rn. 67 C)ak Rirlue TN 17$M1 . nriwc available frnm (47’3) ‘576-. . . . . . . . . . . . . . . . . . -. --,. --, -—. -.. -~-, -------- , =-------- --------- -----, --- /----

8401.

Available to the public from the U.S. Department of Commerce, TechnologyArlminictratinn ~~~~~~~] ~wb~~ca] !~fo-w-a[~Q~ %w~ce, ~p~hlgfi~!d, VA ~~ ! 6 !. ---------- . . . . . . .

(703) 487-4650.

Also available (with the exception of Appendix B) through the DOE Office of international Healthl%nor~mc’ w~~~~!e ~! httn. //tic Ph Line m-w/ihn.. .v ~....-..” ----~ . . ..-- .-... __-. D_. ._-r.

. IBNL-52548

DOHEH-0593

FIVE YEAR REPORT ON THEMEDICAL FOLLOW UP OF

MARSHALLESE RECEIVING SPECIALMEDICAL CARE RELATED TO

1954 BRAVO FALLOUT RADIATION(JANUARY 1992- 1996)

By

Ashok N. Vaswani, M.D.And

Jean E. Howard, M.D.

Brookhaven National LaboratoryMedical Department

Upton, New York 11973

June 1999

Prepared forU.S. Department of Energy

Assistant Secretary for Environment Safety and HealthOffice of Health

FOREWORD

AS part of the United States atmospheric nuclear weapons testing program between 1946 and 1958, 23 nuclear deviceswere detonated at the Bikini Atoll and 43 nuclear devices were detonated at the Enewetak Atoll. A 1954 United Statesthermonuclear weapons te~ code named “Bravo” was conducted at the Bikini Atoll and produced a nuclear yield muchhigher than expected. As a result the levels and dispersion of the radioactive fallout from Bravo were significantlygreater than originally expectedj resulting in radioactive fallout on the inhabited atolls of Rongelap and Utrik. ‘IkeRongelap and Utrik inhabitants were evacuated fkom their contaminated atolls, within 48 and 72 hours, respectively,after the Bravo test. l’he original population directIy exposed to the fallout from Bravo consisted of 241 individuals and12 fetuses. Adsoxbed dose estimates for the exposed population were on the order of 0.11 to 1.9 Gray(11 to 190 Rad)to the whole body and from 1.9 to 200 Gray (190 to 20,000 Rad) to the thyroid.

Public Law 99-239 man&ted that the United States would” . . continue to provide special medical care and logisticalsupport thereto for the remaking 17’4members of the population of Rongelap and Utrik who were exposed to radiationresulting fkom the 1954 United States thermonuclear Bravo test...”. The Department of Energy (DOE) implementedthis Congressional mandate, for the period of this repon through a contract with the Brookbaven National Laboratory.

The propose of the MarahaUIslands Medical Ihogram is to provide medical care and treatment to the Congressionally-mandated groups of Rongelap and IJtrik who were exposed to fallout firm the 1954 Bravo test. As of December 1998,the original Congressionally-mandated population consisted of 130 individuals.

The program offers, on a vohmtary basis, an annual physical examination to these individuals, as well as annual physicalexaminations to volunteer comparison individuals. Medical surveillance includes a complete annual physicalexamination (based on American Cancer Society criteria) by a variety of specialists including gastroenterologists,hematologists, obstetriciandgynecologista, endocrinologists, oncologists, mdiologists, cardiologists, nephrologists,puhnonologists, and rheumatologists.

This, the 1P report of the Marshall Islands ProgrrtrtLprovides information concerning the medical status of the 253Marshallese exposed to the fdout iiorn the 1954 Bravo test.

DirectorOffice of International

Health Prognum

DEDICATION AND APPRECIATION

This report is dedicated to all of the patients who have participated for the past 44 years in the medical program.We wish to thank them for their voluntary participation in one of the longest running patient care programs in the historyof medical practice, and sincerely appreciate their commitment. We wish them continued success in reaching theirfuture health objectives.

The Marshall Islands Medical Program is deeply indebted to the many outstanding physicians who, despite theinevitable personal inconvenience, participated in the medical team visits of 1992-1996. It is fair to say that they werethe heart of the program.

.

CONTENTS

Page

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PatientGroups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The MarshaII Islands MedicalPragram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ProgramMandate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ProgramAdministration andPhysician Volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ProgramPolicies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .InterimCare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Co@titiommdMuutiomdActitities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ProgramGversight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ProgramOperations andprocedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................

ClinicalFollowUpforthe 5YearPeriod . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PatientParticipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ExaminationsandLaboratoryTesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Specific Medical Conditions- ~yroidNodties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .HistologicDefinitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

1

111223334

55568

Sigrnoidoscopies andGIWodcup.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Referrals to the TertiaryMedicalCare Centerandto theRMIGovemment . . . . . . . . . . . . . . . . . . . . . . . . . . 11PatientDeathsDuring 1992-1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Epilogue . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

AppendixA-ListofParticipatingPhysicians andTechnicalStaH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

AppendixB- ReaultsofCBCsan.d LaboratoryChemis@iesUsingPatient IDNumhers . . . . . . . . . . . . . . . . . . . B-1

5-Year Report

,

INTRODUCTION

This is the 17tb and fml report of the MarshallIslands Medical Program as carried out by theBrookhaven National Labomkwy (BNL). Thepurpose of these publications has been to provideinformation on the medical status of 253 Marshalleseexposed to radiation fallout m 1954. The medicalprogram fidfills a commitment to disclose uniquemedical information relevant to public health.Details of the Bravo thermonuclear accident thatcaused the exposure have been published. A 1955article in the ~~.Asmahcm, which described the acute medicaleffects on the population that required specialmedical care, remains a definitive and relevantdescription of events (Cronkite et al., 1955).

Marshallese participation m this Congressionallyman&ted program is voluntary. Throughout the 44years of the pro- each participating individual’srelevant medical findings, laboratory &ta, diseasemorbidity, and mortality have been published m theBNL reports in a manner preserving patientconfklentislity. In each repo~ there has been anattempt to interpret these findings and to infer therole of radiation exposure in their development. Anequally important aspect of the reports has been thepresentation of data that allows for analyses of themedical consequences of the Marshallese exposure.

PATIENT GROUPS

The MarahaUese population mandated (themandated group) under the bnpact of FreeAssociation Act (’P.L.99-239), originally comprised64 persons on Rongelap Atoll who had received anestimated 190 rad (190 cGy) of whole-body externalgamma radiatkq 18 on Ailinginae Atoll (Sifo Island)who received 110 md (110 cGy), and 159 on UtrikAtoll who received 11rad(11 cGy). For the purposeof this reporg the Rongelap and Ailinginae patientsare treated as one and refeued to as the Rongelapgroup because the persons on Ailinginae wereRongelap inhabitants tempoxari.ly residing on thisnearby atoll. The dii%ences in the dose due toexposure to radioiodines wcze dependent on therelative distance of the atolls andl islands fkom theBravo test site. At the time of the acciden~ therewere 12 pregnant women (3 on Rongelap, 1 onAilinginae, and 8 on Utrik), each of whom receivedwhok-body doses equivalent to doses received by theother inhabitants of their rqective atolls. Thetwelve individuals who were exposed m utexo werealso considered part of the maudated group after

birth. Due to the presence of radioiodines in thefallout the thyroid gland received an exposure that wasmuch greater than the whole-body dose; the dose dueto radioiodine exposure was a fimction of theindividual’s age at the time of exposure (Lessard et al.,1985).

In I957, a group of 86 volunteer comparisonindividuals from Rongelap were selected to match themandated group by gender and age (Conard et al.,1958). A second volunteer comparison group wassubsequently initiated and matched by age and genderto the mandated group. The second comparison groupwas statistically similar to the Rongelap and Utrikgroups. Both these groups are listed in this report asthe comparison group. As m previous repom, it is theexpanded volunteer non-man&ted group which is usedfor comparisons of year-to-year medical events andcauses of death. The survival rates of the mandatedand volunteer unmandated groups are also compared.

THE MARSHALL ISLANDSMEDICAL PROGIWM

Program mandatw

The man&te of the pro-as required by the U.S.Congress in 1980 (PL 96-205, Sec. 106 (a)), specified“...a program of medical care and treatment ....for anyinjury, illness, or condition which may be the resultdirectly or indirectly of such nuclear weapons testingprogram.” Subsequently, m 1985, the Can@ of FreeAssociation between the U.S. and the Republic of theMarshall Islands (RMI) allowed the Marsl@ese tomanage their own radiation injury compensation.However, in response to a request fkom the RMX, asubsidiary agreement permitted the BNL medicalpro- to continw supplemental local health care forthe man&ted persons. s@.ficdy, P.L. 99-239states: “..the President....shall continue to providespecial medical care and logistical support thereto forthe remaining 174 members of the population ofRongelap and Utdc who were exposed to radiationresulting fiorn the 1954 United States thermonuclear&SVO t@ pursuant to Public Laws 95-134 and 96205.”

Program administration and physicianvolunteers:

The MarshallIslands Medical Program and itsmedical mkaions to the Marahd Islands were based atBNL since the inception of the program. Theprogram’s staff included a physician-director, an. .adnmmtmtor, a BNL medical associate, and aMamhallese laboratory technician on Ebeye. The

1

medical missions were usually conducted in thespring and fall of each yeaq a variety of physicianswere recruited to be part of the medical team. Theywere skilled volunteers, primarily selected horn thestaff of uoiversity-affiliated or gowmrnent hospitals,and often had past experience with the program. Atthe time of the initial medical examinatim Dr. JacobRobbins, (Chief of the Endocrinology Sectio~Genetics and Biochemistry Elranck NationalInstitutes of Heal@ Bethes@ MD.) providedguidance and management of the program’s thyroiddisease aspects.

Currently, Bechtel Neva& (under DOE contract)provides logistical support to the medical prograruPreviously, this support had been conducted byRaytheon Services Nevada until 1995. LogisticalSUppOrt illVOhWS d transpoll, housing, andaccommodation arrangements fix the staH andpatients traveling between Honolul% Hawaii and theentire Mar&all Islands. Additionally, BechtelNevada was involved m converting the programfrom a vessel-based to a land-based prograqworking closely with the U.S. Army Kwajalein Atollpersonnel and executing the necessary structuralchanges to the medical trailers (adjacent to KwajaleinHospital) which currently houses the medicalprogram. The proximity to Kwajalein Hospital haseliminated the need for duplicate wrvices that werenecessary fm the vessel-based program. Since 1996,all radiologic services have been performed by theKwajalern personnel; most of the routine hematologyis now completed in the Kwajalein Hospitallaboratory. On request the Mar&all Islandsgovernment provides nurses, translators, and otherhealth care workers. Bechtel Nevada offices onMajuro and Kwajalein oversee local sti.

Program policies:

The MarshaU Islands Medical Program wascreated for the benefit of the mandated Marshallesepatients. It was a program of radiation-relateddisease surveillance consisting of periodicexamination and treatment of disease. Periodically,clinical investigations had been carried out by theprogrsuq the intent of these investigations was toident@ present or fhture threats to the health of theman&ted Mamhallese patients, hopefidly in time toprevent or limit morbidity and mortality. Based onthe medical program’s early findings of numerousthyroid nodules in the mandated group, thyroidhormone suppression was initiated for the Rongelapgroup in 1965 in an attempt to prevent thyroidnodules/carcrnoma. It is possible that this

prophylaxis has met with some success. As discussedin detail later in this paper, thyroid ultrasoundexaminations were initiated in 1994 as a means ofdetecting early changes in the evolution of thyroidnodules.

The Marshall Islands Medical Program providedmedical care to the mandated group by visiting theislands where most subjects resided: namely, Majuro,Ebeye, Mejatto and Utrik. In addition, the medicalteam provided health care monitoring and surveillancefor all comparison group patients.

Any individual of the special medical care groupwhose medical findings suggested a malignantneoplasm or other ndiation-related disease wasreferred to secondary or tertiary medical facilities fordefinitive evaluation and therapy. Those persons withproblems that could be effectively managed on Majurowere referred to the Marshallese Health Services.Those requiring a more extensive evaluation werereferred to hospitals in Honolulu. Individuals needingrefemd for non-radiation related problems were sent tothe Marshallese Health Service on their island ofresidence, where treatment was initiated.

Interim care:

Dining the paid between the two medical missionsconducted by the Marshall Islands Medical PrograrQthe continuity of health care for the man&ted and

~n grOUPSw= c=i~ out by fie M_eseGov ernment Health Services, which is a national healthcare program involving two hospitals on the mostpopulated islands, Majuro and Ebeye. A network ofclinics scattered over some 20 atolls also assisted inhealth care. This network of health care providers,which included physicians and public health careworkers, seNed the entire population of the MarshallIslands, which numbers over 64,000 people. Interimcare was also provided by the physicians and healthworkers belonging to the 177 Health Care Rogram.‘llw 177 Health Care ProgranL operated by the Sistersof Mercy, is currently responsl%lefm the health care ofan estimated 12,600 people. Based on Majuro Atolljthe 177 Health Care Rogram provides primary healthcare to the four atoll communities of EnewetakRongelap, Bikini and Utrik.

At the end of each medical Sessiou with thepermimion of the exminem, copies of all examinationand laboratory &ta were &livered to the MarshallIslands Health Service hospitals on Majuro and Ebeyeand to the physicians of the 177 Health Care Program.In additiorL copies of physical examinations andIaboratmy test results completed at Kwajalern wereprovided to the patients themselv~ thus ficilitdng theexchange of thorough medical information.

2

Consummationsand educational activities:

While providing medical surveillance to themandated and comparison groups, the medicalprogram physicians came into contact with familymembers of the mandatd! and other islandinhaiiirams. it was the policy of me Department ofEnergy to support the medical program in its efforts. . —--.:> - -- —.-.1.- L--—- -—4 IL ;.- 2 L--— —. .-LU PIUVIUC CUILSLUULUUIb ~U L.ULLLLCUKCdLLIICIIL LU

these individuals on the basis of humanitarian need“*A PA--S1++A-. m,-.-u as rescx&”cespermmtted. ““- w Uku”u . -.*initially provided by the program staff as they visitediclam+c t-hwino th~ rnntw= nfthe tin miccinnc-—- --—~ -. “.-.. . . —. . . . . _“.._. w.~g

the program became land-based at Kwajalein,consultative services were provided aimost

exclusively for the residents of Ebeye and theMarshallese employees working at the U.S. ArmyKwajalern Atoll base on Kwajalein. The medicalprogram also provided in-house consultations bysending specialists to the Ebeye hospital toaccompany local Ebeye physicians on rounds.During each missio~ lectures given by teamphysicians contributed to the) continuing medicaleducation of the Kwajaiein and Ebeye hospital staHand physicians.

Program oversight

The Marshall Islan& Medical pro- as a“..+-11:.- ..1:-:,. .4- A. m;..:.,.l n -.-..L P—*—===UK ~U~ V1 Ul= b~b~ fi=~bLl QGUtGL ,

Brookbaven National Laboratmy, was accredited bytha 1A;+Pn—hcinn n. A .4;titin. nf U.alihea... . . . . . —— ●“AA . . . . . ..--... “. . . . . w- “

Organimtion$ a nationwide organization setting andma~t~n~g perfmmance Wandarcls f& inciituti~==

dispensing medical care. By voluntarily @c@t@in the accreditation process, the Marshall IslandsMedical Program received a valuable and impartialexternal review of its policies and prowdures, as wellasan aasessment of the provided services.Laboratory and radiological services, medicalrecords, patient satistkctiom pharmaceuticrd serviees,and clinical competence of physicians were amongthe many items reviewed by the Jornt Commission.Guidelines and questionnaires were developed togenerate the information necessary for comp-ticewith the Joint Commission’s rr‘~ts.

Program operations and procedures:

Sinccthemandated group needed to beconaidered.+ <a—-e-~ WeL ~rw-al:nnm+ A;em... (-e m la+--b LLLwA— * - .“. —&-u. --w ~. . . .

complication of radiation exposure), the medicalnrnumm im-lld s emnr-arirntul mntnal healthy- .~.—— ——-. - —--- . ...— - —= .-——evaluation. lhe examinsb .Ons followed the

guidelines of the Amtican Cancer Society andincluded a medical histo~, complete physicalexamination annual pelvic examinations andPapanicolaou smears (TAP smears) on womem annualmammogmphy (offered to ail women forty years of ageor older), annual prostate specific antigen (PSA) testson ail maies, bbod coung urinalysis, stooi testing foroccult bloo~ and flexible sigmoidoscopy (every three..-- —r-- ——-—- cm.-.--—- -r --- -- -* -l-_ \ A J. :--ycxtrs lUI pmsurm lllly ycsm U1 dgc Ur UIUCI .) AUvlcc

on self-detection of lesions and on decreasing the riskf. .+m- C*. ,’.. -,--- =,.. -V-. AA A ~,t.-b. ”.= .“, -... . w pv . SUbu RAW, *.A

p Uu.u

informational materials and discussions with the publiche~th _mmm*l wh~ were wwt nf the mediral team~-...—.- r-- - -- -. —---- .-_.

The public health persomel also developediIlfOITLMtiOllai mttiiS k tie lQCa! i~=m~edocumenting the prevention of common communicablediseases, such as tuberculosis and acquired immunedeficiency syn&ome, and non-radiogenic diseases,such as diabetes and hypertension. Ophthalmologicexaminations were provided by the Marshall IslandsHealth Services since ophthalmologists had notaccompanied the medical team in the past four years.As mandated individuals were also considered atincreased risk for certarn endocrine problems, theyreceived annual thyroid function blood tests andthyroid examina tions by a specialist in endotioiogyor thyroid surgery. Since 1994, when the thyroid--,.uurasound program was initiate~ ultrasound-guidedfine needle aspirations (FM%) had been included as--- - C&L--.-. -.11----- --A -.— -A—-2 .- -. L—&..pill L UL LUG MU VCUMMA, 4UU WCIG ~MMllCU ULI~aUCUQ

with palpable nodules, or nodules greater than 10 mm;* A;.-A.. A-“,,.11., A.I,n-ardnh,,l;fiAa+—;mr+ianeu —“w.. ——J 9 -J ..6*..— .“.A—.”-were made on all subjects as clinical fhctors wammte~w]ch ac a histnru Qf thvrnid rzmwwr or nrmt thvrnirl---- — - —--J —, ---- -—--. , -. ~--- —, ----

lesion surgery. Other serologic tests were performedon a re-gularbasis in an attempt at early detection ofmalignant nonthyroidal lesions. These rncluded serumprotein electrophoresis, ealci~ prolact@ and alpha-fetoprotein levels on persons known to have pos;tiveHepatitis B surface antigens. There was also ongoingimmune competency monitming, srnce the mandatedpersons may have been at increased risk of acquiringinfectious diseases.

While the program was vessel-base~ speeialprocedures (such as thyroid ultrasound andsigmoidoseopy or colonoscopy) were performed in twot. –...-, ––. —.- S–S,--L–S .- AL–..nospna.I rooms aearcmea to UICSCpurposes. SOiticpatierm were examined at dispensaries on Mejatto andTTAL .-A h--- .4.:- ..,— .—..A s.. &- .1A-1.,WU4 - ASUUAG VUAW W GAG OAACkkA&U AUA UK. WLUGAIJ

and infirm who prefemed not to be transported to theChrn ~r fl~~= to Kumj+in f~~ ~~ ~~mp!ett-7 . . ..- -e-

xamination.Clinical ~mtory ~ml~c~ for & miaaiona wm—- .-—

performed by several BNL technicians with support

3

from personnel of the Kwajalein Hospital and HealthServices of the RML Routine hematology testingwas performed on a J.T. Baker 5000 electroniccounter an~ begitming in the fall of 1989, on aSerono Baker 9000 RX automatic 8-parameter cellcounter. Leukocyte differentials and platelet countswere part of each evaluation. Cliical chmistry testswere performed on Easman Kodak EktaChem DT60,DTSC or DTE analyzers. These am@zers provideda wide variety of basic chernishy tests with a damount of disposable waste. Urinalysis rncluded adipstick examination Sn& when indicate~microscopic analysis. Stool exams were performedat physicians’ request for identification of parasitesand occult blood.

Roentgenographic services on board the vesse~Offshore Venture, were provided using a dedicatedmammogmphy unit (beginning m 1995,mammography was performed at the U.S. AmyHospital on Kwajalein Island) and a standard x-rayunit manufaclued by the Bennett CorporatioIL LongIsland NY. X-ray interpretation was done at thetime of examination. However, iiino radiologist waspart of the medicai t- the x-ray fiims werereturned to BNL and then referred to a consultantradioio~ Dr. Harokl Atkins at the State Universityof New York Stony Brook. Gnce the program was1.—3t----l —-:-——t:- ----- -—s —-——-——-lanu-cwsc~ raa.lugrapnl~ lcsls aau m=J=Jmwere performed using the GE units located atV=,.%IA.. U.-:*1 ~ .ia,}*=_ W C4JCUWU

-,, A:,.1...+.+Amqn LaA. AauAww&a L

physician always accompanied the medical tearq~l%+mstimuthe n-cl fn~ YSZVC in he crnt tn the TT S—e —. . . . . . . . . . -.

for review.J- -- ------- -. ----

A portable battery powered electrocardiomanh~ .=—machine was available. Electmcad .Ograminterpretation was done at the tikne of examinati~with a copy often given to the patient. Allelectrocardiograms were subsequently returned toBNL and then referred to a consultant cardiologist(Dr. M. Zerna) at Brookhaven Memorial Hospital onLong Island NY, for definitive ~analysis.

A General Electric thyroid ultrasound machinewas purchased for the detection of thyroid noduiesand used fm uhrasound-guided fine needle aspiration

e .,01 rnyroid noduies suspected of malignancy. Asecond uhasound machine (a Hewlett-Packard Sonos1nnl --- -.-:1.%1- c.- -.-.-—* ,4 -A. .1:----1 WV) Waa av-uAG Au& WG-GUL VA Dubu WV WL>G

items or fkctors as abdornimd paiq hematuriqoakn-=1 -n- -wA twrrlizar rli~e It wsac Imd mily~-—.— .~., -. —— —. . . . . . --- ..-

under the guidance of a radiologist or subspeciahtnhvsicimn with m ultrasound examinationr—, ---— ..-— expelme — _______

Sera collected during the routine physicalexaminations were analyzed at the time of patientexamination as clinically indicated. The remainder

were frozen for further testing upon return to BNL.The latter tests were performed at commerciallaboratories. One of these referral laboratories,Labcorp, of Garden City, New York carried out allroutine and special chemistries involving thyroidhormone analysis. Labcorp also was responsible forthe PAP smears. All other cytology and pathology wassent to the Pathology Departmen$ State University ofNew York at Stony Brook for analysis of thyroidbiopsy specimens aud special cytology for GI or GYNbiopsy specimens.

The samples analyzed by the BNL M were subjectto a laboratory environment with quality control and

*W assumuce and rnvolved routine calibratio~maintenance, and monitoring of all ins-entation.Daily tri-level analysis of reference materials wasperformed on the hematology analyzer. The chemistryanalyzer was calibrated prior to each missioq and bi-level quality control samples were run on all analyses.Pursuant to the enactment of the Clinical LaboratoryImprovement Analysis L.egislatio~ the programsubscribed to Wisconsin State Hygiene Laboratoryproficiency testing. When necessary, laboratoryinslrarnentation was inspected and repaired bycompany service representatives. Otherinstrumentatio~ such as sphygmomanorneters,electrocardiograph machines, and doppler units, was—.—.–3,..*,–--., -- -.. ,penomcauy camnmea and bad routine preventativemaintenance performed between missions at BNL.

A AA:&.._..l -...l:&. ---.—--- —_&L_A_ :__l.. J..A AL..AUULUUW1 qlMUILy -U3 GIJbG U.ELUUUS IIlblUUCU LUG

use of patient questionnaire s. These questionnaires -tmncls+mA ;n+n Mmchalbca . cnlir+a~ eritbkm mvl..--... . . . . ..-—. - “.....- . . ..”— -.

advice for improving the medical program’s operation.One important m.aliti assurance mcchankn was the~———-, —- ——-.mission’s use of volunteer physicians fkorn across theUnited States. Tle on-site advice, commentary, andcriticism of these physicians helped to maintain thehigh standards of patient care. Additionally, allphysicians participated in on-site peer review. Finally,the results of these and other mechanisms of qualityaasumnee were reviewed by the BNL Clinical ResearchCenter Quality Assurance and Care Cmnmittee. Alsoinciucied in that review was the appropriateness ofusing anti-infective agents; a certified medical recordsconsultant randomiy reviewed approximately 20percent of the records for accuracy and completeness.

Stare

The volunteer medical staff was drawn fromcxcdient medical centers and private nracticesr–—-.––throughout the United States. During the past few~ each mission was successfully manned by a coreof physicians (mm@ing the medical director @Xemal

4

.

medicine), an endocrinologist another rnternist orfamily practitioner, a gynecologist and a radiologist.These physicians provided the program with a widerange of up-to-date clinical experience andperspective that contributed to better patient care.Appendix A lists the physicians by their respectivespecialties, as well as medical team personnelinvolved in the 1992-1996 missions.

CLINICAL FOLLOW-UP FOR THE5 YEAR PERIOD

Patient participation:

As previously indicate~ patient participation m theMarshall Islands Medical Rograrn was entirelyvoluntary. Prior to the anival of the medical team inthe Marshall Islands, local newspapers and radiostations announced the imminent rmival of themedical groups and the Iocatialn of the proposedexamination sites. These announcements permittedthe patients to make appropriate arrangements fortheir visits. For the first four years of this repmtingperiod - when the program was vessel-based - theboat docked in Majuro pofi where patients werescheduled for their medical evaluations. At the endof approximately one week the Offshore Venturedeparted for Kwajalein. The vesse~ with on-boardmedical facilities, docked at Ebeye, where themedical Staff evaluated the mandatedand~groups residing on Ebeye. The boat also made atwo-week trip to the outer islands of Utrik andMejatto. The total duration of the mission wasapproximately 4-5 weeks.

1999-199~

At the beginning of the 19$V2repmting perio~there were an estimated 154 patients in the mandatedgroups and 113 patients m the volunteer groups.These patients were given the opportunity to returnon an annual basis; the actual percentage of mandatedand comparison patients who awailed themselves ofthese savicea is listed in Table 1. Patient acceptanceof the tnnsf-cc of care from vessel-baaed to land-baaed was enthusiastic, as patients were affordedmom flexibility m scheduling appointments. Duringvessel-based examinations, a patient who had to beseen in Majuro only had a total of seven days toschedule aviait %ncetheland-baaedprogramlasted

~@lY fo~ - Patien~ ~ -= - ~schedule visits and were more likely to complete aphysical examination for that year. Ovti theacceptance of the land-baaed program by all of the

patients was extremely positive. They were able toreceive reports of theix most recent blood tests done onKwajalein. At the end of each missio~ copies of thesereports were also sent to the respective prirnmy care .

physicians on Ebeye, Majuro or the outer islands.Patients who reside outside of the Marshall Islands

are not necessarily represented in the patient groupexamined during the five-year period. These patientsare predominantly located on the islands of Hawaii;some have migrated to mainland USA. All patientswere notified about pending missions; however, theymay or may not have availed themselves of theseservices. Appropriate arrangements had been made forthese non-resident patients residing in Hawaii toreceive care at a tertiary center in Honolulu orelsewhere.

As previously note~ srnce 1996 the program hasbeen land-based and located at Kwajalein Hospital.Two trailers, refurbished for the purpose of themedical progranL included a male examining room afemale examinin g roorq a gynecological examining~ ~ end~ology ~ ~bOmtOIy and @iUIIEICyfacilities, a waiting area for the patien@ and a room foradminMrative proposes. Two special procedure roomswere leased from the hospital - one for performingsigmoidoscopy/colonoscopy procedures and one for athyroid ultrasound unit.

In additiorLthe hospital laboratory and biologicalservices wese made available fm CBC, chemistries andurinalysis and other routine tests. l%e hospitaltechnician who performed IMUUIIOP and X-m)%was also available to schedule these tests. Thyroidultrasound was done by a specially trained technicianwho had been subcontracted for each of the medicalmissions for the past five years.

Examinations and laboratory testing

Generally, in keeping with the presemation ofcultural sensitivities and individual wishes, malepatients were examined by a male physician and femalepatients by a fernale physician. Blood was drawn forroutine and special chemistries, and other tests deemednecessary were conducted at the hospitaL The land-based program allowed for greater ease m obtainingtests and prevented duplication of the laboratory

-em or ~o~el.It should be noted that once the mission was land-

based at Kwajale@ the routine and screening

~m~ inmeased dramatically, due tothe availability of an approved mammography site.

5

TABLE 1. Total number of patients seen each year between 1992 and 1996.

=’ : : ‘: : :*This includes patients from Rongelap and Utrik combined at the beginning of fiscal year 1992.

Additionally, a radiologist began accompanying eachmissio% so that an immediate mammogram readingwas available, greatly facilitating f-e patient care,as mammograms were accepted by virhudly all of thewomen. Additionally, a gastroenterologistaccompanied the missions on a.regular basis for thepm purpose of performing routine flexiilesigmoidoscopies; this physician was available forconsultations, and after 1995, peffOHIld

colonoscopies and upper endoscopies at U.S. ArmyHospital on Kwajalern Mar@ thereby decreasing theneed to refer patients ofi-isiid to Honoiuiu.

The total number of special procedures and

~%r—Wfi~ ‘~~ e~mpie’~ f~r *e ~~’~~duration of the Five-Year Report are listed in Table9A.

~n-ifir mdiesl emditinnc . *h-id nnd-tlewr--—- —--— . . . . . .._ .-J . ..= -.-=—.

DUIiIM the @llSitiOll between VeSSCi-bSSed~d~ —.land-based operaliq one of the major emphases forthe MarahaUIalands MedicalProgramwas toimdtutethe detection of thyroid nodules by use of theultrasound teChIliqUC. The initial ultrasound-..-:——. --- -—1——6A L.. - 9 < —---l.—G~Ul~LLLGIIL W O Ml~jJN=UJGILLSU Uy = I J UK~-G1 =

uhasmndmachine from General Elecixic, which wasused predo minantiy for the detection of thyroidnodules. At the end of the previous five-year report(which ended in 1991), there WCreSeVCd qlleStiOIISieft unanswered regarding the thyroid nodules:

- will the entire mandated and vohmteeranparistm gro-ups -— T.:—-s -.-_—A% I_ .- -—.rclndulcu wLaLqnWAc w Ilcw

nodule formation?-A.* :. A- -1- ..C. ..-A- k, A- A..*-l---+ .$- W -L S UJG lUIG WA ~WUGl 111 WG ULZ v GSU~UAWAL WA

thyroid nodules?—-ha+ M th- -l= nfmAb6nn Ancao_ mirl SO* m— “-. -“ -“ A“*UU “. .—— — 6- — -e- -

relation to the detection of nodules?- -S the ndmle f~ tinn rndud. a~ ~ fimctinn..— — --—- --—— —

of exposure to previous radiation?-didtbemdiation increase the incidence of occult

Carcinoma?Most of these questions were addressed m the

previously-cited Qonkite paper. A summary of someof the important tables fkom that paper follows.

During the spring and fall 1994 surveys, thyroiduhrasounds were done on a total of 164 patients: 117from the rnan&ted group, and 47 from the volunteercomparison groups (T’able 3). Tle total incidence ofthyroid nodules detected in all of these groups was25.0%. A totalof117 of these subjects (non-surgicalpatients) had not undergone any surgical procedures.Of these, 28.2% had developed thyroid nodulesdetectable by ultrasound.

The percentage of patients who had nodules greaterthanlOrnm. rndiameter(the criteria foreitheran FNAor surgical expiorationj was i ().470 for the totalpopulation of 164 patients, and 12.8% when the 117--- -.-d--l --d—e —.— -1. — :--- _---:2_— J--lwLL-wu&lL.ilL JJiaucllls WCIG LaNsJl luw Guumuclauull.

The number of patients who had nodules greater thanIn~v = ~ A:end- AA-+-A k,, ,.hefimw,-l A,,&- +k-UWb.. UWWUbW UJW. WUUUUUULWe US.1994 survey is depicted in Table 4.

All nf th-e fiwlinuc hav~ k nmhliehd in n recrnt. - -. —-- —— 0“ — .- --— =——--- -- ------publkatioq Z@.@dlXwareAmong the Rongelap and

U.. Porpdation -An uDUkre (Howar~ etai,j 1997)._r ______

The initial thyroid ultrasound done m 1994 seined astie basis for the majority of patients who came forannual visits.

In 1995 and 1996, an additional 230 ultrasoundwere done on all patients ikorn Rongelap, U- and the~ group. These are reported in Tables 5 and6.

During the 1995 and 1996 medical missions, a totalof 240 ultrasound were done on 113 patients. Of the50 patients fbrn the mandated group fkom Rongelap

..--.+-rested m i995 ana 1W6, u subjecis (or 44 percent)had detectable thyroid nodules on uhrasound. Of the.fie —–A,.—A–e.—- A,-. .-–—s.. - s –—.-. e– -- *,L.s–

1 UJ palltma Irom Tnc Inanoawu group rrom Umlc

testing in 1995 and 1996,50 subjects (or 47 percent)L..A A--L1- *L.—:A -- A..1-- -- ..lL--.-A\Imu UGLCVLUUIG Iuyiulu lluuuwa Uu Luuasuuuu).

These numbers were similar between the two--- 1. arlfinn A1 ..L;- t.. AAw-v. —-+\ ACA.- —.”* 7 &a*”J-Q ,“. - p...-.., “. -canpariaon group also had nodules. Therefore, there~~~ =QgSnn-sr tn b Zlnv d&ff~_~~ ~ d&t@@_~!~-==— - -- —,nodades~themandatd - d b volunteermmmison .mup. Of the subjects seen between 1995–= –––and 1996, a total of 62 percent of the women were onthyroid supprewion therapy. A total of 51 percent of

TABLE 2. Number of procedures done each year between 1992-1996.

I X$94 m95 1996

x-rays 40 47 173 118 90

Mammogmms 20 24 39 47 64

GI procedures -- 23 30 44 35

TABLE 3. Percentage of subjects in each patient group with thyroid nodules during the 1994 survey.

1=Rongelap

Utrik

Comparison

AI. Non !h@icaliRtlk?nta Patients

-

Total Patients with Percent Total Patients with PercentPatients nodules* Patients nodules*

47 6 28.7 23 5 19.7

70 23 42.7 55 17 47.0

47 12 28.6 39 11 33.3,..-

“.“i&”’-”: -. ,42-: ‘“.“~:“., .:2%0. . 117 .: 33 28.2-

*Nodules detected only by ultrasound.

TABLE 4. Number of patients who had nodules greater than 10 nnn in diameter, detected byultraaour@ during the 1994 survey.

I Rongdap I 3 I 2 IIUtrik I 9 I 8 IICotlmariaon I 5 I 5 I

7

TABLE 5. Total number of Subjects With thyroid nodules detected on ultrasound m1995-1996.

, d

I IIM.arldated

1Mxnd@ed

IComparison I

=Group

Rongelap Rongelap

b“ y “- ‘2; 20

% 9, 24 , 21} TOTAL. 22 50 41

TABLE 6. Total Number of ultrasounds performed on 113 patients which showed detectable nodules.

1995 1996

Females Females “

Number 44 54 85 57

<10 mm 34 39 60 43

>l”mm 19 23 28 21

<10 & >I”rnm 9 8 13 7

Mean #of nodules 1.68 1.44 1.59 1.47

the men were on thyroid suppression therapy. Thethyroid stimulating hormone (TSH) levels in all ofthese patients between 1995 and 1996 were witbittnormal limits. The availability of the ultrasoundequipment also permitted FNA of the thyroid at themedieal hospital base in Kwajalein. Table 7 lists allpatients with nondiagnostic or auspicious FNAs thatwere refhed fa surveys. Initial SuccessWith thyroidFNAswas minimal while the program was stillvessel-based on the Offshore Venture. Since theprogram was installed in the trailers on the KwajaleinHospital site, greater usage of the thyroid ultrasoundtechnique for biopsies occurred. As a resul$ fewerrefkrrais were sent to Honoiuiu.

U2A.9. L. A-E-s&----Jalwuluglc Ucluuuulls:

~-- 4L- = A e .,— -.—1*+A tha —Am.Uuw w. * A.- w w w w.+... bu.+ u. q!?vwnawan

wae sent back to New York fix hiStO~OgiCdkfJllOSiS.Tf emrcrn urae nwm- natknti umre refd in the- --~--, ..- —._ J> r——— ----- ---—--- - —contract terdary care center, Straub Clinic andHosnitd. m HonolulI.L Hiatoloticid ChlSSifiGltiOn=._ — -––—.–—— -— .. . . ~–-—–-.oecumed according to the pathology group at theStraub C21i.nicand Hospital.

‘fhe patients listed in Table 8 had surgay between1992 and 1996. All of the surgical pmcebes wereperformed at the Straub Clinic and Hospital.

The thyroid ultrasound and pathology findings aremmmarind below:

The non-neoplastic adenomatous nodules wereassociated with higher doses of radiatioq whileneoplastic nodules developed m individuals whoreceived lower doses of radiation. Women generallytended to have a larger number of palpable thyroidnodules than men. There were no signitkant..-currerences ‘between the thyroid nodules detected byultrasound in the Rongelap and Utrik mandated

.. .commumue~ as compamd to the voiunteer group.Eight of the mandated patients were referred for-.4 --1 —L.:— -r AL- .L---:d -_d.-*-- -.L:-.L —.—-~w~ ~A~mluu UA UIG Ulylulu Iluulum, Wnwn w GIG

only detectable by ultrasound @roving the thyroid,.lwQ..-A +n h a eAl&4 __-e of &~w-Q -all ------- w WV . . . . aas— — .“.-

palpable nodules). Ofthese patienta, one hadahcrnnmhatic cvst three had adrnnmatnuc vnitwrc twn0-- -, --a —-- — -—.. —— ~.-—. -, . . -

had folkular adenoq one had adenomatoushyperplaai&andonehadadewMoW hypplasia withoccult papillaxy carcinoma. The thyroglobulin levels mthe patient who had Occult papillaxy eareinaorna were

TABLE 7. FNAs Performed 1992-1996(* next to subject indicates patient is also included m Surgery table whichis Table 8). All nondiagnostic or suspicious FNAs were referred for surgery.

Subject Date ofFNA Mand Group

No. 1 1996 Man&ted

No. 2 1995 Man&ted

No. 3* 1995 Man&ted

No. 4 1996 Man&ted

No. 5 1995 Man&ted

No. 6 1994 Man&ted

No. 7* 1994 Mandated

No. 8 1996 (twice) Man&ted

No. 9 1996 ~-

No. 10 1995 & 1996 ~~

No. 11 1996 Comparison

No. 12 1996 Comparison

No. 13 1994 Comparison

No. 14 1994 & 1995 comparison

No. 15 1994 Comparison

No. 16 1994

No. 17 1995 Comparison

No. 18 1995 & twice in 1996 comparison

No. 19* 1994,1995, & 1996 Mandated

No. 20 1996 Mandated

No. 21 1996 (twice) Man&ted

No. 22 1996 Mandated

No. 23 1996 (twice) Mandated

No. 24* 1994 (twice) Mandated

No. 25 1994 Mandated

No. 26 1994 & 1996 Mandated

No. 27* 1994 Mandated

9

TABLE 7 (continued). FNAs Perfoxmed 1992-1996 (* next to subject indicates patient is also rncluded in Surgerytable which is Table 8). AU nondiagnostic or suspicions FNAs were referred for surgery.

Subject { Dateof FNA I Island GroupI

No. 28* I 1994 I Man&ted I

No. 29* By Japanese Man&ted

No. 30 1994 Man&ted

No. 31 ! 1995 & 1996 I Mandated INo. 32 ! 1994 & 1995 ! Man&ted

INo. 33 1995 Cornption

No. 34 1994 Comparison

TABLE 8. Thyroid Surgmy Patients 1992-1996.

Subjeeit “’ ‘Ilistopathologic Diagnosis Mand (kOQp

No. 1 1994 Follicular Adenoma Mandated

No. 2 1596 Adenomatous Hyperplasia Mandated

No. 3 1994 Atypical Folkular Cells, No Thyroid Tissue Mandated

No. 4 1996 Adenornatons Goiter Mandated

No. 5 1994 Adenornatons Goiter Mandated

No. 6 1994 Adcnomatons Goiter Man&ted

No. 7 1995 Adenomatons Hyperplasia and Occult Papillary Mandatedcarcinoma

No. 8 1995 Fokdar Adeno~ Focal Benign H@nized Nodule, MandatedFocal Benign Adenomatous Hyperplasia

within normal limits. Anintema@finding wastbatthyroid auppmssion had been initiated in theRongelap group earlier in the course of the MarshallIslands Medieal Program. Interestingly, the patientsin the Rongelap mandated group had a lowerincidence of ultrasound detectable thyroid nodul~ as~totiumww. Alaoofintemtwasthefact that of the five patients who had thyroid tissue at

SW8CIY, fo~ Wm k Utrik and only one fbrnRongelap. It is noteworthy that thyroid suppressiondoes appear to have either redueed the rncidence ofthyroid caneera due to wntinned anppmssion of the

TSu or reduced the rncidenee of new thyroid cancersinthe remnant thyroid tissue. The higher percentage ofnodules detected between 1995 and 1996 is adeflection of the imxmaed number of patients that werefollowed up dnriug these two years. An rncidenee ofapproximately 28% m the group that had been Stied

Up to 1994 was previously reported.In either even~ patients from Utrik did not have or

need many surgical pmeedma, and had not beenpreviously mppraaed with thyroid hormonereplacement Thereftn-e, the findings of a higherineidenee of thyroid surgery in this group may simply

10

be a reflection of the slow, but beni~ process ofnodule formation, which appears to be inevitable invirtually all endocrine tissues.

Several studies have shown that the addition of L-thyroxine to patients who are being treated for benignsolitary cold nodules is effective in suppressing thegrowth of the nodules (LaRosa et al., 1995). Itshould be noted that none of the thyroid nodules thatwere detected by ultrasound in the group werepalpable. Numerous studies have shown that clinicalpalpation of the thyroid is less sensitive than thyroidultrasonography when ident@ing nodules. Thedetection limit for most thyroid examinations is aminimum of 1.5 cm in diameter (Tan et al., 1995).

Several long-tam studies have been conducted inpatients who have previously undergone thyroidsurgery and radioactive iodine ablation for papillarythyroid carcinoma. In a long-tmn study of over 35years, cumulative recurrence rates of thyroid cancerswere less than 9% (Mazzaferri and Jhiang, 1994).

The second major emphasis for this report was tofollow up on mammograms in women, both in themandated and volunteer comparison groups. Nomammography was performed m 1994 because it wasagreed that the vessel-based unit was not up tocurrent standards. In 1995, anangements were madewiti the U.S. k-my Hospital on Kwajalein Island torefer all female patients for routine mammography.In 1995, patients requiling diagnostic mammographywere referred to the Straub Clinic and Hospital. In1996, with the inception of the land-based programand the availability of a radiologis~ diagnosticmammography was perfoxmed at the U.S. ArmyHospital on Kwajalein Island. During the course ofthe five years, palpable nodules were detected on anumber of patients. Initially, the majority of thesepatients were referred off-site to Honolulu fordiagnotic biopsies and surgical procedures. Thesepatients were subsequently followed-up through theStraub Clinic and Hospital. In 1996, amangementswere made with the Kwajalein surgical staff toperform routine biopsy procedures, thus creating areduction m the number of Honolulu refd. Tlwrewere a total of 39 referrals made for mammogram-related abnormalities. These patients were referredfor surgical pmcedum or evaluations at Kwajalein orHonolulu. A number of these procedures turned outto be benigQ and only one patient was detected tohave breast cancer. lbia patient was treated withradiation therapy in Honohd% since that was herlocation of residence.

The third major initiative for this report was toinstitute the blood tests for PSA for all males whohad palpable prostate enlargements. This resulted in

approximately eight patients with detectable levels ofPS& who required referrals to the urology services inHonolulu.

Sigmoidoscopies and GI workup:

Sigmoidoscopies were done on the Offshore Ventureand at the U.S. Army Hospital on Kwajalein Island.Once the program became land-based, two additionalOlympus flexiile sigmoidoscopy units were purchasedfor the medical progmrn. This increased the efficiencyof the gastroenterologist’s time. Also, it should benoted that both units were in compliance with theincreasingly stringent sterilization requirements. Thesigmoidoscopies, colonoscopies and proctoscopicexaminations were conducted either by the visitinggastroenterologis~ or by one of the surgeons locatedpermanently on Kwajalein.

Hepatitis B surface antigen was detectable in anumber of patients, who were routinely monitored withalphafetoprotein for the development of anyhepatocelhdar problems. This was an ongoingprocedure, and patients were treated annually withalphafetoprotern levels, hepatic uhrasoun~ and liverbiopsies, as indicated.

Hematological evaluations were continued whenapppriate by means of routine blood counts, plateletcounts, serum protein electrophoresis, and bonemarrow aspirations. The results of the CBC’S andchemistries are listed m Appendix B.

Referrals to the Tertiary Medical Care Center andto the RMI Govemrnenfi

As previously indicat~ the number of referrals tothe Tertiary Medical Care Center in Honoluludecreased after the progmm became land-based. Theoverall refd for various patients are listed in Table9. In gene@ the thyroid-related refd were mainlyto repeat thyroid FNAs, to perform surgical excision ofthyroid nodules, and to follow up with radioactiveiodine scans for those patients who had previousthyroid cancers.

Patient Deaths During 1992- 19%:

There were a total of 25 of the original 253mandated patients and 14 of the 227 volunteermmparim patients who expired during this reportingperiod. The total pementage of mandatd patients whoexpired during this reporting period was 9.99??; theexpiration percentage of the volunteer comparison~tients Who returned fm annual visits was 6.2%. After42~there atillcontinue to befm differences

11

TABLE 9. Refermls to the Tertiary Care Center and to the RMI Government.

DisemMhndilions No. of Snbjecla O/.of Total

Anemia 26 7

Back pti 1 <1

Breat 39 ii

P..A;A1A.W,-UU..6J ~ ~

Dental 2 1

Diabetes 13 4

Endocrine visits 10 3

Gastroenterology 73 21

Gynecology 30 9

Hypertension 10 3

Leg cramps 1 <1

Non-thyroid neck mass 3 1

Neurological 2 1

Gphthahnological 12 3

GsteOarthritis 2 1

Pituitary tumor 1 <1

Pulmonary 18 5

Sti lesions 1 <1

Surgmy (non-thyroid) 5 1

Thyroid 70 20

Urology 26 7-.~..:?,:..-.>-.,----- ,,,, -,.,.-‘=~.~ : “ ‘. ‘: - id=-:;’:’..:.. “:’’.’”*, -’: “ . . %.“

..s..?.”.. ... - X&k

between the percentage of patients m the mandatedgroups compared to the gender and age-matchedvolunteer patients. It should be noted that. -.––-.——-———-—.J—& 1:.-.s — .-n- — -— :-1—A.Occauscmany Pau- Jlvcu UII ULUIIS U1 Uuu=l IMauus

located a great distance fkom major populatione-t- the muse of death is usuallv not mmrded.——-, —- -—- -- —-——— ——<S@ thcrefdre, unknown. Individual summaries foreach of the patients who expired within each group(mandated aud VOhIXlteCKwmpariaon) are _

‘ below

Deceased patients in the mandated groups are-cd by island Rongelap (R) and Utrik (U).

Subject No. 1 (R). This was an 82-year old womanwhose main symptoms were inability to x B12A-CL —-.UGubmaby ,

~~ —..l.A—l””A.and pchajj =Y=~yY y==u~

syndrome. She also had persistent psonams andhypothyroidism she was ~ treated with ?@hroid200 mcg daily and B12 rnjechons for the anerma. TheCauaeof death is llnlmown.

Subject No. 2 (R). This patient was a 60-year oldmale whn harl ctatnc post thvrnidertnmv ~~—. . . . . — “.— —=. ..—-.-—J

laryngectomy for squaxnous cell cami.noms. Hisk?lVIQ(?d carcinoma devekmed m 1992; when he ikst_—, _e __ _- —–—– — =---

had symptoms of Progressive hoarseness forapproximately 8 months. The C&llOSiS was made bykiryngoscopy and the fhdings were of dtipienodules among the vocal chords. He also receivedchemotherapy for metastatic Iagmgeal carcinoma tothe right upper lobe of the lung. His thyroidectomywasin1977for abenigndiaeasc. Hehadahistoryofhypothyroidism fm which he was being treated withSynthroid 200 mcg daily. The cause of death was not~ti- but -may have been due to metaataticlaryngeal carcinoma to the right upper io-be of the

-.

Subject No. 3 (R). This w an 82-year old malewho was last seen in 1992 co~?g of mild backpain which was due to an xqury. His physicalexamination was unremarlcabk: at that time, and his@problems were the presenm of bilatad cataractsandstableauemk Healsobad verymildremdins@iciency as evidence of adightinaease m aennncreatinine. The patient was also known to havehereditary neuropathy. The cause of his death isunknown

Subjeet No. 4 (R). This was a 60-year old malewhowasscen in March 1996. Hehadahistoryofblood m his stools for which he was being examinedby colonoscopy. This test found no evidence of~, amino Ment@ble lesions were visible.Thepatienthadmildrensd ins@ciqasevidenceof slight increase inaemmcreatinine and B12&ficiency. Hewasalsonoted tohaveanabnonnalPSA. Hewasalao being treated with Vasotecfmmiid~on. Theimmdatecause ofhisdeathis Imhlowm

Subjeet No. 5 (R). This was a 64-year old male..k. -e I.c.t Q— k Mswh 10OA -A hic I&trwu“.” .- -. -- w ---- .,.., — - —W*J

rncluded hypothyroidism fm which he receivedCvnthrnid 9fU) meo ddv Hie nast mdkal hiclnrv-J-—-- --- —~ —J. — =—. —__ __,included amilddegree ofrenal~ andminimal llmwr GI dlux _ :..<: -mtly whh-= .- —---——-Maalox. Hewasalso known tohave Hanaedsdisease with extcusw“emultipleammtat3 .Ons of his_andtoas. Healsohadbelow* ampu@tionof theright legalao dueto Hansen’s disease. TheCauseofhisdeath isunknowxl.

Subjact No. 6 (U’). This was a 78-year old femalewhowsslaat aeeain1995 asahomeviait Shehad

a long standing histoxy of diabetesmellitus and was~zted ~~t~ -Mfcro~Qe ~ m~ d~y. she WJ LCQ

Iweiving 100 mcg of Synthroid daily fm a prior historyof thvroidectomy for beni=gpdisease. When she was—<..––.last seen at home, she was confined to bed and had aIOWblood pressure, but the rest of the physical examwas unreadable. The immediate cause of death isunknown.

Subject No. 7 (R). This was a 78-year old malewho was last seen m 1992 and expired in 1995. Hedeclined visits to the medical facilities when he wascmtactdduringthemissions. Whenhewaslast~he had a history of decreasing vision and difficultywaiking. He had a fixed fiexion defbrrni~ of his kneeand dhinished flexion of the spine. He also hadhypothyroidism for which he was mxiving 200 mcg ofSynthroid daily. In 1991, he had been seen at StmubClinic and Hospital fix tubercdosis. He also had ahistory of cerebral vascular accident with lefi-sidedhemipamsis. The cause of his death is unlmowm

Subject No. 8 (U). This was an 80-year old malewhowaslastseenrn 1991. Thepaticathad ahistcnyofleft-sided hmipamis and infection of his right footHe had a previous hiatoxy of left lower ememity belowbe amputation. He also had a history of peripheralneumpathy and mild cataracts. The immolate cause ofhisdeathwas notreportd

Subject No. 9 (U’). This was a 92-yin old malewhoexpired inMa@roin1993, duetopmmmniaandsenility. Hewaslastseenby themedicdprogmrnin1992inahomevisit Atthattime, hispredominantcomplaints weremild derma~cmatipation sndapilonidal cyst He was also found to have benignprostatic hypertmphy. He was given symptomatictmmnentatthattimewith localcreams forhisskinlesions and Dulcolax for his amatip@on. He was-d to Maaur-uHospital for a totata0: five *ys ad>

expiredinthehoapitaL

Subject No. 10 (U). This was an 89-year old male+n M_s histnry ~ffi. dcl%icncv anemia and ~paiac——-, ——

poaitiveatooL Hewaslastaeenaa arefkrralto StxaubQinicand Hoapital fmaworkup ofa large scrotalmas$andiowhem@oMnand hmatomk Thepatienthadaurgcr? for leftinguin dhcmialrepai randleft-Sided mbxtomy ‘rhepathdogyr eportoft hisapecimn~.tha ttipatientha dabydigcelltumor withevidence of@monarymeMaaea asseenon cheat x-ray. l%ccause ofhiadeathwaa noteti-ykve~duetib~ticLeydig cell tumor.

13

Subject No. 11 (U). l%is was a 45-year oldfemale who was seen by the medical progmm mMarch 1993. She had a history of long standing andpoorly controlled diabetes melilitus. In May 1990,she had a left breast mass which was found to bek~~ M natient w admitted to &faiuro Homitsl= .—-—. —— —-— —,—- ----r_—

inAugust 1993, andtheimmediate cause ofherdeatbwasreported to becardiacamest whichwaspmumedto be due to electrolyte imbalance secondary tochronic diarrhea.

Subject No. 12 (U). This was an 82-year old malewho was last seen as a home visit in 1995. Thepatient expired in March 1996. He had a history ofdiabetes mellitus with acceptable contro~ and chronicanemia which was stable. He ,a.lsohad status postright toe amputation due to his diabetes. Hisdiabetes was adequately controlled with Mieronase10 mg daiiy. His prior history rncluded surgery forbenign pmstdiC hypextrophy m 1980, and surgery

-------fbr cmamets m 1987 and lwu. l-ne immediate causeof his death is unknown.

Subject No. 13 (U). This. was a 40-year old malewho was Iastseen m 1992. me patient had a historyof hypertemion for which he was being treated withVasotec 10 mg daily. llte patient also had anelevated prolactin level which was not related tohypothyroidism or the result of other medications thathe was reeeiving. Work up of his pituitary glandincluded a CT scan which showed an empty Alaasso&ed with elevated levels of prolactin. The highlevels of prolaetin also caused him to be impotentThepatientalsohad probable ealnaryarterydiseasewith (ZUd.iOIIlyOpathy,and there was evidence ofmyocardial in.fktion on an old cardiogmm. Thepatient asaehronic smoker and also had beenaheavy alcohol drinker, which may have contributedto the eardiornyopathy. ‘he immediate cause of hisdeath isunknown.

Subject No. 14 (U). This was a 71-year oldwoman whowaslast aecnatthe mediealmissioninMarch 1993. She - refkmed to Siraub Chic andHospital m May 1991 fm a questionable abdomid_. llrA .- .+ A.+ &. . . .-... —.&L1. s.VvuLa up EbWb — Ww -—A- AWL

anymasaes. shewasseen again iu 1992. There Wasaeollcem &ve@htloas= She WasseenorleemoreiuApril 1993 fm recurrent abdomid ‘problems. Amasswaadiseovcred by~iuthemgion of theaortaand a biopsy of this mass indicated poorlywerclltiated adenocarernoq with an unlmownm~. l’heeauaeofdeath iatiowwbutmayhave bcendueto the poorly difkentiatedadenocareinoma.

Subjeet No. 15 (U). ‘Thiswas a 90-year old womanwho was last seen m the medical progmm in April1992. She had a history of constipation hernaturia,nonnocytic anemia and borderline hypertemion. Thepatient also had bilateml cataracts and nonspecificccmmlaints of iornt nains and was talcin~ symptomatic—__——_ -—#___ =_- ——— ~ _,–––

treatment for all of these problems. The cause of herdeath was not immediately apparent

Sub@t No. 16 (U). This was a 67-Year old malewhowaslast seen foravisitrn March 1992. Hehadahistory of myocanhd idaretio~ hypertemiou anddiabetes rndhtus, and W= being treated withMicronase 5 mg daily and Vasotec 5 mg daily. Hisdiabetes was ina&quately controlled and he hadmultiple ulcerations over his extremities. Dining hislast visit he was found to have a prominent abdominalaorta and was being refined to Majuro for anultrasound. The immediate cause of his death isUnlmown.

Subject No. 17(U). This was a 75-year old womauwhohad*been seenin March i992byrnemedicai team.She was found to have out-of-trol diabetes,increasing kidney fiction impairment andhypertension. In 1991, she was refereed to Honolulufor-t microscopic hematur@ WhiCh W= foundto beduetoarenal ealeulus. A mammogram showednipple mtractiq and there were vasculm calcificationsiu both breasts. ‘fhecause ofherdeath isunlmown.

Subject No. 18(U). This was an 83-year old f-ewhowaslastseenduring tbeapring 1993mission. HerP@ hiatoxy included CQloncancer surgically Comeetedin 1985. She had negative coknmacopies m 1988. Shewas found to be unresponsive and to have massiveUriuary met infbclion. Shewas treated withintravenous antibiotics and hydratioq and thentransf’to Majuro Hospital forccmtin@ care. Theimmediate eauseof herd@hwasunlmown butpr=umedtobe duetourosepsis andeoma.

Subject No. 19 (R). This was a 78-year old maleiastseenin the faiiof1993 vmthahiatory of diabetes

-----

with ophthalmopathy. He also had a history ofhypemnai~ hyperuigiyeeri- and positiveHepatitis B. The patient expired m 1994; immediate.— -_ -r S--L 2-—1—-——Gauscul~lsullnlowR

14

had a history of a CVA and aphasia. The patientexpired in October 1994; the cme of his death is notknown.

Subject No. 21 (R). This 75-year old female waslast seen in 1994 during the :fallmission. She had‘beentaking Synthroici for hypothyroidism. Sineaisohad a history of Type II Diabelm Mellitus which was-.*.J . ..4Ln#:-—... m.- . .. . . ..4... --.6 --.-L-1UGUkG+A WAU4 LVUbLU-G. bJUG W- ~~~ ~3L bGLGU1~

vascular accident. The patient expired in July 1995,smrlthe imm.mrliate *BIICP nf hor death ic nnt lrnnwn—. -. ~.—- ---- . . . . .. . . . . .“ . . . . . . . . .

Subiect No, 22 @_T)emis natient WLS am &ye~r,---- ~.——_—.

old male, last seen during the fall 1993 mission. Hehad a history of anemia, glaucoma, mildhypertension and renal abnormalities. His paathistory also included aortic stenosis andhypertriglyceridemia. The immediate cause of hisdeath is not known.

Subject No. 23 (U). This 7’7-yearold male patienthad a histmy of chronic obstructive iung disease andhematu@andhadbeen seenatthe Stmub Clinic andrr--. ,,e, e. -, 3–--.-., –--, .nospmu ror aoaormnm aomc aneurysm. He had aurinary cytology which showed no evidence ofcarcinoma. He was extensively worked upon withabdominal CT and renal ultrasound at the StraubClinic and Hospi@ and the only abnormalitydetected was a large aneurysm. No cause of deathwas identiilable.

Subject No. 24(U). This female was born m 1923and probably died m 1992. The patient was a 69 yearold female who had a history of iron deficiencyanerni& dernenti& organic l)rain syndrome, andhypothyroidism. The patient was homebound andhad been m that condition fm several home visia thelast one in 1992. The immediate cause of her deathis unknown.

Subject No. 25 (U). This 62-ye&old f~e wasanunlmowndiabetic formanyyears withahistoxyofback and knee paiQ as well Iashemorrhoids. Herdiabetes had been well controll~ and the patient’smm tnrrlc relieved ~@h mvalotwic themnv- -W-——— were ------- 0--- —---r~ -

The patient was last seen m September 1993, and theimmediate cause of her death is unapparent.

Subject No. 1. This was a 56-year female lastseen during the spring 1996 mission. She had aI&tory of congestive heart failure, atriai fibrillation%

rnicrohernatur@and diabetes mellitus. The patient hadaortic stenosis and regurgitation with an- and hadrequired cardiac surgery for valvular replacement in1980. The problem with the congestive heart failureappeared to be worsening when she was seen duringthe mission. An electrocardiogram showed atrialiloriiiatio~ and the chest x-ray showed congestivecardiomegaly with pleural efi%sions bilaterally. The-.4—. ---- . . . .. A A..J-- ●L- —:”.:-- --> .L—~fXUGllL W- UGaLGU UUILU~ LUG uuaalu~ auu Lucll

refereed to the RMI Government for continued care.ThI=;rnrn.-.~;~imes~teenfhnr rhmth W-C mmb+irmrn

. . . ——.. --- . . . . . . . . . . . . —“ . . . .

~~~jti No: 2= T’& mas ~ 84-vear dd female w~~, -— ..- --—-

was seen during the spring 1993 mission. She had ahistory of anemia of non-specific origh a heartmurmur and elevated cholesterol levels. She also hada histoxy of diabetes mellitus and mild renalimpairment. She was treated with Micronase 5 mgdaily, and symptomatic treatment for analgesia withTylenol. The immediate cause of her death wasunknown.

Subjeet No. 3. This was a 62-year old wornan witha previous history of anemia and nonspecific joimpains, as well as diabetes mellitus with adequatecontrol. She had been treated with Micronase (4 tabletstwice a &y) and multivitamins. She had noabnormalities noted on her most recent thyroidultrasound. Flexiile sigmoidoscopy done dwing thatvisit was normal. ‘Ike was no immediate knowncause of death noted.

Subjeet No. 4. This was au 81-year old woman witha history of diabetes mellitus and status post thyroid_OIIla treated slli@dy in 1982. It was an occultpapillary carcinoma. She had been treated withMicronase 5 rng daily and Synthroid 100 mcg daily.She also was known to have nonspecific joint pains anda hiatmy of anemia. She was last seen in March 1996,and treated with the above mentioned medications. Shealso had elevated creatmm. . e, and high triglyceri&s andcholesterol. The immediate cause of death is notknown. She is Imown to have expired m September1996.

Subject No. 5. This was a 70-year old male whobad a previous history of hypothyroidism dia-mosed m1992. He was being treated with Synthroid 200 rncgdaily. Routine thyroid ultrasound indicated amultin* gland with some retmstemd extension.FNA was done on one of the nodules, and this was—-—s:.—-4 . m- —-d—. -t -- L_sIWlulagnosl.w. 1ZIG pucm alau nau a hk-try of

catamts m both eyea, and had a routine aigmoidoscopyin 1007 which waQ nmnml The imrndiaiP rmIw nf hic- ---- --—— .- —---— --- ——. —— .-—

death ia not knowm

15

Subject No. 6. This was a 73-year old female whowas last seen duriug the spring 1985 mission. Noother records were available after 1985 to make asatisfactory assessment of her medical condition. Shewas, however, known to be hypertensive, and wastreated with Hydrochlorthizine. There is no lmowncause of death.

Subject No. 7. This was a 47-year old womanwho was last seen during the fall 1995 medicalmission. She had a history of diabetes mellitustreated with Micronase. She also had a history offungal infections and microhematuria. Her thyroidfimction tests were normal and her last known bloodtests for serum chemistries were normal. She alsohad iron deficiency anemia, a urinary tract Mectiowand multiple joint pains. The immediate cause of herdeath is not known.

Subject No. 8. This was an 82-year old male whowas last seen during the fall 1993 mission. He hadprogressive anemia and refbaed to have bone marrowtesting. A house call was made to evaluate hismedical status. He was found to be unresponsiveduring his visit but moved all his extremities. He hadsome cough and fever for about a month prior to thehome visit. The impression was that of severecachexia secondary to his age, and the family decidedagainst transporting the patient for further care at ahospital. The patient repcmedly died soon after thehome visit.

Subject No. 9. This was a 62-year old fde whowas last seen during the Medical mission in March1993. She had a history of diabetes mellitus whichwas treated with Micronase 5 mg daily. She also hadnonspecific joint pains, as well as vulvditis. Herlaboratory testa during the last visit indicated nospecific abnormalities. She was later admitted toMajuro Hospital in a coma of 24-hour duration andsepsis. She was eventually diagnosed with meningitiswhich was reported to be the cause of her death onthe death certitkate.

Subject No. 10. This was a 70-year old male seenat Ebeye Hospital during the spring 1994 mission.He had been admitted to Ebeye Hospital with ahistory of osteomyelitis, and sepsis. He also was almowndiabeticandwasbeingtxeatedwithMicronase5 mg daily. He had a prior history of~ of unknoum etiology. During thehospital visit he was given CPfloxin 500 nag twicea day and was given a renewal of his Micronaaepresmiption. The immediate cause of his death was

not known but presumed to be sepsis due toosteomyelitis.

Subject No. 11. This was a 53-year old male whowas last seen thing the 1994 fall mission. He expiredm 1995. He had a history of cerebral vascular accidentwhich occurred several years ago, and he had residuallefi-sided hemiparesis. He had impaired renal fimctioqand a history of anemia. He also had a history ofhypertension%which was controlled with Nifedipine 10mg four times &ily. The patient had no thyroidabnormalities. The immediate cause of his death wasnot known.

Subject No. 12. This was a 70-year old male whowas last seen during the fall 1995 mission. The patienthad a history of multiple thyroid nodules which werediagnosed on thyroid ultrasound. These were benign.He also had a history of hypertemio% bronchird asthmawith chronic obstructive lung disease, and congestivecardiac failure. He also had Type II Diabetes Mellitusassociated with obesity. The patient expired m 1996and the immediate cause of his death was not known.

Subject No. 13. This was a 5 l-year old female lastseen during the fall 1993 mission. She had a history of_ ~ti infectiow Diabetes Mellitus withneuropathy, degenerative arthritis of the cervical spine,and a class III PAP smear. She had a painless mass inthe right breast which was most likely of Mamma toryorigin. She was referred to the 177 Health CareProgram for treatment and excision of the mass. Theimmediate cause of her death was urdmown. Sheexpired in 1996 since 1994, she had not beenattending follow-up visits to the Medical Program.

Subject No. 14. This was a 71-year old female lastseen during the fall 1992 mission during a home visit.During the last mission that she was seaL she wasfound to have Type II Diabetes Mellitus (she tookinsulin for a short time, then switched to oral agents),hypenemi~ heruing difficuhy, and bilateral CS~CtS.She was treated with Micronase 5 mg daily andVasotec 10 rng daily. She subsequently retied othervisits and expired m 1995. The immediate cause of herdeath is UnknOW1l.

16

BIBLIOGRAPHY

Cronkite, E.P., Bond, V.P., Ccmard RA., Shulrnaq N.R., Farr, RS., Coh.WS.H., DunhanL C.L., and Browning, L.E.10C< n----- . . -(h. ,... m.. h.;., - .,....<,.?-+” 11., —n..d +- .<-;4,.--+ #mllA,,+ .nA;nh”nw174>. nufwr4ac u/ JMw/tb4rL Uc’, qy L4*K4Gr*tu”y cap”.wx4 ‘“ .’=r..,.L.w,’ *,w*”*’ # --’’” .,.

T Arnm. M.A Accn,- lCQ.A211. . .—”. . . .. W!.L.. ● -o”w. *#, .T4” —

434.

Lesaard, E., Miltenberger, R., Gina@ R, Musolino, S., Naidw J., Moorthy, A., and Schopher, C. 1985. l%yroid-absorbed Dose for People at Aongelap, Um”kand SIfo on March I, 1954. BNL 51882.

Ccmz@ RA, Meyer, L.M., Rti J.E., Lowery, A., Bach SA., CannoQ B., Carter, E.L., Either, M., and Hechter, H.1958. March 1957 Medical Survey of Rongelap and Um”kPeople Three Years ajier Ekposure to Radioactive Fallout.BNL 501 (T-119).

Howar~ J.E., Vaawani, A.N., iandHeotis, P.1997. l%yroid Direase Among the Rongelap and Uti”kPopulation - AnUpdate. Health Phys. 73(l): 1!90-198.

LaRosa, E.L., Ludo, L., Giu.ffiic@ D., GuIlo, D., Vigne@ R, and BeKore, A. 1995. Levothyroxine and potassiumiodide are both ejlective in trwzting benign solitary solid cold nodules of the thyroid. Ann. Intern.Med. 122:1-8.

Taq G.H., Gharii, H., and Reading, C.C. 1995. Solitary thyroid nodule. Arch. Intern. Med. 155:2418-2423.

Mazzafeni, E.I. and Jhiang, S.M. 1994. Long-term impact of initial surgical and medical therapy on papilla~ andJ-11:-.1 -- .L. -_:2 ..____- A- T XX-A C)7. AIO

Jwbm.ubur Wyr U6U U41L6C1 . — 4. LVLGU. 7 I.-L 0.

17

Epilogue

by

-c D (-.--1.;*.XK nG.r . blullILLLG, lVA.U.

On March 1, 1954 following a detonation of a thermonuclear bomb, Rongalap and Utrik inhabitants, as well as&m-ican Servicemen were exposed to fallout. Several Marshallese had sufficient fallout material on their skins toproduce Beta bums. The bums healed leaving scars in some individuals. There were si@lcant decreases in whiteblood cell and platelet counts which ultimately returned to normal. There had been muses, vomiting and diarrhea insome of the Marshallese which was not reported in the exposed Americans. The team that observed the exposed personsreturned to the US when it became evident that the exposed persons were recovetig from the effects of the falloutradiation.

On July 12-131954, Dr. John Bugher, Director, Division of Biology and Medicine of Atomic Energy Commissionconvened a meeting of all personnel that had observed the Rongalap and Utrik inhabitants caught in radiation falloutin order to discuss the fiture management of these Marshallese patients. He made it clear that the DBM-AEC wouldbe responsible for the fbture observation and care of the Marshallese that had been exposed on Ailinginae, Rongerikand Utrik Atolls and that the Department of the Interior was responsible for general medical surveillance of theMarshallese on other atolls. It wss decided that V.P. Bond would lead a team to survey the status of the Rongalap andUtrik inhabitants of the above atolls six months after the accident and that E.P. Cronkite lead a team 12 months afterthe accident. Dr. R.A. Conarci aw.uneci responsiioiiity in i956, for direction of the continuing Ivfarshaiiese MedicalProgram involving those individuals exposed on Ailinginae, Sifo, Rongelap and Utrik under auspices of BNL. For 25------ n- P--.-A -.:A.A ●L.. -.--— -2*I. “1.:11 ..-A 2;1. —----- m--- -.—- --—- &.-l-.4 --4 L— --ycxan, J#l. Wualu gulucu LUG plu~haul WILU au au LLLplullliwy.

-- .L---- -L.L UGIG WG1 C MJI.UC LLU UUIGLLL LUUGb, %%CU LLLLUU&L

misunderstanding of the role of the BNL t- the Marshallese became uncooperative largely as a result of political-..hl-.pu”a”-.

~_~~~ ~ ~Q q~es~~~t~? t~,~p-dfi~~~ wac recnnnct%b fnr ~~ ~l~m~, epfi~~~q tmnnnrarv cmmr-ccinn Of..- .-.= -—---- .-. . . . . . . . . ..y.~. -------

hemopoiesis, thyroid hypofimctkm thyroid tumors and probably responsible for the fatal case of acute leukemia. Onecan never be absobtel~ c-1 fiLce it is not nosslble to tell the diiT~_ce between spontaneous leukemia ~d tition-=-––-––- -- —.=-——–__ .-induced leukemia. Based upon the extensive data collected in Japan on the survivors from the atomic bombs atHiroshima and Nag~aki, it is most unlikely that further radiation effects will be observed in the Rongalap and Utrikinhabitants caught m radioactive fallout. However, there are problems traceable to the nuclear bomb testing in theMarshall Islands.

Appendix A

.

APPENDIX A

NAME/SPECIALIY

CARDIOLOGY

Maj Janet Hays, MD

DERMATOLOGY

Richard Ostreicher, MD

EMERGENCY MEDICINE

Douglas Binder, MD

Eric Lindborg, MD

PROFESSIONAL STAFF PARTICIPATING IN THE

1992-1996 MARSHALL ISLANDS SURVEYS

Steven Mehaffey, MD

PARTICIPATING AFFILIATIONSURVEY

S192

S192

F193

F/95, S/96

S195

ENDOCRINE

LaVonne Berg. MD S/92

Robert Blank, MD s/95

Col Michael Bomemann, MCI SAM

Senior Cardiology FellowBrookAMCSan Antonio, TX .

Sr Resident, DermatologyNY Univ Mad CenterNYC, NY

Resident, Emergency MedBronx Municipal Hosp CtrNYC, NY

Chief of StaffKwajalein HospitalKwajalein, MH

Staff PhysicianKwajalein HospitalKwajalein, MH

Fellow, EndocrinologyCase Western Resewe UnivCleveland, OH

Fellow, EndocrinologyRockefeller UnivNYC, NY

Chief, EndocrinologyDept of MedicineTripler AMCHonolulu, HI

A-1

Barbara Fleming, MD

CPT Lloyd Hancock, MD

Maj Gregoy Hughes, MD

Mark Lakshmanan, MD

James Magner, MD

Lawrence Parker, MD

Maj R. Michael Tuffle, MD

Ashok Vaswani, MD

CMD Ann Yoshihashi, MD

FAMILY PRACTICE

CDR Nathaniel Cobb, MD

Kevin Cmk, MD, MPH

S193

S196

S194

S193

F196

F/94

F/93, F/96

S/92/ F194, F195, S/96

S195

F/96

F192

Assoc Chief of StaffVA Medical CenterCleveland, OH

Asst Chief, EndocrinologyEisenhower Army Med CtrFort Gordon, GA

Staff EndocrinologistTripler AMCHonolulu, HI

Senior InstructorDept of EndocrinologyMetro Health Med CtrCleveland, OH

Professor of MedicineEast Carolina Univ Sch ofMedGreenville, NC

Asst Chief, EndocnTologyVA Med CtrLong Beach, CA

Chief EndocrinologyWalter Reed AMCWashington, DC

Consulting Endocrinologist,MIMPAsst Prof of Medicine, SUNY,NY

Fellow, EndocrinologyNational Naval Med CenterBethesda, MD

Director, Indian HealthSewice, PHSAlbuquerque, NM

Staff PhysicianKwajalein HospitalKwajalein, MH

A-2

GASTRONENTEROLOGY

Michael Bliss, MD

D-b-. C] I.. fi~nI- GLGI Iala, Ivlu

VVavne Lucas. MD,.. _ —____, ..—

HEMATOLOGY

WNiam Adams, MD

Jean Howard, MD

INFECTIOUS DISEASES

Dina Toren, MD

INTERNAL MEDICINE

Coiin Atterbury, MD

Maj Benjamin Berg, MD

Michael Hamilton, MD, MPHI

Thomas Minor, MD

F192

S193

S/w

F/94

S195

Prof of MedicineBoston City HospitalBoston, MA

Fellow, GastroenterologyBoston City HospitalBoston, MA

Medical Dir, MIMP (to 1992)Brookhaven National Lab,Upton, NY

Hematology/Oncology. .. J.-—.R.—..,. .- ,L-—MealCal ulr, nmvu- (worn1993) Brookhaven NationalI -h 1Im+n..NIVLau, upuil, IN 1

Dept of Infectious DiseaseFellow, NY Univ Med CenterNYC, NY

Chief of StaffYale Schml of MadNew Haven, CT

Staff PulmonologistDept of MedicineTripler AMC, Honolulu,HI

Clinical Asst Prof of MedicineDuke Univ Mad CtrDurham, NC

Fellow, MedicineMayo ClinicRochester, MN

A-3

NEPHROLOGY

James Barr, MD, PhD

NUCLEAR MEDICINE

John Harbert, MD

Henry Royal, MD

OB/GYN

Stuart Abrahams, MD

Frank Anderson, MD,

Lauren Brown, MD

Pui Chun Cheng, MD

Richard Gallagher, MD

Col Samuel Heth, MD

MPH

Robert Holland, MD

William Inkret, MD

S192

F195

S/96

1=195

F/93

S193, S194, S195

S194

F196

F/94

F195

—---F196

Staff NephrologistDept of MedicineBrookAMCHouston, TX

Prof Emeritus, Nuc Medm--. --. -.. —#,-:. .---:&.-eoryewwit UIIIWI WY

McLean, VAA,.1.,;e-. +- Dt.aeiAan4;alnuviaw m r I WIW21 ILICW

Committee on Radiation

Prof of RadiologyM~!!~n&rQ!!n~tSt. Louis, MOMember of PresidentialCommittee on Radiation

Private Practke, GYNGreensboro, NC

Fellow/Instructor,GYNJohn Hopkins UnivBaltimore, MD

Pediatric GynecologistChildren’sHospitalBoston, MA

Chief Resident, GYNStony Brook UnivSUNY, Stony Brook, NY

Private Practice, GYNConcord, MA

Staff Physician, GYNTripler Army Med CtrHonolulu, HI

Staff Physician, GYNMountainview Woman’sHealthGrandView, ‘WA

-2 .—*- --— A,_- n\,. ,rnva~e rracuce, u T N

Denver, CO

.A4

Michael Janicek, MD

CMD Robert Laliberte, MD

Gilda Lorensen, MD

Rochelle Mathieu, RN, NP

Leonard Schonberg, MD

John Tucker, MD

Marina Torbey, MD

Maj Mary Zozulin, MD

PATHOLOGY

Donald Paglia, MD

PULMOHARY

Herman M. Blaton, MD

Robert Fallat MD

Maj Joseph Kern, MD

S193

S/96

F/94

F193

S/96

s/92

sr92

St9s

S193,S194

S192

F/93

F/94

Chief Resident GYNJohn Hopkins UniversityBaltimore, MD

Chairman, Dept of OB/GYNPhoenix Indian Med CenterPhoenix, AZ

Staff Physician, GYNCarolina PermanenceMedGrpRaleigh, NC

Private Practice, GYNHilo, HI

Private Practice, GYNHelena, MT

Asst Clinical Prof of GYNHarlem HospitalNYC, NY

AttendrngPhysician, GYNAlbert Einstein College ofMedicineBronx NY

Staff Physician, GYNUS Air Force MCGrand Forks, ND

Prof of PathologyUCLALos Angeles, CA

Chti, Pulmofwy ServiceBrooke AMCSan Antonio, TX

Dir of Pulmonary ResearchCaliimia Patic Mad CtrSan Francisoo, CA

Staff Physioian, PulmonaryONklad~an Army Center,Taooma, WA

A-5

CDR Scott Sageman, MD F/96

RADIOLOGY

Wdliam Brant, MD F/94

Maj Allen Chantelois, MD S192

LCDR Daniel Davis, MD F196

Col Chris Jennings, MD S196

CMD David Lawrence, MD S194

LTCD Robert McFarland, MD s/96

Maj David May, MD SDS

Philip Meyers, MD

Robert Shepherd, MD

F/95

Fi’95

Staff Physician, PulmonaryDivNaval Mad CtrSan Diego, CA

Assoc Prof of RadiologyUniv of CA - DavisDavis, CA

Staff radiologist-..t-ttzsimmonsAMC/wora, CA

Diagnostic Radiologistm.-A -s n-a:-: -- ,Ut+JL UI MUIUIU~y

National Naval MCPk-.mm.-.-b- \ IAWI lwa~on=, Vn

Chairman, Radiology DeptNaval MC San DiegoSan Diego, CA

Staff RadiologistTripler Army Mad CenterHonolulu, HI

Director, MRINational Naval Mad CtrBethesda, MD

Staff RadiologistSan Diego Naval Mad CenterSan Dngo, CA

Staff RadiologistWilford Hall AFBLacidand, CA

Fellow, Radiology & Nuc Madm.-ne$ HQ$p&lSt. Louis, MO

Chair of RadiologyUniv of Texas Heatth CenterTyler, TX

A-6

VirginiaToombs, MD

PhilipWlest, MD

SURGEON

Earl Thomhill, MD

NURSES

AltinaAnien

Toltha Arelong

Sandy Bales

Marlene Brady

Kathy Campbell

Trudy Campbell

Lynda Firment

Deborah Greenhill

Reine Heine

Aurelia Inkret

Stanley Jamb

Helen Jetill

Nennet Joel

F/96

F/94

F193, F196

F192

F195

F194

S/92, F/92

S193

S/w

S194

S/96

F196

S195

F194

S195

Private Practice, RadiologyPalo AltoCalifornia

Asst Prof RadiologyVA Medical CtrAlbuquerque, NM

Staff PhysicianKwajalein HospitalKwajalein, MH

Majuro HospitalMajuro, MH

Majuro HospitalMajuro, MH

Majuro HospitalMajuro, MH

Kwajalein HospitalKwajalein, MH

Kwajalein HospitalKwajalein, MH

Kwajaiein HospitalKwajalein, MH

DOEWashington, DC

Kwajalein HospitalKwajalein, MH

Majuro HospitalMajuro, MH

Private PractioeDenver, Co

Ebeye HospitalEbeye, MH

Majuro HospitalMajuro, MH

Majuro HospitalMajuro, MH

A-7

Kelly Johnson

Leslie Kkkham

Clementina Lalimo

Tinar Laiimo

Rosebeth Lang

Risen Lomae

Utena Marshall

Tina Naisher

No Pniiiips

Linda Puchon

Nanik Rantak

Patricia Rembert

Albina Rklon

Patricia Robins

Ivy Springer

Caroline Tuman

Maw Ulyat

s/95

1=195

F/96

S193

S/96

F/94

F19,S195

F195

- ---WY*

F193

S193

S195

S192, F192

F195

F/W, F196

F196

s196

Tripler AMCHonolulu, HI

Kwajalein HospitalKwajalein, MH

Majuro HospitalMajuro, MH

Majuro HospitalMajuro, MH

Majuro HospitalMajuro, MH

Majuro HospitalMajuro, MH

Majuro i-iospitaiMajuro, MH

Majuro Hospitaliviajuro,W-i

,. —,---- 9 l_- —,A-lwrajurw n9spIm

Majuro, MH

Kwajalein HospitalKwajalein, MH

Majuro HospitalMajuro, MH

Kwajalein HospitalKwajalein, MH

Armer Ishoda HospitalMajuro, MH

Dept of HHS/Public HealthService, Bethesda, MD

Kwajalein HospitalKwajalein, MH

Resident NurseWalter Reed AMCWashington, DC

Private NurseUpton, NY

A%

PHARMACY

NAME

Jiri Cizinsky

Blanka Cizinsky

ADMINISTRATION

NAME

Peter Heotis, MPS

. . .....wmam Scott

TECHNICIANS

NAME

Robert Brown, Tech

Linda Cavaliere, RT

Helmer Emos, Tech

Lee Harris, RT

John Heinrichs, MS

William Lehman, RT

Fran Putnam, RT

Tonya Sheppard, RT

Veronica Simpson, RT

Hany Ulyat, Tech

S194, S196

S196

Consultant, MIMPUpton, NY

S192, F192, S193, F193, Admin. MIMP (from 1993)S194, F194, S195, F195, BNL, Upton, NYS196, F196

----- —.-r-

slw, l-l%? Actmin,MiMPBNL, Upton, NY

1=193,S194, F194,S195,F195, S196, F196

F195

S192- F/96

F192, S193, F193

S192

S/92, F/92, S/93, S/94

S192

SN4

S/94 - F196

S/92, F/92, S/93, F/94 - F/96

MIMPBNL, Upton, NY

MedicalBNL, Upton, NY

MIMP, BNLEbeye, MH

Honolulu, HI

MedicalBNL, Upton, NY

MedicalBNL, Upton, NY

Stony Brook Univstony Brook NY

Sacramento, CA

Long Island, NY

BNL, RetiredCfystal Rwer, FL

A-9

TRANSLATORS

Capelle DeBrum, Translator

Elsa Patton, Translator

Kosang Mitzutani

Sebio Shoniber

Pamela Hazel

Max Helkena

Estella Leviticus

Heddleson Jeadrik

Marie Laik

Linda Hall

F193- F196

F/96

S192

S/92, S/93, F/93, F194

FI$)3

F/93

S195

S/96, F/96

-,-- -,--WYQ, tlYo

F/96

Bechtel NevadaHonolulu, HI

Kwajalein, MH

Majuro, MH

Kwaiakin MH. . . . -. -. . .. . . . . . . .

Majuro HospitalMajuro, MH

Majuro HospitalMajuro, MH

Ebeye HospitalEbeye, MH

Becntei Nevada, i-ii

Kwajalein, MH

A-10

Appendix B

APPENDIX B

Individual patient ;(Ma=hallesej ) laboratory data collected during 1992

through 1996 medical surveys. (Identification ntiers 1 to 86 belong toexposed persons of Rongelap and Ailingnae; numbers beginning at 2102 belong tothe Utirik exposed;group) .

Abbreviations:

PID

WBc

LYF!PH

m2?o

SOS

BAso

PLT

Rsc

ms

-C

NOTES :

numbers from 805 through 1578 belong to the Comparison

Patient Identification Number

1 - Male; 2 - Female

years

White Blood Cell (leukocyte) count/pi

Polymorphoxauclear cells (neutrophil) count/yl

M forms/pi

L~hocytes/ pl

Monocytes/@

Boainophils/pl

Basophils/@

Platelet count ● 10’/pl

Rematocrit (percent)

Red Blood Cells (erythrocytes ●10’iI.Ll)

Nean Corpuscular Volume in fl (cu. microns)

R~oglobin level in g/all

Thyroid 8thmlating hormone level in pIU/ml

serum p=olactin in rig/ml

Fasting blood sugar in mg/dl

hanoglobin AIC (glYcOsYlated) in Percent

Random blood sugar in mg/dl

calcium in mg/dl

Total protein in gldl

Series of 9’s indicate test not performed or unavailable.

series of 0’s indicate test performed but results below lower

limit o:Edetection.51

COllPUTER LISTINO OF 1992 RAU DATA

PID

21456

789

14151617la19202123242733343637394041424445414a495361626364

..r 03666770717273747516177879838586

005

SEX AGE

11 :;1 761 391 391 722 401 582 622 451 782 412 591 431 442 401 422 511 642 402 821 461 582 521 61

79: 411 422 701 462 412 542 452 462 -62 732 682 jg

2 612 512 542 642 451 562 532 491 481 622 731 771 311 312 372 38

klBC

90001140011800

5700‘72009300

126008000700091005100680051007,200590061007700610069009000

105007400

10100760070005BO057005500

PUN

62105130d4962394468039065796!64043684277209140802805540030093294269531723519396063004440747438004270336429072475

99999 999996800 39445600 40326800 30607900 3871

12500 850010500 99999

6600 27125100 )734~:~~ ,*IIII.“.”7400 22207400 46625200 30686900 32436100 36604300 23659300 50227500 36757500 33007~00 54025700 23376600 2904

10200 49987900 45037900 53724200 99999

BAND

o0

141657

093

00000000000000

3150

20276

140000

LYMPH

18903990

5902337230432556174288032763549178516321785122418291708400427452070360021002590141428121820162425082365

HONO

90570

1062342144465126160

78728153544153504177610462

b::270735

Eos

8101254

0456

721488

370320

78546969544255

72767488539183690900

1050

BASO ‘PLT HCT RBC HCV HG!3 TSH

O 218 41.4 4.30 96.3 14.6 2.30114 233 44.4 4.97 69.3 15.3 999.99

0 207 44.3 5.23 84.7 15.3 .90114 250 45.6 4.57 100.0 13.3 999.99

0 265 47.4 4.93 96.0 15.2 3.1293 314 39.2 4.33 90.6 13.8 999.99

126 305 39.0 4.16 93.7 14.4 4.330 220 43.1 4.79 90.0 14.4 2.900 270 39.4 3.05 102.0 12.7 1.900 318 40.6 4.35 93.4 13.6 11.50

102 219 38.6 5.29 72.9 12.8 7.740 267 37.6 4.32 87.1 13.3 11.70

102 215 39.0 4.24 92.0 12.6 4.600 200 46.5 6.21 74.9 15.3 999.99

118 260 46.4 5.42 85.6 15.6 2.800 276 38.2 4.78 S0.2 13.2 999.990 207 45.5 5.28 66.1 15.5 6.680 282 43.6 5.02 86.8 15.5 .40

138 225 45.1 4.37 103.0 14.4 2.10270 344 41.2 4.52 91.1 15.1 35.40

0 245 32.3 2.98 108.0 10.0 5.70370 99999 99999 231 35.1 3.79 92.7 12.5 15.22202 909 0 187 37.9 4.11 92.1 13.0 1.50304 532 152 402 38.5 4.27 90.2 13.0 4.60140 630 0 279 36.6 4.10 89.3 12.9 2.70232 580 0 215 36.8 3.94. 95.0 12.1 3.80114 57 114 181 37.7 3.92 96.3 14.0 .12440 220 0 299 34.6 3.73 92.8 12.3 1.30

99999 99999 99999 99999 99999 999 99.9 9.99 999.9 99.9 50136 2176 272 204 60 247 42.5 4.31 98.6 15.2 3;60

o 1176 280 56 56 225 42.4 4.39 97.0 13.3 999.990 3400 0 204 136 299 39.3 4.50 87.3 13.2 500 3397 316 237 0 391 38.2 4.33 88.2 13.5 3:400 3375 250 250 99999 206 37.9 4.37 06.7 13,0 7.40

99999 99999 99999 99999 99999 246 38.9 4.41 88.2 14.1 999.990 3168 132 462 66 210 39.2 4.33 90.6 13.3 3.400 3060 51 204 51 210 38.2 3.83 100.0 12.1 21.60!?9914 i&9. . . ..- - ~J~ ~~~ ~ss 3s.1 3.82 91.9 11.6 999.99

148 4144 740 148 0 216 38.6 4.34 89.0 13.4 7.800 1850 444 444 0 245 41.1 3.99 103.0 12.9 17.300 1716 208 156 52 205 36.5 4.20 87.0 12.1 6.800 3105 207 276 69 237 39.2 4.2@ 91.5 13.8 6.30

122 1891 244 61 122 402 36.5 4.11 88.9 12.5 999.990 1290 430 215 0 200 46.4 4.85 95.6 15.9 1.90

186 2883 372 837 0 223 44.7 5.02 89.1 15.2 3.300 2925 300 450 150 257 40.2 4.45 90.3 13.1 11.800 3225 450 450 75 180 44.6 4.02 92.6 16.0 999.99

73 1314 292 146 73 263 45.0 5.03 89.5 15.5 2.5057 3135 0 0 57 259 38.0 4.06 93.7 13.5 2.90

0 2904 396 264 132 01 46.3 4.72 98.0 14.6 1.400 3774 612 714 102 158 47.4 4.87 97.3 17.0 5.70

79 2449 790 79 0 286 47.9 5.35 89.5 16.4 1.400 1896 158 395 79 220 41.2 4.59 90.0 12.7 3.10

99999 99999 99999 99999 99999 324 37.6 4.62 01.4 12.2 999.99

PID

611815816020822023825826827832833834835838840841843844845651865867079881882881808896911914920922925926932934938939942943944955959960963965966971977981990

10011007

. 1035

.

SEX AGE

2 38

: ::1 4)1 461 402 502 551 512 541 591 582 581 591 622 592 632 731 622 d22 592 642 371 591 581 802 622 522 392 511 602 672 412 412 672 672 59i 462 771 611 612 392 432 401 642 401 601 492 461 382 442 581 812 41

Wtlc

84005200740063005900710064003800960055006300660093009700

15000550081004700660061005200

PHN

4536306852541575277328403456i4325472215032763696660361115550258551842632435632332080

CO14PUTER LISTING OF 1992 RAW DATA

BAND LYMPH HONO Eos

840000000

960

12666

000000000

3276171613324284271424852432

9502880225524572244195325222850264022681692178218302496

336208148315413426384

76672305318198651582

1350110162188

“ 3?38305260

168104592126

01349

0342480

550

39693

4854650

165324141198671208

BASO PLT HCT RDC flcv HGB TSN

O 309 34.4 3.60 95.5 12.6 1.60104 223 47.1 5.12 92.0 16.2 1.20

74 255 41.5 4.45 93.0 12.8 999.990 266 40.2 5.09 94.7 16.7 999.990 253 44.6 5.03 88.7 15.0 .50 “O 258 43.9 4.69 93.5 15.5 999.99

128 297 39.0 4.53 86.0 13.7 999.990 151 32.3 3.64 88.8 10.7 999.990 283 42.8 4.59 93.2 14.2 999.99

55 250 41.6 4.89 85.0 12.6 999.9963 220 42.8 5.07 84.5 15.1 999.99

0 241 46.7 5.37 86.9 16.3 999.990 280 52.7 5.60 94.0 16.8 999.990 268 50.2 5.47 91.7 16.9 999.99

600 310 42.6 5.31 80.3 14.5 2.300 178 35.4 4.06 87.2 12.4 999.99

162 249 35.4 3.71 95.3 12.4 999.9947 175 42.0 4.28 90.0 13.2 999.9966 230 44.3 4.16 93.0 13.1 999.9961 305 33.5 3.30 102.0 10.8 999.99

156 246 37.5 4.05 92.5 14.2 999.998700 99999 99999 99999 99999 99999 99999 195 41.2 4.65 88.6 15.0 .036200 35967900 34765100 21426900 22086200 35968000 39206400 32499600 43205600 33607100 2982

10600 55126100 39046900 42097600 38007000 4620---->bUU 24646200 34109800 69588100 42127900 33189600 52607300 49645900 24198100 58325100 306088oO 5016

10400 582435200 29920

5700 23945500 24204400 23320500 5270

0 21080 35550 22440 33810 2232

80 29600 18240 33600 18480 31240 44520 i641o 18630 31920 1680

----0 44UU0 22320 20580 25920 37920 2784

146 16790 31270 1377

51 1224264 2816

0 31200 35200 2679

55 26950 17160 2805

186 186474 158357 255621 552248 124640 320171 342480 1248168 112497 355310 212244 244138 552228 228490 140

56 56G310 124686 0648 405158 632384 1056438 73177 177567 324408 408704 ,0416 936

1408 0627 0220 110

88 220255 170

124 323 38.8 4.46237 320 48.3 5.23102 193 49.0 5.70130 225 44.9 4.14

0 280 42.2 4.510 310 42.2 4.57

57 370 40.5 4.47192 267’ 34.5 4.11

0 177 42.1 4.537i 289 41.1 4.55

106 456 38.9 4.6761 146 40.6 4.7669 285 37.3 3.93

152 334 36.6 4.4170 168 37.6 4.35

. . m -.-114 dIu 46.6 5.45

62 330 37.9 3.9098 348 44.9 4.02

243 153 43.6 5.150 273 40.0 4.340 324 41.3 4.610 270 41.2 4.570 310 43.2 4.580 337 38.0 4.54

51 215 38.4 4.170 310 45.0 5.11

104 267 37.1 4.350 193 52.1 5.760 267 43.2 4.860 224 40.5 5.030 190 30.4 4.000 265 42.3 4.9Z

87.0 13.7 999.9992.0 14.8 999.9986.0 15.3 999.99

108.0 13.4 6.7094.0 13.0 999.9992.0 13.6 999.9991.0 12.9 999.9984.0 12.1 999.9992.9 15.0 999.9990.3 14.5 999.9983.2 13.2 999.9985.2 14.3 999.9995,0 12.3 2.4083.0 13.1 999.9986.4 13.3 999.9986.G i5.2 599.9995.0 11.s 999.9993.1 15.6 999.9984.7 15.6 .4092.2 13.7 999.9989.6 14.3 999.9990.0 13.1 999.9994.0 13.0 999.9983.7 13.0 999.9992.2 12.9 999.9988.0 16.O 999.9985.7 13.1 999.9990.4 18.8 999.9989.0 13.8..999.9980.6 13.3 1.3096.0 11.8 6.6086.0 15.3 999.99

COHPUTER L19TIN0 Or 1992 RAW DATA

PID

1036151915201524152515291541154215461548154915501552155615571558155915601564156715721573157721022104210521062107211021112113211421152124212621302132~!j;

2)3621382139214221412i442145214821492150215221512155215621582160

SEX AGE

1 401 492 611 492 491 452 642 391 782 501 391 491 622 471 442 422 392 68

2 432 381 441 422 411 402 611 901 422 631 852 412 421 781 381 392 462 402 392 3e1 422 432 731 431 411 451 701 822 46

50; 551 391 38

: :;2 42

WEIC

750056007700

106006000

1030010600

64001030011600

860010300

540077009200

1000011000

6600750073007400

1070012400

910066000700

1300015100

710010200

66008200

121009200830082005200-Lnn,“””790078007000

10400600065005100600065007900730058005600270072006400

Pnn

4275369646207314318072104452275252531424438661802646508255204400748040922415321244405457868060064158548159808154433155082442593466555980398444282288Kt&n-.w-4107483631507072300030552809210026654661518338283192!13442483456

BAND

::0

21200

10600

2320000

920

11066

0000000

0700000000

830

52y~

000

20800

530000

580

2772

0

LXHPlf

2700128826952544126020604982313641202204292432962430215625764000275019804350321220723745210825482310208836404832205933663696197843562116398422142392!~9~

3002234028702392240028601537288032502449153313342016137719442368

HONO

300336308742480824636320824464602515162231460600220

. 64$ 25365370642372455

0261780906426306

0344726920166246208Iao2374684~o624420390318240195474365232280135648256

EOS

75224

0106

1080206318192103

1044516309162154552800330198450365370856

124091

132783

24701057

2841020

330344121

920

1230208600474156560104

60195530180195237

73348112

0288256

BASO PLT HCT R8C

150 213 48.0 5.530 262 46.5 5.17

77 360 45.9 5.330 202 47.3 5.OJO 334 38.6 4.270 242 42.2 4.97

106 215 41.2 5.080 256 45.0 5.630 112 46.6 5.21

232 281 25.0 2.68172 318 .41.4 4.71

0 377 39.7 4.490 256 41.7 4.72

77 283 37.6 3.960 236 42.4 4.59

200 358 41.3 4.64110 345 42.2 5.24

0 209 38.3 3.940 265 39.2 4.48

146 327 35.0 4,06148 227 48.4 5.66

0 206 47.2 4.940 282 39.4 4.36

182 277 41.2 4.910 237 38.7 4.240 405 35.4 3.88

130 239 45.0 5.31151 240 38.4 4.41

0 255 32.4 3.030 447 40.3 5.19

132 318 41.0 5.4986 254 31.8 3.68

121 325 50.4 5.6192 240 44.7 4.9683 327 38.3 4.4682 200 37.2 4.2752 222 41.9 5.0976 321 42.0 4.80

0 304 39.8 4.360 401 37.8 4.390 321 34.0 3.600 194 45.0 4.87

120 999 39.2 4.820 J97 47.3 4.95

53 274 40.2 4.240 175 34.9 3.74

195 286 33.7 3.8179 1B8 45.1 5.36

146 269 39.9 4.410 223 44.4 5.610 257 50.3 5.03

27 121 45.5 4.7572 271 40.3 4.5964 304 42.0 4.71

flcv MOB TSH

86.8 17.0 999.9990.0 16.0 999.9986.0 14.8 999.9994.1 17.1 999.9990.4 13.2 999.9904.9 14.0 999.9981.0 13.2 999.9979.9 15.0 999.9989.5 16.8 999.9993.1 99.9 999.9988.0 14.3 999.9988.4 13.7 999.9988.3 14.1 999.9994.9 13.5 4.9092.3 14.8 999.9989.0 14.7 1.9080.5 14.3 999.9997.3 13.9 999.9987.6 13.5 1.3086.1 12.4 999.9985.5 16.5 999.9995.6 16.6 999.9990.3 13.9 999.9995.0 17.3 .6491.3 13.3 5.9091.0 11.4 .9084.7 16.0 2.9087.1 13.5 2.80

107.0 10.0 3.7077.7 13.5 1.80 .75.8 13.3 2.3086.4 11.0 .4089.8 17.9 3.0090.2 15.2 1.2085.9 13.0 1.5087.2 12.6 2.3082.3 14.5 3.0087.4 14.5 3.1091.2 13.6 1.7086.1 13.7 1.91-94.5 11.6 3.9092.5 16.0 3.0081.3 13.3 999.9995.8 )6.8 2.1294.9 13.7 1.7093.3 12.0 999.9988.4 11.7 5.3084.2 15.5 1.8090.4 14.8 1.2079.1 15.0 3.5686.3 17.5 .6095.8 15.8 1.5087.7 14.0 1.8089.0 14.7 1.10

COMPUTER L19TIN0 OP 1992 RAW DATA

PID

216221662167217121722174217621822188219321952196219722052206220722082209221022132215221622112220222422252226222722282229223022312232223322342215223622372239224422472248225022512254225622512260226122692211227322742277

.

.

SEX AGE

2 701 751 522 402 501 301 482 90

: ::2 622 762 391 671 701 432 152 432 382 3’92 712 72

2 592 632 692 452 402 422 462 562 502 391 401 391 501 461 491 4522 ::2 462 531 482 432 422 431 452 381 631 371 371 381 372 38

WBC PHti

10100 74740900 70317000 25906600 34406600 4554

10600 65724400 15846300 45365300 ~?06

6300 5;297900 45038900 53406500 41607300 4:078100 50227000 3150

11800 94407000 42005700 24518300 31548000 4320

13400 777216500 15345

6400 41606300 32139600 5568

BAND LYMPM

101 21210 16020 4130

232213! 1320

0 31800 23320 1386

53 148463 567

0 21330 18690 20150 24090 2268

70 2940118 1416

0 23100 2280

83 44820 2800

134 4824825 165256 1216

63 25200 3264

HONO

404267210430198212220315477252395267195365324280472

35:83

400402165512126

96

EOS

o00

2064396636

8863

0189

791424

130219405490118350570415400134

0192252672

BASO PLT HCT RBC ‘Mcv HCIB

O 271 33.5 4.150 325 42.9 4.85

70 217 45.3 5.20258 252 41.8 4.75

0 300 43.9 4.920 336 49.4 5.70

176 249 42.8 4.520 245 32.5 3.35

53 191 47.9 5.460 440 33.4 3.470 300 38.4 4.670 330 39.9 4.300 242 33.3 3.840 234 44.8 5.400 280 40.6 4.67

70 284 43.5 5.25236 407 35.3 4.08140 513 26.9 3.20

0 281 40.1 4.5683 326 37.5 4.42

0 333 38.2 4.41134 637 40.4 4.S7

O 245 38.4 4.1764 265 39.7 4.34

0 365 35.6 3.820 316 31.8 3.86

80.8 11.388.0 13.687.1 15.988.1 13.709.3 14.786.6 17.494.7 15.097.0 10.707.8 16.496.0 10.882.2 13.091.0 12.886.6 11.702.9 140886.9 14.282.9 14.686.6 12.881.9 9.007.9 13.184.8 13.086.6 12.6S4.5 13.992.2 13.291.5 14.193.2 12.282.4 11.5

99999 99999 99999 99999 99999 99999 99999 999 99.9 9.99 999.9 99.98800

11700640077007100860061006600970082005600650053008500

1120072009300530060006200

11300610074005400700053007200

4928 999996786 2342752 03850 04260 04644 03477 03894 666014 05412 03304 04160 02173 04250 1707616 03816 06231 02544 04140 03348 07119 04026 03922 02530 542590 999992173 04464 0

308033933200277224142838189121122813213216801040249111oo24642160195321731140217032771464273822143850243B2088

264702

128385284688366396485574280520232510560144651265240558339366222378560424360

528585320616142430366

0291

82280780371

1530448936372265360124565183444162

70159

72

0 320 38.9 4.67 83.3 13.10 999 39.2 4.27 92.0 12.90 265 40.0 4.61 88.5 14.00 326 43.6 5.21 83.7 14.50 409 44.0 5.57 79.0 15.1

TSH

1.944.50

.4046.50

1.702.47

.804.301.502.101.40

20.904.101.201.201.407.201.301.401.306.901.101.103.501.003.853.722.401.501.60 .1.101.50

0 258 47.0 5.06 92.9 16.1132 300 45.7 5.14 09.0 15.7

91 392 44.4 5.09 S7.3 15.80 397 44.9 5.26 85.3 14.6

56 381 43.9 4.87 90.1 15.10 323 38.5 4.36 80.2 13.1

53 235 35.4 3.76 94.1 12.6340 320 33.4 4.39 76.1 10.9112 309 41.8 5.03 83.1 14.0144 315 44.9 5.13 87.6 15.5

93 369 42.0 4.93 S5.2 14.953 366 37.5 4.71 79.7 12.7

120 404 28.8 3.42 84.2 9.80 236 46.4 5.64 82.2 15.60 322 35.0 3.95 88.5 12.6

61 257 47.5 5.13 92.5 16.50 273 47.9 5.10 93.9 16.6

54 350 47.5 5.31 89.0 15.20 305 50.0 5.85 85.5 17.5

106 255 48.4 5.56 81.0 15.20 285 34.9 5.04 69.2 10.8

0 180 51.1 5.19 98.0 16.1 999.991.803.70

.657,502.20

1:;:1.20

.301.10

15.106.401.502.401.002.301.302.701.121.201.37

[2”1 C-91 t“SO 02”S 6“S0 t9Z S91 SLz Ss !ssfI s9t S09C 00ss Ec I 9BSZ

lass em A3H Oeu Jon &’ld 0SQ9 S03 ONOH lMdl+A’30NQ13 Nbtd 3at4 a~v xzs ald

V&VO nVU Z661 JO 9NIJ,SI’1 k!if.tfldHOD

PID SEX AGE WBC

21415161718291

12 214 215 216 117 218 219 120 121 222 224 221 133 236 139 240 142 244 145 247 149 261 264 265 266 267 270 212 271 114 275 276 177 i78 285 186 2

816 2822 1823 1826 2627 1630 1631 1832 2833 1834 1a35 2838 1

40 630077 530040 450040 720073 520040 710059 780055 690063 840046 860070 840042 850060 870044 410045 740042 730055 540052 480065 850040 930046 ‘ 750053 600068 44oO42 940043 400071 990040 770055 590047 1150069 690040 870068 880052 610055 430046 600051 580054 1170050 800049 680063 ‘“--J*VV74 360018 122003e 730043 630047 660050 580056 880053 800054 650052 900055 610060 370059 810059 980060 0800

COMPUTER LISTING OF 1993 RAW DATA

PHN BAND LYMPH HONO EOS BASO PLT HCT RBC I’lcv HGB TSH CAL PHOS CALB AL1 AL3 BET GA!! NOSA AliSA AIIBC20981643 5;1665 04320 01560 04047 714602 04002 694360 03870 0)864 O5185 06177 02173 04366 04018 02862 023524930 a:5115 04725 759999 999922007520206454455390300955202622722138723355240840203480526552802856----31UU154875644599359143562900i89612001420I41O867961

,69019781400

000

990000

87000000000

7200

630

58

2772 315 252 63 207 43.9 4.543180 53 318 53 227 32.4 3.842070 270 45o 45 219 44.1 4.722440 144 280 0 221 42.9 4.572964 208 416 52 319 37.2 4.092485 142 284 71 300 40.8 4.40280a 390 0 0 166 42.8 4.742415 138 276 0 300 37.0 4.193528 336 84 259 33.0 3.524214 2;: 344 0 357 39.1 4.202604 588 1260 84 353 30.0 5.002465 255 510 85 207 36.4 4.191827 87 348 261 269 37.4 4.271435 123 164 205 154 30.7 4.061998 370 444 222 300 45.1 5.291825 365 438 0 309 34.9 4.382214 54 216 54 276 36.7 4.022112 288 40 197 33.4 3.792550 340 34; 255 166 36.0 3.923069 558 Ssb O 209 41.3 4.532475 75 260 35.0 3.659999 99;; 99;; 9999 380 38.3 4.2219801128230436631771253755203381104445762257146217402030503120803468----JIU4172832942263220515182436

132 lj2 O 238 35.0 3.9294 564 94 212 36.0 XXXX96 240 96 242 45.9 5.55

198 495 0 382 34.8 3.66154 385 0 206 48.6 5.01177 177 0 251 40.2 4.64460 0 211 37.7 4.28

0 34; 552 220 34.5 3.61174 174 0 408 27.0 2.99264 08 0 253 42.5 4.75183 305 0 307 40.7 4.31129 258 43 226 36.2 4.49240 0 0 402 30.3 4.23232 58 0 250 44.8 4.67351 936 117 200 43.3 4.88

0 640 0 255 19.2 4.35136 340 60 193 44.2 4.67---~zz 296 2oi 37.6 4.26180 36 3: 193 25.3 2.69366 732 244 234 46.0 5.14

73 219 146 274 39.1 4.62189 252 0 290 39.5 4.53264 264 132 239 41.7 4.76290 58 58 205 40.4 4.38

96.6 15.1 9.6784.3 12.1 3.6893.4 15.2 3.5193.9 15.1 2.0590.9 13.3 .0892.7 14.7 4.8090.4 14.7 1.5088.3 12.5 2.7696.1 11.B 1.5993.1 13.4 8.2674.8 11.9 1.4886.9 12.4 16.4587.5 12.1 .1675.5 10.1 1.1205.3 15.4 1.5279.6 12.0 12.2991.3 12.1 1.6788.2 11.0 1.9896.9 14.1 .8991.2 14.3 43.1995.9 12.1 6.6690.8 12.6 2.61

9.0 4.2 3.7 .3 .6 .7 2.2 09.3 4.2 3.5 .3 .6 .9 2.4 09.3 4.1 3.7 .2 .7 .7 1.9 00.8 3.9 3.4 .3 .6 .7 1.7 09.6 4.2 3.1 .3 .6 .9 3.2 0

3 .8 .9 2.5 0;:: ;:: ::: :3 7 1.0 1.8 09.4 4.1 3.5 .3 :7 .9 2.0 09.4 4.5 3.9 .3 .7 .8 2.2 08.0 4.3 3.4 .2 .7 .9 2.4 09.3 3.7 3.3 .3 .7 .8 2.3 08.6 4.6 3.8 .2 .6 .0 2.4 09.3 3.7 3.6 .3 .6 .9 2.0 09.3 3.6 4.1 .2 .6 .0 1.8 09.8 2.7 4.0 .2 .6 .8 2.0 06.2 5.2 3.4 .3 .8 .9 2.5 09.1 4.0 3.5 .2 .7 .9 2.2 09.0 3.7 2.8 .3 .6 1.2 2.6 09.o 3.5 4.1 .3 .6 .7 2.2 08.5 3.3 3.2 .3 .7 .9 2.3 00.9 2.7 4.0 .2 .6 .S 2.6 08.7 3.8 3.3 .2 .7 .9 2.4 0

89.4 12.0 1.5598.9 13.0 .0982.7 15.4 .0595.0 12.0 2.7597.0 16.9 1.6886.6 13.7 .1288.0 13.2 8.9495.5 11.3 56.6792.9 9.1 99.9989.4 14.5 .0894.5 14.1 13.4580.7 12.7 .0290.6 13.2 18.9896.0 15.5 .668B.8 15.5 1.9690.1 12.6 6.9694.7 15.1 4.4988.2 iz.1 1.2093.9 9.1 4.7389.4 15.9 1.9284.6 13.2 2,0187.2 13.0 1.0487.6 13.9 .5692.2 14.0 .84

8.5 3.0 3.6 .2 .5 .6 1.8 09.2 4.4 3.4 .4 .7 .8 1.6 09.4 3.7 4.3 .2 .n .8 1.7 09.0 3.5 3.3 .3 .9 .9 2.4 09.4 3.3 3.8 .3 .6 1.0 2.2 09.2 3.9 3.7 .2 .6 .8 2.1 08.8 4.0 3.3 .3 .9 1.0 2.2 09.0 4.2 3.5 XXX .6 .8 2.7 09.0 4.1 2.4 .5 .9 1.1 1$4 09.6 3.9 3.9 .3 .9 1.0 2.9 09.3 4.0 3.9 .2 .5 .9 2.5 19.2 4.4 3.5 .3 .6 .7 2.5 0

10.1 3.6 3.6 .3 .8 1.0 3.5 08.9 3.3 3.8 3 5 .6 1.7 09.0 4.2 3.3 ;2 :7 .9 3.1 08.8 4,1 3.1 .2 .7 .8 2.7 09.9 3.4 3.9 .2 .5 .7 1.0 09.3 3.5 3.5 .3 .7 .s 2.5 u901 3.6 3.5 .3 .6 .0 2.1 09.7 4.4 3.9 3 .9 .9 2.1 09.3 4.2 3.9 :3 .6 1.0 2.3 08.7 3.7 3.7 .3 7 .B 1.9 09.0 3.3 3.8 .2 :5 .7 1.5 08.9 3.2 3.7 .3 .6 .7 2.0 0

1056 960 880 0 0 333 35.5 3.98 89.3 11.6 1.61 8.8 3.0 3.5 .3 .6 .5 3.4 00 4640 80 80 0 273 43.5 4.90 88.8 1307 .99 9.2 2.6 4.1 .3

130 1430 65 390.6 1.1 2.8 0

0 216 32.1 3.44 93.4 11.4 .63 8.7 3.6 3.7 .2 .7 .0 2.0 00 3510 630 270 180 264 47.7 5.11 93.4 16.3 74 8.5 3.1 3.6 .2 .8 .0 2.5 10 3111 61 61 0 202 38.0 4.63 62.1 12.7 1:81 8,8 4.0 4.1 .3 .7

37 1295 185 148.9 2.2 0

74 222 43.2 5.23 82.6 14.3 .63 8.8 3.2 3.7 .2 .50 3321 162 0

.8 1.7 00 257 45.1 5.16 87.4 15.8 2.73 9.4 3.3 3.9 .3 .7 .9 2.3 0

98 3528 98 98 98 285 43.0 4.76 90.4 15.3 .53 8.9 4.0 3.6 .3 .8 .0 1.7 00 4048 352 0 0 220 48.1 5.20 92.5 16.4 .07 8.9 3.7 3.9 .3 .8 .7 1.8 1

0101110101011000

;o11100101111100100010io11101011010110

010111’01100

;o00

;o110

k11

;2

1111111111clo11111111111111

.

PID SEX A(JE WBC840 1841 2“.+o~a 2844 2g45 :

851 2~~~ :

865 2n&7 2---

868 1019 2881 1882 1883 1888 2896 2911 2914 2920 1925 2926 2932 2934 2938 2939 1942 2944 i955 2959 2960 2965 2966 1971 1977 2980 2981 1993 2998 2

lWO1 2inn~.“”, :

1035 21043 21505 2!506 21519 1!s20 21524 11513 11546 11550 11552 11553 11555 21556 21563 1

63 720060 570064 GZeo74 7600g~ ;~~~

83 11700~? eAnn..””59 6900~~ Q?nn----69 510039 110060 600059 560081 740063 800053 700040 610058 870061 640042 1090042 ‘ 670068 720068 920060 990047 570078 550068 640041 820044 570041 970049 780061 700050 680047 830041 950039 800046 650045 620059 7400g? ~~gfi

42 590058 750054 3900as 9999

.50 690062 Ssoo50 190040 800079 720050 160063 660041 910050 1030048 510057 5600

COHPUTER LISTINO OP 1993 RAW DATA

PHN BAND LYHPH HONO EOS DASO PLT HCT RBC Mcv MOB TSH CAL PHOS EALB AL1 AL3 BET CAM HBSA AHSA AHBC30243306---->~~o2660j:~~

6552lnAn-..”

2898Gncn----280536s034202912266444003150286749593712773936953240542864352394 99993080 554608 03772 03192 1145820 974446 04690 04148 04814 834045 05920 02990 13059043774 7:!gl~ Q

2773 04500 09999 99999999 99995106 0275Q 555214 09999 99!393960 724100 03960 07254 936695 02754 02408 0

26642052-...4Lbv4712~~~~

3393A41O. ..”

3519l~?n. ..”19B9~99J222021a43996296035702623304524962616227a324028522970

1008 576 ‘O 279 44.0 5.59114 171 57 196 36.5 4.12m-> . .- . .- .Llv 81v- Auq 257 35.8 5.83228 0 0 200 43.0 4.82~~~ ~~~ ;5 --’668 41.5 4.77

0 1755 0 252 29.0 3.39ceA ~g~● “. !3: ~~~ ~~,~ ~,~~

130 207 138 273 39.1 4.50~gg ~~~ Q 997 43.$ 4.52

204 102 51 ;;~ 14.2 4.69lJ A~~ !A~ j~g ~g.? A Ko----

360 0 0 157 47.4 5.51112 192 0 ~1~ ~~:? ~=$1~222 296 222 195 39.5 3.95320 240 0 224 30.2 4.29140 140 0 232 38.4 4.41305 61 244 262 40.9 4.62

0 696 0 265 34.3 4.030 163 40.9 4.44

3;; 2i{ o 390 39.3 4.77335 201 134 190 39.2 4.67288 216 216 264 35.2 3.67460 276 184 318 32.9 3.91495 0 0 163 36.0 4.21

70.0 15.580.7 12.693.4 12.590.8 14.367.G i3.607.9 10.3gg.~ 9.691.3 13.9an is.?a“.:89.1 14.2n~ A 11 7----- . . .86.0 15.4g~=~ i~,i99.9 13.889.1 i3.387.1 13.488.5 13.805.1 12.092.1 14.362.3 12.783.9 13.991.0 12.284.2 11.285.6 12.3

1.201.05

.241.40i.36

.99:.952.24

.C32.179 A6----1.24

.~~4.12

.671.8s

.451.25

.831.221.062.232.36

.07

8.8 2.4 4.1 .3 .8 .9 2.3 09.1 3.6 3.6 .2 .8 .9 1.6 19.7 3.9 3.6 .3 .9 .9 Z.2 i9.8 5.1 4*1 .3 .9 .9 3.0 0e.6 (.; 3.6 .3 .6 ..# i.$ iU.7 3.8 3.0 .3 .7 .0 2.1 0~o~~.~~ .;.;,~n ~~.~n “0.5 3.3 3.7 .3 .6 .0 2.2 0

*OGS.6 4.!3 3 .9 . 3 .9 .9 . . ●

8.5 3,4 3.7 .3 .6 .8 1.9 0g.: ~.~ J-g .- .6 .~9 ~=~ Q

8.7 3.5 3.0 .3 .7 .8 2.3 1gel ~.f ~.~ ,3 ,7 ,9 2,2 09.1 3.9 3.8 .2 .6 .7 2.7 09.4 4.0 4.2 .2 .6 .8 2.0 09.5 3.0 2.9 .3 1.1 1.1 2.4 09.0 3.9 3.9 .3 .7 .7 1.8 08.0 4.1 3.5 .3 .7 1.0 2.1 08.8 3.1 3.7 .3 .6 .9 2.4 09.1 3.3 3.8 .3 .6 .9 2.5 08.8 3.4 3.0 .4 ,7 .7 3.0 09.2 3.5 4.2 .3 .8 1.0 2.5 09.5 4.5 3.4 .3 1.0 1.0 2.5 00.4 3.7 3.4 .3 .5 .8 2.4 0

2964 114 228 0 222 48.9 5.83 83.9 16.4 1.85 9.3 4.0 3.9 .2 .82035 55 330

.9 2.20 222 34.0 3.69 92.1 11.8 XXXXX 8.5 3.4 3.3 .3 .6 .8 2.5

1472 128 192 0 114 35.7 4.29 83.3 12.6 .30 8.6 3.0 3.6 .3 .8 1.0 1.94264 82 82 0 291 37.5 4.14 90.6 12.9 1.95 9.3 3.7 3.7 .2 .8 1.0 2.11881 285 114 114 267 39.0 4.45 87.7 13.4 1.60 0.9 4.4 2.9 .2 .73007 291 388

.0 1.997 306 37.4 4.39 85,3 12.3 1.79 9.5 4.3 3.4 .3 .8 .8 2.0

2574 468 312 0 343 38.8 4.51 86.0 13.0 1.77 9.6 4.3 3,4 .22170 140 0

.6 1.0 2.40 217 39.3 4.20 93.5 12.7 .92 9.2 3.2 3.7 .2 .5 .8 2.4

2312 136 204 0 322 46.1 5.31 86.9 15.3 33 10.3 2.9 4.0 .2 .72490 332 581

.8 2.20 273 40.7 4.82 84.4 14.3 4:36 9.4 3.9 4.2 .2 .9 .8 2.5

4180 190 285 0 252 40.8 4.71. 86.6 14.0 .63 9.3 4.1 3.7 .2 .81520 480 160

,8 1.90 295 46.3 5.03 92.0 16.4 .49 9.1 3.3 4.1 .2 .7

3185 0 19508 2.2

0 264 39.3 4.61 85.2 13.3 1.21 9.3 4.2 3.9 .2 .52050 82 164

.8 1.70 277 38.0 4.60 02.5 13.1 1.,51 9.7 3.7 3.7

3256 148 0.4 1.1 .9 2.6

74 247 42.4 5.21 80.4 14.4 .61 9.5 4.1 4.0 .3 .92964 104 1S6 o

.9 2.3175 28.6 3.13 91.3 10.0 XXXXX 8.9 4.0 3.7 .3 .6

2773 118 177.8 2.7

59 285 39.7 4.57 86.8 14.O 1.10 9.1 3.6 3.0 .32475 300 225

.9 1.1 1.80 273 44.2 5.33 02.9 14.3 1.29 9.5 4.0 3.9 .3 .8 .9 1$8

9999 9999 9999 9999 211 37.6 4.18 U9.9 13.0 1.81 9.2 4.0 3.9 .3 .8 1.0 1.89999 9999 9999 9999 9$+9 99=9 9,99 999=9 99,9 99=99 99,9 99,9 99,9 xxx xxx 99.9 99.91518 276 0 0 320 46.0 5.09 90.4 15.8 .98 9.3 3.7 4.3 .2 .62420 110 165

.8 1.80 212 4!J=2 S,lli 80,3 13,4 ~,5i 9+5 3,2 3,9 3 .8 .9 1.9

2370 150 0 158 223 46.9 5.03 92.8 16.4 1.65 8.4 3.8 3.8 :2 .8 .8 1.89999 9999 9999 9999 262 46,5 5.94 78.2 1s.1 3.38 9.0 4.1 4.i .3 .6 .7 2.02736 288 144 72 84 37.0 4.22 87.7 12.6 99.99 99.9 99,9 99.9 XXX XXX 99.9 99.92584 380 456 0 322 37.6 4.26 08.2 13.0 1.93 9.4 4.1 3.9 .3 .7 .8 1.61650 396 594 0 269 38.2 4.37 87,3 12.7 .99 8.7 3.3 3.8 3 .71860 0 93

.9 2.40 319 39.8 4.27 93.2 13.5 .82 9.2 3.2 3.9 :2 .7 .8 2.4

2472 618 515 0 191 39.2 5.04 77.8 13.2 .95 9.3 4.7 3.5 .3 .81887 102 306

.9 2.051 240 36.2 3.90 92.9 12.3 2.21 9.3 4.3 3.6 .2 .6

3136 56 0.8 2.0

0 241 40.3 4.43 91.0 14.5 1.73 9.6 2.9 3.8 .3 .6 .8 2,1

000000000000000

00009

00

019000100

00iioc1~

oi

o~o0

1

:100111011100100001001111

:09

101090

00000

COMPUTER L1S71N0 O? 1993 RAW DATA.

PID SEX AGE WBC1564 21572 11573 11577 22102 12104 22106 12107 22108 12110 12111 22113 22114 12115 12119 22126 22130 22132 22134 22136 12138 22139 22142 12143 12144 12145 12146 12149 22150 12152 12153 12155 12156 12158 22160 22162 22166 12167 12}71 2-.-D.l4406 22174 12175 12176 12179 121s8 12195 22196 22197 22206 12207 i220!7 22210 22213 22215 22216 2

44 1290045 640043 690042 820049 880062 690043 1470064 1470049 550086 470042 910043 1140079 800039 1070057 680041 810041 920040 520039 690044 ,720043 190074 420044 720041 890046 800071 600083 650047 630051 900056 540040 430039 710048 410068 650043 120071 810076 130053 1090041 96005: 7ecG39 8100

0 999949 780042 860042 760063 630077 580040 150071 560044 980044 630039 680040 030072 1030073 12600

Pt4tJ BANO LYflPH HONO EOS BASO PLT HCT ROC HCV H(JB TS14 CAL PHOS EALB ALI AL3 BET GAH NDSA AHSA AHBC11094 0 1419 516 .0 331 39.3 4.39 09.6 13.3 .37

2880 64 2944 256 25: 0 224 46.1 5.38 05.6 15.4 .043105 0 2829 621 345 0 149 45.4 4.86 93.5 16.0 23.406068 0 1960 82 82 0 338 38.5 4.25 90.5 13.0 1.246160 0 2024 440 88 88 326 43.4 4.64 93.5 15.7 1.214485 0 1725 276 276 138 299 39.0 4.32 90.2 13.5 4.349999 9999 9999 9999 9999 9999 261 47.0 5.50 85.4 16.0 1.3673503025253850967182464071693400421263482548469242484s19231041765162404826406500403245002916249434792173325039604374306971945472~~:g

4374

00

47000000000

7200000000000

710000000co

9999 99995538 04386 864524 03150 02436 584050 03416 06956 03591 99994692 04150 06469 07560 0

4704192519273276342026403317244899992208182013802520252817222304284836082700247015123690216015052698139426652880299727012616

2106

1176110

940

45680

47:32436836462128s316

5::534616180260

63540162

86426246325

1::292327

243

9.4 2.8 3.7 .3 .9 .9 2.1 09.0 3.9 3.8 .3 .6 1.0 1.8 09.o 3.5 3.8 .2 .6 .8 1.9 19.2 2.4 3.3 .4 .7 1.0 2.9 18.7 2.5 3.6 .3 .5 .7 2.2 08.a 3.3 3.7 .3 .9 .8 2.6 18.0 2.5 99.9 XXX XXX 99.9 99.9 0

1176440

94637114560214476729276468

2070‘7t316

0

35:528360195630180108172426205130288406511763

1632:~~

1215

294 214 ]9.9 i.56O 219 38.3 4.420 307 32.4 3.31

91 371 41.7 5.27114 347 44.7 5.77

80 112 34.5 3.620 312 48.1 5.500 332 37.7 4.340 370 37.4 4.410 242 37.4 4.300 247 44.3 5.320 311 39.4 4.540 255 40.3 4.400 357 36.9 4.31

84 223 24.9 2.65216 250 44.7 5.03

0 346 45.3 5.410 202 49.4 5.09

180 299 40.9 4.310 137 32.4 3.55

63 272 36.7 4.1490 218 46.5 5.5854 257 44.4 5,0043 246 44.8 5.66

0 211 48.4 5.6441 115 44.6 4.85

130 296 38.2 4.320 288 43.8 4.92

81 305 35.0 4.300 234 43.4 5.030 250 45.0 5.200 308 39.5 4.49

7!3 303 3!?.t! 4.3:162 290 45.9 5.39

999.6 Xxxx 1.87 9.3 3.3 3.7 3 .8 .8 2.4 086.7 13.2 1.47 9.9 1.6 99.9 X;X XXX 99.9 99.9 097.9 11.7 2.30 7.5 2.9 2.8 .3 .7 .8 2.8 079.1 14.3 1.10 8.6 3.3 3.8 .2 .7 .9 2.6 077.5 14.9 1.54 8.9 4.6 3.8 .3 .7 1.0 2.1 090.4 11.9 .87 8.6 3.5 3.4 .2 .6 .7 2.4 087.5 16.0 2.24 9.0 3.8 99.9 XXX XXX 99.9 99.9 006.9 12.7 .61 9.0 3.3 3.5 .2 .7 .0 2.2 084.8 12.9 1.07 8.8 3.2 3.8 .2 .7 .8 2.2 087.0 12.6 1.74 8.6 3.7 3.6 .2 .8 .8 2.7 082.8 15.0 221 9.2 4.0 3.8 .2 .7 .9 2.6 086.8 14.1 1 52 8.6 3.2 3.6 .3 .7 .8 2.7 191.6 13.7 1.12 E.9 3.6 3.8 .2 .6 .6 2.3 185.7 12.4 1.44 8.8 3.2 3.5 .2 .6 .6 2.1 094.0 8.3 2.81 9.0 3.5 3.6 .2 .8 .0 1.8 188.8 15.8 1.33 8.6 3.4 3.6 .3 .7 .8 2.0 182.9 14.9 3.37 9.7 4.3 4.3 .3 .8 1.0 2.1 097.0 17.4 3.11 9.1 3.8 4.1 .3 .6 .9 2.1 194.9 13.6 2.12 8.7 300 3.8 .2 .7 .9 2.3 091.4 11.5 1.58 8.0 2.9 3.5 .3 .6 .6 2.1 188.6 12.9 .50 9.0 4.0 3.B .3 .8 .8 2.4 083.4 16.3 1.02 8.9 4.1 3.6 .3 .9 .8 1.9 088.7 15.8 2.31 8.8 3.1 3.9 .3 .7 .9 2.3 179.2 15.6 4.47 9.3 2.9 4,.1 .3 .9 .9 2.6 085.8 16.9 1.31 9.4 2.5 3.8 .4 .9 .8 1.5 092.0 15.7 1.22 8.8 4.2 3.5 .2 .5 .7 2.5 188.4 13.4 1.33 8.7 3.3 3.2 .4 .8 .8 2.5 089.0 15.4 1.18 8.9 4.4 3.6 .3 .7 .8 1.9 081.5 11.5 2.10 9.0 4.5 2.9 .5 1.0 .9 3.2 186.3 14.2 4.66 9.2 3.8 3.6 .5 .9 .8 2.5 086.6 16.0 .40 9.1 3.7 3.9 .3 .7 .8 2.2 087.9 13.7 30.98 8.5 3.6 3.7 .2 .8 .0 2.2 0an n 1* c * na g.~Z“.” **.-. .“” ~.~ ~+.~ g~~ ~~~ ~~.~ ~~.g Q

85.1 16.1 2.37 8.8 3.7 3.8 .3 .6 .7 1.9 19999 9999 9999 99991072 234 156 03526 258 258 01872 546 702 1562583 315 189 632146 232 870 583150 150 150 01904 112 224 02548 98 196 02079 189 126 2521836 136 136 03486 498 166 833193 309 309 03024 630 1134 252

999 99.9 9.99 999.9 99.9 99.99 99.9 99.9 99.9 xxx xxx 99.9 99.9 9220 43.3 4.63 93.6 15.0 .77 9.9 4.5 3.9 .2 .7 .7 1.6 0235 45.9 5.55 82.7 15.6 .91 9.4 3.4 4.2 .2 .S .8 1.5 0179 49.5 5.59 88.6 16.8 .94 9.0 3.3 3.8 .2 .7 .9 2.1 0336 37.7 4070 80.2 13.2 2.07 8.7 3.8 3.8 .2 .7 .8 1.4 0275 34.9 4.03 86.7 12.3 5.70 9.1 3.4 3.5 3 .7 .8 1.7 1244 36.0 4.27 84.2 12.7. 2.68 9.0 3.3 3.1 :3 .7 1.0 2.3 0255 40.7 4.69 86.8 14.2 .66 9.0 3.8 3.9 .3 .7 .7 2.1 1288 45.1 5.36 84.1 15.1 1.07 9.0 3.7 3.9 .3 .9 .8 1.8 0408 37.7 4.48 84.2 12.9 1.24 9.3 4.3 3.5 .2 .6 .8 2.4 0292 3S.9 4.41 88.3 13.2 1.59 9.0 3.6 3.6 .2 .6 .8 1.9 0290 37.1 4.40 84.3 12.4 40 8.6 3.2 4.0 .2 .6 .9 1.9 0351 39.7 4.64 85.5 13.3 2:79 8.8 3.4 3.5 .3 .8 .7 2.2 1730 40.5 4.85 03.5 14.0 .36 9.0 3.8 3.4 .3 .7 .0 3.1 0

1001101101000001000000010010001

“oo010001~

o91111010010101

111011

:1100111110111111111111111111010]

1911)1111001191

22

PID SEX2217 22220 i2224 22225 22226 22227 22228 22229 22230 22231 22232 12234 12235 12236 12231 12239 22242 12244 22245 12241 22248 22250 12251 22254 22255 22256 22257 12260 22261 12269 12271 12273 12274 12277 2

COHPUTER LISTINO 0? 1993 RAW DATA

AGE WBC PHN BAND LYHPH MONO EOS BASO PLT HCT RBC Ucv HGB TSH CAL PMOS CALS AL1 AL3 BET OAH HBSA AHSA AHBC6900

:: 730070 640095 890040 760043 950047 1690057 740051 6600

40 550041 780051 8000

46 860050 650046 910042 570039 700083 1840039 999941 ,860054 660049 670044 1060043 560039 820044 730046 570039 860064 540030 950038 106039 1410038 740039 11800

5340 055483712 6:6400 04560 765130 0

10816 1693626 04356 03685 03666 785520 05504 03055 09999 99993363 1144410 0

16192 5529999 99994988 864148 683350 06572 03360 041005037 7!2679 04042 863132 05605 0

562 010857 0

3700 748260 0

3471 89 0 ‘o 265 37.1 4.04 91.9 13.0 2.07 9.1 4.3 3.4IJ87 73 146 146

.5 1.0 .9 2.9270 39.5 4.28 92.2 13.9 4.26 8.7 3.9 3.7 .2 .6 .0 2.5

2176 256 192 0 325 34.7 3.71 93.5 11.9 1.26 8.0 3.3 3.9 .3 .8 .0 1.01780 356 356 0 306 33.2 3.85 83.7 10.8 3.19 8.0 3.5 3.0 .3 .7 .9 2.72584 >o~ 76 0 337 38.7 5.21 74.2 12.6 3.25 7.5 2.7 3.2 .3 .7 .9 2.83990 190 190 0 324 34.1 4.36 78.2 11.0 3.04 8.5 3.7 3.7 .3 .7 1.0 2.54901 845 338 0 363 39.4 4.63 85.2 13.5 1.03 8.2 4.3 3.5 .3 .0 .9 2.23108 296 370 0 245 40.8 4.60 88.6 13.9 1.25 8.9 3.9 3.6 3 .6 .8 2.31716 264 264 0 293 43.6 5.27 02.8 14.2 75 9.1 3.6 3.9 :2 .7 .9 1.91485 220 55 429 41.4 5.)3 77.6 13.9 :66 8.8 3.9 3.9 .2 .6 1.1 2.73120 624 31; O 999 52.1 5.48 95.1 17.8 4.03 8.7 3.6 3.5 .3 .5 .8 2.42160 240 80 0 324 44.5 5.12 87.0 15.5 3.75 8.8 3.7 4.2 .2 .7 .7 2.32666 172 258 0 278 42.8 4.89 87.6 15.1 .70 8.9 3.2 4.2 .3 .7 .9 2.62860 130 455 0 312 44.3 5.31 82.8 15.1 6.29 9.4 5.1 3.9 .2 .9 .8 2.99999 9999 9999 9999 335 38.1 4.21 90.5 13.2 1.24 9.2 308 4.1 .2 .1 .7 2.51710 171 342 0 201 33.3 3.83 87.0 11.4 1.29 7.9 3.0 3.6 .3 .7 .8 2.12450 0 140 0 274 42.0 4.52 92.9 14.6 1.08 8.9 3.9 3.9 .3 .6 .6 1.91472 9999 184 72 29.8 3.30 90.2 10.5 99.99 6.8 4.4 99.9 XXX XXX 99.9 99.99999 9999 999

!999: 999 99.9 9.99 999.9 99.9 99.99 99.9 99.9 99.9 xxx xxx 99.9 99.9

2838 86 60 0 240 36.3 4.44 81.8 11.7 .75 8.9 3.8 3.5 .3 .9 .9 2.62106 204 204 68 314 41.7 5.11 8106 14.1 0.00 9.4 4.3 3.52144 536 610

.3 1.2 1.1 3.20 278 44.1 5.00 80.1 15.2 .92 8.2 3.6 4.0 .2 .5 .8 2.0

3180 424 318 106 387 41.6 4.68 88.9 14.3 92.84 8.2 3.5 3.9 .2 .8 .9 2.81848 168 224 0 378 39.7 4.99 79.6 13.4 3.57 8.2 2.0 3.9 .3 .9 1.0 2.73444 164 410 02 224 39.9 4.65 85.7 13.4 1.58 8.7 3.2 3.8 .3 .7 .9 2.21825 0 365 0 473 22.3 2.76 80.7 7.6 .46 6.6 3.0 2.7 .3 .8 .6 3.52337 570 114 0 242 43.4 5.28 82.2 14.8 1.05 8.0 3.6 4.1 .3 .7 .8 1.53704 86 430 172 346 40.0 4.72 84.6 13.9 1.31 9.3 3.6 4.1 .2 .8 1.0 2.02052 54 216 0 211 48.3 5.23 92.3 16.7 3.00 8.1 2.9 4.1 .2 .5 .8 2.32850 180 475 190 271 46.4 5.05 91.0 16.1 1.55 9.0 3.6 99.9 XXX XXX 99.9 99.9

360 85 42 11 306 44.3 5.18 85.5 16.1 2.61 9.3 4.4 4.o .2 .6 .8 1.72397 705 141 0 337 51.6 6.13 64.1 17.3 1.32 9.3 308 4.4 .3 .7 1.0 1.82960 592 74 0 294 46.4 5.37 86.4 15.6 J.75 9.0 3.1 4.2 .2 .5 1.0 2.03422 118 0 0 188 37.1 4.77 77.7 11.8 1.89 9.6 3.7 3.7 .3 .7 1.0 3.4

ao00100000000000099100

:1010010000

010100001000101119900311010

:01010

100010010

;1111119911000

;11111011

0

z

COMPUTER LISTING Or 1994 RAW DATA

PID

2

;6789

i615i6171819202121232421333637394042444547404953616364656667

“ 7071727374757677788183g~86

QQ~

816~~~823

SEX A(3E

1 411 411 41

43; 742 4i1 602 6;2 41: 792 432 611 451 462 622 56

: ::1 662 ‘411 471 602 541 692 421 442 711 482 452 562 472 482 152 102 412 6922 ::2 662 411 502 552 511 501 642 15

2 48

1 39! ]92 402 402 44i ~~

40

1

WBC

690011800

540052006400----Y3VU

10900..#.#.❑ ouu

10600~~~~

6500860061008400660046007500540096009200920042007500440084006200780092006500640075008100

PHN BAND

4416 07670 999991944 0.——2704 99!39’33264 64---->ii38066 21:. . ..-*u*a 666042 0*C,.3339 G3445 05292 999993904 999995292 03894 02024 03675 03456 05472 05000 01268 03234 423000 999991760 445040 843286 999994446 999996440 923445 03904 04200 03321 0

LYHPH

179421242052i7161856----4bYl1635. . . .SIJO3922**-I-L4tu24702520170821001518216233751890336027601564

7144125158424362232273020242470204820253402

MONO Eos BASO PLT HCT RBC Hcv NOB

207 483 0 188 43.8 4.62826 826 236 208 47.5 5.35486 810 0 202 46.0 4.99728 52 99999 199 45.9 4.92384 768 64 325 36.o 3.97. - - - ~-- - - -

lui$ 41Y IUO 3i4 37.0 4.i3i654 327 0 163 44.2 4.91#.. . . . . a--a- . ,.-40s &vq 7YYYY L&v 46.; ;.ci%

318 318 0 330 39.8 4.34..n.a.J Lu m .“.tno u L&a 59.9 5.;2130 455 0 209 37.0 4.40336 84 168 278 38.6 4.46305 122 61 217 44.9 6.06504 420 84 228 .41,6 5.69

0 1188 0 249 34.9 4.4992 322 0 231 37.8 4.21

300 150 0 229 45.1 5.290 0 190 41.3 4.78

M:: 384 192 176 39.0 3.98216 276 0 321 40.1 4.47184 92 92 236 34.8 3.63

42 168 0 119 33.2 3.68225 150 99999 374 37.3 4.19264 616 132 202 38.2 4.35336 420 84 171 39.3 4.11434 248 99999 237 48.5 5.82468 18 78 266 31.6 3.47368 1840 92 203 47.7 4.97520 0 65 251 39.1 4.16320 64 64 220 42.9 4.91450 600 3 341 39.4 4.42729 648 0 79 34.2 4.06

94.088.792.293.290.8~~.j

90.193.591.8;3.786.086.574.183.777.889.785.286.398.109.895.890.385.087.995.583.491.295.994.187.389.284.2

15.4[6.J15.8L5.913.013.615.2i3.513.212.1313.2:3.5,4.96.411.9,2.94.8,4.74.64.2,1.7!1.52.913.314.96.52.5

,7.53.74.63.52.0

6000 3120 99999 2460 99999 420 99999 189 40.6 4.64 87.6 13.7580061008900620055001200

83006200

11300930070005600640063005800@Jo~7900h70~

9200llQQ4200

2745 03551 03026 999993410 02860 99999--.-Julo5395 8;4712 6262155766 9;3640 03696 03008 2563654 02378 0~~i~ Q5293 025gg 99999

4324 0~~g~ Q2604 0

317222114806198422552606215810543729223223801344256022682784i99~189634il

2668i~An1176

TSH

5.427.827.432.592.78i.5i1.152.ii2.037.6;3.480.00

381:48

1:::5.031.601.84

36.1461.35

5.411.94

. 152.08

.53

.48

.961.061.682.87 ‘

11.651.58

61 0 122 196 36.6 3.94 93.0 12.6 999.99134 737 67 261 31.6 3.58 88.2 iii 8.73712 356 99999 181 37.9 4.22434 248 124 203 39.5 4.19110 165 110 191 39.4 4.99. . . .Zmlq- Jov 72 266 3S.3 3.S9498 166 0 369 37.6 4.21310 0 62 237 46.6 4.93339 1017 0 193 44.8 5.04

93 1023 93 223 40.1 4.55560 350 70 169 42.4 4.62392 112 56 234 38.6 4.41320 192 64 279 35.1 3.74189 189 0 263 40.4 4.47232 406 0 138 47.9 4.92~~~ ~~6 ~ i’9fj ~~e~ ~=~i395 316 0 263 38.0 4.51260 469 g$?ggg ~az Jl:a 4,6J644 1564 0 229 37.5 4.27300 ~a~ i~~ ~~~ QJe~ 4.gfi

84 294 42 192 42.8 4.67

89.894.279.0at a----88.094.688.880.291.787.698.390.497.4Rq=~84.200,187.8al:a91.6

3.2 2.313.7 5.824.0 0.002.7 3.33

2.9 35.156.4 ,456.3 743.4 :72

,4.1 2.98,3.3 1.672.4 5.023.7 2.39

,7.5 2.60~.~ i,Ali

,3.3 2.63!~,4 i,s4

13.1 .79!~=~ ,46[5.1 .46

.

PID

825830831832833a34835838840841843844845864865867868081802896911914920g~g

931$;~

934~~~

93994294495595996096)966971

“97798098198699J998

10011007103510361519152415411542155015521555

SEX Aal?

2 521 551 542 561 611 602 601 611 642 612 652 751 641 602 612 651 711 611 602 ’542 412 591 622 :31 40~ gg

2 69~ f~1 482 791 692 4122 :;1 661 621 51

.2 482 411 402 392 472 462 601 832 431 421 511 512 662 411 51i bi2 51

wBrl

620066006300770044008000

10900730072005900550049008100

10600750083005400660052000800480083005000c~nn.“””6800annn.“””

79006500640062008200

PHN BAND

2914 04422 999993087 634389 02156 864800 06213 04964 04176 03835 02640 5525975427 8!51945625 7;5063 03132 03498 02600 04488 082736 04891 02000 50>cAn.“.” c3876 99999IAll Q. . . .3819 0ls~a ~3520 03658 05240 99999

2790158423312695109226403052197124481652214518622268466412752988

9182244202833441392199225003C-4.-..

2380‘)AR9..”.

2211~~~Q22401s602214

COMPUTER LISTINO 0? 1994 RAW DATA

nnNn

310264441385264320436146360110165392324530375

83486330

b645283045s1

186 0 255 39.4 4.54264 66 230 41.8 4.51315 63 226 45.9 5.06231 0 213 40.2 4.97

0 214 43.2 5.2224: 0 241 45.2 5.13981 218 248 40.2 5.42146 73 202 48.1 5.19216 0 256 42.3 5.48295 0 193 38.5 4.44440 55 217 36.4 3.83

0 49 183 36.8 4.070 0 209 41.9 4.84

212 0 224 435.8 4.13150 0 381 33.9 3.76

0 03 207 40.7 4.43810 54 162 40.9 4.13528 0 142 47.3 5.35208 0 119 46.4 5.73176 176 216 41.5 4.86192 96 200 39.2 4.50830 0 218 34.2 4.05

204 272 99999252 ln99 ?~.“..134 469 67

~~ ~Q~ gQQg+g128 448 0240 434 0410 82 246

1:

86.7 13.492.6 14.790.3 15.560.8 13.302.7 14.788.2 15.789.0 17.692.6 16.577.2 14.186.6 13.295.1 13.190.4 12.286.5 14.286.7 12.090.2 12.391.9 14.986.5 14.1S8.5 16.180.9 16.085.3 14.587.0 13.884.4 12.3

~su

2.201.381.613.131.293.291.38

.69

.571.57

.991.382.361.281.99

.411.771.30

.601.73

.451.12

13 39.1 4.33 90.4 13.8 999.99!5 :,Q9:5.5 g~.~ :~a~ :.45i3 44.4 4.88 91.0 15.9 .99!g 16 1 1 a= 01 n II n 9 7A-“ . - - . .- . . . . .< .“ -. . -14 33.7 4.11 82.0 11.9 2.84is ~~:~ ~<~g n~e] !~:g ~=!616 49.1 5.82 84.3 16.S 2.17i7 33:6 3.69 91.1 11.6 87.41il 43.6 5.24 83.2 15.7 .28

9400 99999 99999 99999 99999 99999 99999 257 39.8 4.35 91.6 14.2 2.457700 4851 0 2541 0 231 77 233 31.8 3.79 83.8 11.3 2.288900 99999 0 3827 267 89 0 241 30.2 4.50 84.8 13.1 2.149400 5828 0 2914 470 94 94 222 44.6 5.05 88.3 14.9 2.715000 2992 44 1144 88 88 44 198 41.2 4.47 92.1 14.2 1.209700 5020 0 3395 194 97 194 323 43.6 5.06 86.1 15.2 1.97

11600 6728 0 3480 232 928 232 247 33.8 4.03 83.8 12,0 3.646600 3166 0 2772 396 198 66 247 41.3 4.75 86.9 i5.i) i.586700 4950 0 1340 268 134 0 204 45.2 5.03 09.9 15.9 .90

99999 99999 99999 99999 99999 99999 99999 999 99.9 9.99 999.9 99.9 999.997100 3195 0 2911 355 639 0 205 30.6 4.67 82.7 13.6 1.821500 4275 0 2700 225 225 75 64 38.5 4.68 82.2 13.7 1.786300 3024 0 2898 109 189 0 173 37.9 4.77 79.4 13.0 1.49

99999 99999 99999 99999 99999 99999 99999 999 99.9 9.99 999.9 99.9 999.999500 5890 99999 2755 285 380 190 305 43.2 5.04 05.8 15.1 1.256400 3960 o“ 1728 640 64 0 145 48.8 5.00 84.1 17.0 1.354800 3264 0 1200 2B8 48 0 223 46.6 5.20 89.6 16.1 .578200 4i82 o 3444 164 246 164 181 47.9 5.22 91.7 16.7 2.459100 4368 0 3094 637 1001 0 261 39.8 4.55 07.5 13.3 2.096iao

i76go 34i6 427 427 0 135 42.6 5.42 78.6 15.0 1.31

10100 99999 99999 99999 99999 99999 99999 302 12.8 4.16 09.2 12.8 2.04----- -..>Vuo Z>uu 50 ---

ijoo---3>U --—15U 50 i~i ia.d ~.~si 86.3 ii.9

9800 6566 0i.~a

2450 294 294 196 221 41.0 5.31 77.3 14.0 .67

1556155815591564156715731s7721022104210621072108211021132114211s2117711Q-.@-2126~!~a213221342136213821392142214321442)45214821492150215221552156215821602’1672171217221742176217921882195219621972206220722092210221322152216

.

Ecx A(3E

2 492 442 412 452 401 442 431 502 631 442 651 501 872 451 801 402 64~ SQ2 482 ‘422 412 411 442 442 751 451 421 47

: ;:2 481 5211 ::1 492 692 441 542 422 521 401 501 431 432 642 782 411 721 452 452 402 412 732 74

rllUDllIFEn I.lRTINfl Q! ~~~~ ~~U Q~~~----- - . . . . - - - - - ..-

WBC PnN BAND rYMPM—-. . . . . . nc)no Eon BAEQ PLT uc~ n~c ncv wan TEI!

4200 1306 42 247fl 04 210 99999 223 36.8 3.96 93.0 12.9 3.6610100 6464 0 2826 101 701 74 110 40.1 4.50 89.2 14.0 1.06

8!00 2997 99999 4293 567 162 99999 210 43.3 5.48 79.1 14.0 1.768300 3735 0 3735 415 332 83 234 40.0 4.68 85.4 13.8 .177500 4500 99999 1000 450 600 150 249 36.8 4.29 85.8 12.8 1.226000 1 99999 0 0 0 99999 166 48.0 5.17 92.6 15.9 11.978700 60(33 O 2262 261 174 76 294 39.4 4.40 89.6 13.7 1.218300 4570 0 3150 4150 0 664 283 45.4 4.91 92.4 17.0 .96

99999 99999 99999 99999 99999 99999 99999 999 99.9 9.99 999.9 99.9 999.9911200 0064 224 1904 224 784 0 255 44.5 5.41 82.3 16.6 1.3212100 6413 0 4235 242 847 363 217 36.6 4.24 86.4 12.9 2.30

6900. 3795 99999 2553 207 207 69 201 42.2 4.86 86.0 15.2 2.326900 5509 207 690 414 0 0 330 25.3 2.45 103.1 0.8 21.686700 3283 0 2600 335 402 0 285 39.6 5.17 76.6 13.4 2.42

10500 7245 99999 2310 420 525 99999 211 36.1 4.17 86.6 12.6 1.5014400 9936 0 3456 720 208 0 282 50.6 5.76 87.9 10.1 2.84

0000 4800 160 2640 240 00 80 273 42.1 4.70 89.5 15.2 2.54~~QQ ~~y~ ggg~g ~~~~ 113A ~Qjg Jig Ilio dn.11 A.13--- .-.- ...- ~($.~~~c~ ,g~8400 4956 84 2608 “-ii;i 504 0 362 37.6 4.36 86.3 13.0 .867000 4992 0 !7~6 >90 624 18 ~11 ~7,a ~e~9 a6,2 13,0 2.295900 3540 0 1947 236 177 0 224 41.7 5.13 01.3 14.8 2.576600 3762 19B 1848 660 66 66 204 313.7 4.57 04.6 13.8 1.077500 5180 1730 3900 525 130 250 42.9 4.66 92.0 14.8 1.028100 5430 9999; 1940 2592 3321 99999 315 36.9 4.31 85.7 13.3 1.366400 3520 99999 i470 4096 4480 384 278 33.4 3.58 93.3 11.5 5.156000 3540 0 2160 240 60 60 216 41.0 4.31 87.1 14.9 1.237100 4615 0 1917 355 213 0 261 42.5 5.17 82.3 14.0 2.35

99999 99999 99999 99999 99999 99999 99999 999 99.9 9*99 999.9 99.9 999.99700059009400980051006000420081007800830079006200950063000400580071000600710058008400

10200530088008600

11600

39202300 9999;4512 00036 9820563300 999;:2940 424212 0475e o5093 043603100 9999;4940 999994030 3784200 043190 04686 05680 999994050 999993070 999995124 846732 999992010 9999946644730 999::7076 0

238027103102

98016321980

672307821842J242964298023801830344420881420189028402200294025502010290429203016

420 210 70 337 39.2 4.143835 1062 354 152 33.9 3.69

376 1316 94 200 35.3 4.05392 294 99999 196 48.8 5.01357 102 102 230 44.3 4.97

2000 1440 99999 190 49.1 5.79

546 42 0 117 41.8 4.66

162 486 162 286 37.6 4.30468 390 0 310 41.8 4.78

03 99999 99999 212 41.5 4.71312 156 0 244 38.0 4.41372 372 99999 214 40.2 4;56

4465 1710 99999 266 45.4 5.31819 1197 370 254 43.1 4.61168 504 99999 245 51.1 6.23406 56 0 161 44.7 5.13355 639 0 284 42.0 5.24

2216 3698 2924 294 37.2 4.16497 497 497 216 35.6 4.29

1602 1334 1334 202 39.1 4.55168 84 239 44.1 5.29

20: 612 102 411 32.0 4.20265 2226 99999 220 37.0 4,35704 264 0 295 30.0 4.56

5934 1462 774 34 40.1 4.721160 232 116 693 37.9 4.58

94.791.807.284.089.184.809.787.407.488.187.988.285.593.502.087.280.189.403.086.083.676.787.003.384.982.8

3.02.02.46.66.27.54.42.7

,4.35.613.314.016.115.317.515.614.113.1~2.814.415.110.913.613.013.513.2

Z.QJ3.57 .Z.72

.77

::!.44

1.141.911.19

37.9130131.02

.651.231.33

.896.782.55

.901.861.05

.97

.37

.101.44

COHPUTER LISTINO Ot’ 1994 RAW DATA

PID

221722202224222522262227222822292230223122322234223522362239224222452247~~~~

225199GA----

2255

22712273227422172548

SEX noc

2 612 652 712 412 412 442 482 502 522 411 421 521 471 512 431 401 402 40I ,5!!; 45~ {~

2 402 ~s1 411 651 401 191 391 392 401 39

WBC

660071001600750073009400

13300780069006300

127000800830086007000610080007900qnnn,.””7400R&nn----

7100690034005700580060007200750089007JO0

P

343337

iN BAND LYHPM HONO , E08 BASO PLT IICT RDC

)8 13217 010 608iO of2 o)5 o10 99999,2 7013 13018 631314 8:‘9 83‘2 o‘o o2 00 00 0A c

,; o!g ~g

11 0to 9999914 9999919 010 0!0 9999916 00 99999,9 011 0

2376 330 198 66 247 30.1 4.292637 710 426 0 230 41.8 4.642740 3496 4636 99999 313 33.4 3.611425 300 225 0 288 32.4 4.062190 219 73 0 232 38.0 4.982625 225 22s O 320 34.9 4.553720 8911 5320 1729 334 39.B 4.602806 312 312 0 259 43.0 4.062415 0 345 69 311 44.2 5.401197 126 0 366 38.1 5.033040 7% 127 0 201 49.5 5.262112 440 8S 314 44.0 5.252573 498 2:: 166 21s 41.4 4.731970 258 430 172 287 40.3 4.992030 350 420 70 305 37.6 4.301159 122 427 0 234 43.6 4.882240 400 160 0 200 47.3 5.071900 .4 77 2520

t66 220 29.7 3.74

-ant.“.” ~~: 7? ~~~ :?*Z ~.$~

1776 2:: 814 74 300 30.0 4.13ta~n 11~ ~~~---- --- ~g ~~~ la 1 A nn-- . . . ---1988 568 213 0 170 39.1 4.60~~~Q ~9~~ 9~~ ~a~ ~~7 ~J=~ ~=~71122 306 99999 99999 220 99.9 5.322200 570 171 0 163 48.0 5.361624 464 174 58 233 41.9 4.522100 2160 720 99999 299 47.1 5.502232 144 216 72 261 48.7 5.793680 99999 1125 99999 271 43.4 5.141869 356 267 89 198 40.5 5.441533 438 292 146 248 45.3 5.09

Mcv Nan 7S11

08.9 13.4 2.2390.0 14.0 4*O892,4 11.5 2.1179.9 11.0 4.3a76.3 12.6 3.7076.6 11.4 2.0585.1 13.8 103388.4 14.7 23.0081.8 15.0 1.0775.7 13.0 .9794.2 18.0 3.2505.4 15.7 7.0187.5 14.6 1.4380.7 14.2 4.3487.5 13.4 2.1509.4 15.7 1.2693.2 16.5 1.2079.4 9.9 1.12ml a *E 1 * nA“a.” ● “.* ..”.92.1 13.6 56.86as a li.1-- . - .- . - ~.~y

05.0 13.9 .93n~,a 9!6 ,9100.4 14.7999.9991.0 16.8 2.9592.6 15.0 2.0084.4 16.0 1.850401 17.3 3.2484.5 15.2 1.5174.5 13.2 2.2989.0 15.7 1.77

6“666“666“666’121“96“666“661“66“SO“PZ9“)1C“)I1 “112“96“$S“s----V“U6[.5Z.ZI1.)L“66.1SS“19.CL“91Z“L6“668°CI“Le“rC“II?“9[“$L-SC.CL“89.0~“L6“66

O“c1“6

I“LZ“8s’s

.

:“$2*“*Z9.010“06.660.s8“11L“Ct9.10.9‘lIld

L-t 9.C 6“6 ZI”I S“S1 Z.Z6 10”S 9“? ZCZC-C 6°C 6“6 26” C“tI 6.00 6Z”t I.OC 9Lt2“) 6“Z 1.01 CO-I L“CI 9*LO CO”) C*Z) [It1“) 9’C 9“01 LL”t }“CI S“L9 PC”) O“SC OtZZ“} Z.C S“6 09” 8“S1 L.06 LL”b C“Ct 1129°C O-Z Z“6 09. O.ZI S“S9 Ct”t 6“LC L9Z6.66 6.66 6.66 66.66 O*ZI t“Ie or.} O“sc LezO“t e.c t“6 09.2 I“CI 9“CC ts”t O“oc C9Ze.c e.c t.6 19.1 L“SI 0“16 06”) C.St 61ZI.* I.c 0“6 61” 6“S1 9.69 01”S L.S$ OIC9-C S.Z 6.9 tL.t 0“11 9.86 IL”* t.9t tSIO.i S“C Z.6 IL.C t“zI S“8U So”t 8“SC Fcz9.Z L.C 1.9 9s.s 6“01 S.96 )1.C 6“OC 99Z64C 6.C t“6 C6.) I“tI O“ea bunt 9“zt Fczt“c P.C 0“6 CL”6 0.91 9.89 90”S 0“S? C910“) 6.Z C“6 Ob” 9.S1 C.C6 98”t C“St 6S1. . . - . . ,. . A. *A . ma * . ● * # . *8otlL u UL Uu -> 7 KS L

~~.: g.$: :g:

9.C 9.C 9.S IL”t Z“Ct 8.Z6 66°C O.LC IIIZL.c C.c L“8 ZL”E9 6.21 I.ZQ ZC.t S.SC 60Z6.C I.b )“6 9S. 9“CI 0’S6 90.$ S“9t OIZL“C t.C C-6 81.6F }“CI S.L8 UC-O S“OC 181O.C 8-C 6°9 Z9”t 0.11 1“98 66-C t“tC SIC*.C 0.} 0“6 66”SS C’ZI L.16 66”6 O.JC LLI9.C 8°C 2“6 66.66 C.CI 1“06 SC”t Z.6C 011E“”C 8°C S“6 OZ”OZ L“CI 9“S8 RC”} S“LC 96tZ“) L.C 9“6 SZ.Z 9“tI C“L8 98.t t“Z) 96Z6“66 6.66 6“66 66.66 6“66 6“666 66.6 6“66 666L-C 9°C Z“6 91” C“CI 1.88 8t.t S“6C tOZL“C O“t 0“6 L1.Z 9“Ct L.C6 OI”t F“9C LLIC“? 6-Z L“6 09” O.LI B“S6 Zt”S 9“9t IOZ9-C I-t 0“6 PS”Z C*ZI S“16 CL”C T“*C tt22“? O.Z 1“6 09. 0“91 0“Z8 10”9 Q“6B StZ6“[ L“C Z“6 69”) Z“tI 1“66 S6.C 6*SC SS16°C 6“Z 2“6 11. C“CI t“8U Ct.t O“6C IIZ6°C 0“) C“6 61.Z Z.Ct L*89 SC”} 9“OC 01}0“} 2.C 1“6 6t”L8 C“It I“Z6 8S”C O.CC SLZIat 9.C 9“6 OI”CC 9“}1 8“L0 LS”t l“Ot Z6C6°C S.C Z“6 Ot.Z 6“?1 9“66 ZO.} O“Ob 9916.66 6.66 6“66 66.66 6“66 6.666 66’6 6“66 666O“* L-C C-6 tZ”Z 8“)1 t“LB tL.t b.IP 002

8°C B.C S“6 ZI.S 6.tl 8.S0 1-t.S 9.Ct SZZL.C t“t C“6 lt”Z l“C1 S“06 St”* 9“LC (ZZ9.C 0.9 I-L tt” S“11 C“LL 9C”t L“tC 8CZO“t L.Z S“6 SC”Z e“st 9“Z8 S).s I“st *8I6°C C“C t“6 16”11 C“tI 6.CL 90”9 8“tt LOZS“) L“C 1.6 t9. 6*ZI 1“98 OC.tO“LC 8SZ6°C L“C 9“9 CO.I Z.ZI 9“s8 Ct”t }“SC Z916°C Z** t“9 ZZ.tC I“Ct C.Z6 fZ”t t“6C 86Z0“} 9“) S.6 L)” S.ZI 1“96 tL.t 6“SC 91ZS“0 C.t S“6 00.1 0.)1 Z-68 t6”t 8“Ct LSI)“* C.c O“Ot 06” L“Ct S.t6 Z8.C I“9C SLZt“C O“t t“6 86.1 Z.Zt C“06 Z6°C t“SC 09Z@“C Z“C 1“6 LO. Z.SI 8“t6 ZL”} C.CP LLI1“* 9°C 1“6 S9”CI Z.SI L.C6 SS”t 9’Zt 6LtZ“t 6.Z C.6 Z9.8 1.91 9.S6 t6”t Z“LP t6t

61M 50Hd ‘IV3 ns.t Ron A3n 3au Z3H &’ld

001 00P Osz 009ZtOI 9C6 )01 )99o SZZ SL9 00IZLS 9ZZ S8Z S9SZZLI PDC L8C CCCIo Ohz Otz 0861Zzt C6L Sor Z9SZ6666 Z8 ezc b6CI9PI 9*[ S9C 0Z6Zo 8SZ ZLI UL6to Is* Olt Osoz9s Ouz 9[C taIzo 6S 011 c9[to 819 ZIt LIOtLO ZCS 19Z St6C6666 ZSZ 681 St6Ccct Onh Otb anl?““”” .“. . . . ““.”Z8 Ce Z9 90LZo z9t OLZ VIZZo ZCI $6S 9toz01 Ztc tz9 901Z08 00ZI 09S OZLc? Zsz Zsz 9ZZZo OIZ Oez Osbz19 C09 Q9Z Zltzet[ Zzz Ott UCLZ6666 6666 6666 6666ZZI t9 C91 Ohtzo 6666 091 Bz9rLL 80C 80C Zooz6t St2 961 )SZZ00 S61 009Zezt Z61 9LS 9CSISt OLZ SCt Oszz6L o S6C TEOCOtl QL OL 099ZOL 9si 89$ b96Zhe 9LII 091 9S9Z6666 6666 6666 66666666 9LZ StC ZOOtZCC 6PZ 86t 69SC6666 99C 19 Osoc01 OZt OtI OSLI09 Ozt 099 Ooeto SOC 011 SZ61011 Ctt cIt 910to Zcs ZSI OtLI88 Ott Zsc 0V9Z19 CUI 99C L98Z6666 6666 6666 66666666 6666 99 Oasz01 06t OZt OLIZo 9*Z tLS ZtSZS9 Szc oft S6LZ6666 9SZ 9LS 9CSIOsva Soa ONOUHdH1’I

6666 0s91o ZLtCo 00s)o S9SZCt Izoco Obsc6666 81CZ6666 96C9o CZLCo Z691o 69110 PbLZ6S 6Co Cszso S(6C6666 t16tK<&~ onor““”” ““..

o ebzso tSLZ99 Z9L[o zo9t00 09CS6666 8ztIo Oclb6666 Oscco tttt6666 66660 )6ZCo 9ZSCo Sooso 9SIZo SOLCo 896Co 00910 Stcto 090t6666 tc~to 911t6666 66666666 LLZCo Sclc6666 CZ9Zo oz9to 090Co 080Co Otsco 091so Onzso CZ9Z6666 66666661i eItsOL 08?!Co Ocuto Setc6666 996CaNwe NHd

00Z9 ?sOozs 9s00SL SS00LS CsOoct 7.s0009 SP0019 I*00?.8 tbOOCL Ob00[b ObooIb 0?009S 6t006S 9100C0I Cs00L8 9SOOC9 6Snnoa gg.,”..00C0 L900tS LS0099 ts008L 010008 Zt009b IL000L 9L0019 6t00PL 8b6666 L800t9 LS009s 9$00LL 6t006t CL00s9 Stoot9 tbOost 01006L SSOOOL ‘ Et008L Ct00t8 L96666 Cs00Z9 ts00CB bb006t 9SOoof tt0009 Lb00ss 9t006S Z9009L Vt0098 eb0019 S900LL 190098 C9000L S100Z0 Zb00s9 Zb0011 Zb

I 1[8

t oreI Lcaz SZ8I CZ8z 919z SOSz 99T S81 beI C9z 18z @Lz SLZ tL1 CL

z OLz 19z 99z S9c P9z [9z t9z Csz Zsz 60z evI Lbz St1 Pbz ZtI ObZ 6CT 9fz ccI Lz1 9Zz tzI ccz Zzz IzI Ozt 61z etZ Ltz SIc PI16Z9ILt9IsIz

3sn 3f3V X3S O1d

vzva MVU S661 JO ONIJSI~

COMPUTER LISTINO OF 1995 RAW DATA

PID SEX AOE WBC

632 2833 1aJ4 1835 2838 1840 1i34i z843 2-..u~~ z845 1,.,.003 2867 2868 1881 1882 1896 2911 2920 1932 2934 2938 2939 1942 2955 2!459 a960 2963 1965 2966 1971 1900 2990 2

1001 21035 21036 11043 21519 11530 2li41 21542 21552 11556 21557 11556 21559 21563 11564 21572 11573 1● C**salt 22102 1~:~~ :

21o7 2.J:Q~ t

2113 ;

51 690062 34OO61 640061 8500

:: i%----- _

:: %;76 65i3065 6000f ~ * *“AIJUU66 880072 530062 860061 520055 610042 400063 650070 740070 870062 ‘ 680049 530080 710042 800046 660043 ?60067 630051 090063 450052 820042 1020041 740061 650044 B90043 540060 530052 550049 180067 600042 660065 480050 410047 630045 590042 070059 540046 750047 440045 5300:: ~~~~

51 820045 :020066 10200c1 lcnn** .6””46 7500

PIIN BAND

3519 017003520 ;4420 04425 99993864 9999----ZUY1 -3540 999:-----4UY1 592340 120. * ● a “a.-.-Loaf 77YY62483969 99ti5762 024962135 6!1680 99993510 99999999 99994209 99994012 99993445 534473 05120 03630 03816 99994158 1265963 027005000 9:9999 99992294 03315 06141 892538 03180 036304602 7;2820 99993162 99992805 99991?66 o2646 02596 04872 02700 024002200 999:2544 0~:~: 624592 0:ggg gg~~

6164 9999Occn n. ..”3825 999;

LYMPH HONO I?OS BASO2829 345 207 ‘O1564 34 34 682560 256 64 03570 170 170 1702175 75 9999 1503128 552 1564 92---2596 354 591920 30~’ 180 60- .- . . -- .- . --43UJ 111 J3~2940 300 240 U“r.ea “.. . . . .4(I3O 67* OJJ 961760 440 176 881953 63 252 632150 172 516 02444 104 0 1563111 366 305 1222688 286 144 99992410 130 325 659999 9999 9999 99991932 276 )4% 1382440 204 136 99991696 0 106 02343 142 71 712240 160 9999 1601574 132 132 1322964 600 152 99991512 252 252 02581 178 170 01350 100 225 452392 366 460 99999999 99!49 9999 99992368 14B 2516 02535 260 325 652047 89 534 99992214 406 108 541802 265 53 01540 165 110 552418 468 156 782280 720 180 601848 330

~60 ~yg9

1760 550 385 99992773 141 0 02772 315 504 632596 472 118 1163219 174 261 1742268 270 162 04575 225 225 751804 264 132 99992173 265 318 0:~~~ 2+$ :;~ ~~g~

2708 738 62 0:~~~ :;~ ~~~ gggg

5226 804 804 402A9nll n..””

e7c75

2050 60; ;;; 9999

PLT ltCT RBC103 39.8’ 4.92200 41.1 4.94213 42.7 4.95234 42.2 4.62229 46.7 5.08284 44.1 5.62iii8 35.2 3.97181 32.0 3.41.-.IYi 38.9 4.26177 41.1 4.74.m.Z43 36.i 3.69192 40.4 4.39167 41.2 4.73169 46.6 5.43162 45.6 5.6-3205 38.6 4.53234 37.0 4.24161 38.0 4.13251 36.1 3.98230 34.8 4.19133 35.0 4.08163 47.0 5.76172 31.3 3.46237 38.9 4.22210 32.7 3.93231 37.1 4.42213 39.9 4.53328 42.4 5.01217 40.3 4.46258 45.1 5.23230 43.7 5.07261 38.6 4.71145 40.8 5.12248 43.1 5.07161 50.3 5.85226 41.6 4.95233 46.3 5.15354 39.4 4.60201 38.5 4.42~zi ~z.j 5.;;

215 40.7 4.76220 15.8 3.87180 44.9 4.!44281 39.2 4.45241 42.8 5.41234 43.3 4.80208 39.8 4.62171 45.4 5.37115 47.4 5.01:;~ . .

JJ06 5.95

298 45.6 4.79~:~ 45.6 5.43302 35.6 4.11i~fj :1.7 :.~~

302 37.8 5.13

flcv HrJa TSH CAL PNOS ALB80.9 13.3 2.00 10.0 3.3 4.083.2 13.9 .75 9.6 3.0 3.886.2 14.4 4.44 9.9 3.4 4.191.4 15.3 76 10.1 4.1 3.992.0 16.6 1:00 9.4 3.3 4.278.5 15.0 2.04 9.8 3.7 4.888.7 12.4 .iz io.o 3.4 4.093.7 11.3 99.99 99.9 99.9 99.99i.4 iz.~ i.29 i3.@ ;.9 ;.786.8 13.8 1.69 9.7 3.4 3.99;.7 i2.6 .G5 %.4 ;.4 3.592.1 14.2 .35 9.8 4.4 3.587.2 13.9 2.13 9.7 3.3 3.885.8 15.7 1.65 10.2 3.9 3.981.0 15.8 .82 10.3 3.3 .4.185.1 13.0 1.21 10.2 3.2 3.987.3 13.1 .90 8.4 3.1 3.991.9 13.7 1.10 9.2 3.3 3.990.6 12.7 2.78 10.1 4.0 4.183.1 12.0 1.58 9.6 4.1, 3.085.9 13.0 1.80 9.0 4.2 3.981.6 16.7 2.93 9.4 4.0 4.090.4 10.8 99.99 9.9 3.2 3.992.1 13.5 1.05 10.1 4.0 4.1!33,1 11.a J,(I7 9.4 4,1 1.384.0 13.1 2.70 10.0 3.6 4.188.i 13.7 2.60 9.8 3.5 3.884.7 14.2 1.36 10.4 3.8 3.790.3 13.5 1.15 10.0 3.3 3.686.2 15.3 1.40 11.9 2.6 4.886.1 14.7 99.99 9.8 3.9 3.981.9 13.6 1.53 10.6 4.0 4’.579.7 13.5 71 9.8 4.3 4.185.0 15.4 1;20 9.4 4.1 4.258.9 16.9 1.28 10.1 3.9 4.584.1 14.3 1.54 10.6 4.1 4.989.9 15.8 50 10.3 3.3 4.685.6 13.3 6:00 9.3 4.1 4.187.0 13.6 3.10 10.1 4.2 3.9?;.: i4.G

i.i~ 9.4 ~.~ g,!

85.4 13.7 1.03 9.7 3.3 4.591.9 13.1 4.34 10.2 4.6 4.890.8 15.5 .84 10.2 1.3 4.7B8.2 13.9 1.28 9.5 3.1 4.079.1 14.0 2.42 10.1 3.7 4.590.2 14.7 1.42 10.6 3.2 4.686.1 13.6 50.03 10.1 3.9 4.084.6 15.5 .80 9.9 4.6 4.694.7 16.5 .04 9.7 2.6 3.89i7.i i2.9 . 5G 9.3 2.9 3.995.1 16.9 .49 8.6 3.7 3.8~+.~ i7.i7 AA.57 9.5 t.i 4.286.7 12.4 1.70 9.9 3.3 3.5~g.~ i~.~ i.~$ iG.C 3.6 :.873.6 12.6 1.60 8.8 3.5 3.9

PRL6.2

99.999.999.999.9

99.999.999.9

7.5

99.99s.999.9

6.03.1

99.95.3

99.9

4.399.999.9

5.5

99.999.9

4.499.9

99.999.9

99.999.912.199.999.999.913.499.999.9

99.999.9

“11.4aa a----99.999.9

99.9

99.9

99.999.9

99.912.7

5.899.3

6.9

6.57.2g.~

6.5

COHPUTER LISTIN(I 0? 1995 RAW DATA

PID SEX AGE WBC2114 12115 12119 22126 22130 22132 22134 22136 12138 22139 22142 12143 12144 12145 12140 12149 22150 12152 12153 12155 12156 12158 22160 22167 12171 22172 22174 12176 12179 12188 12195 22196 22197 22206 12207 12209 22210 222,13 222i5 22217 22220 22224 22225 22221 22220 22229 22230 22231 22232 12234 12235 )2236 12239 22242 1

r 2245 1

81 710041 1100059 570049 770043 690042 460042 440045 590045 550076 5200

46 750043 520048 750073 590085 450049 680053 610058 690042 520041 660050 ‘ 320070 730045 590055 720043 090053 650041 710051 510044 750044 500065 900079 450042 650013 100046 530046 670041 810042 8500

-Snn?4 ..””

62 1450066 6600

12 8700

47 8600

45 8400

49 1120059 8200

53 7700

42 640043 730053 5700

48 10400

52 730044 760041 ?loo41 6400

PHN BAND4402 716930 02793 1144543 04623 02116 02244 99992920 99993245 02756 05475 153588 04050 02491 99991090 03672 03050 05313 1383048 99992904 01808 03650 03245 03456 04371 1863575 04004 03213 03450 02400 04770 03105 452925 654620 02279 99993752 04617 09999 9999>7&l-.”+ Q

9715 1453828 05829 05100 99993763 99991168 03795 695082 0

75 99993205 2193021 06656 09999 99993512 04686 99999999 9999

LYMPH HONO EOS BASO1349 110 497 il2860 1100 1101995 456 171 17;2541 365 231 01863 69 276 692208 92 138 461496 616 44 99992074 366 732 99991705 275 275 01560 260 520 1041725 225 0 01040 312 260 02325 750 375 02491 31S 53 1591935 495 180 02380 340 400 01091 732 427 01242 69 0 1381144 156 99992970 528 13t i%

992 208 32 02409 365 803 732360 295 02000 504 280 14:3627 465 558 932145 585 195 03080 308 3081479 153 714 5!3150 675 225 01700 500 300 1002880 leo 1080 90

990 90 270 03105 195 65 652030 0 3502305 265 371 999;1943 0 1005 02268 324 567 3249999 9999 9999 99999k97---- ~g~ ~i~

2175 290 2175 999;2178 264 330 02436 348 871725 300 225 15:2414 142 71 99993584 224 224 02415 483 138 99992079 154 231 154

25 9999 9999 99993504 146 146 01995 342 285 572704 312 728 09999 9999 9999 99992660 152 12161633 204 491 999:9999 9999 9999 9999

PLT HCT RBC198 34.2 3.96269 52.9 6.11214 39.6 4.69318 39.3 4.63180 35.5 4.12214 42.6 5.15234 .39.5 4.60235 43.9 4.84331 38.9 4.46250 35.3 3.79196 46.5 5.28235 45.0 5.60187 52.5 5.62230 41.5 4.45112 33.6 3.71273 34.5 3.96202 45.9 5.62210 42.1 4.73253 41.2 5.36256 47.5 5.67

11 42.5 4.50302 31.6 3.68285 43.6 4.97204 43.4 4.90240 38.3 4.49251 37.7 4.28264 48.5 5.70216 47.1 5013225 49.1 6.00175 46.7 5.34323 34.1 4.34246 38.0 4.31227 36.8 4.36190 40.8 4.73256 41.7 5.30527 20.0 3.43277 40.6 4.52279 30.8 4.67260 39.6 4.69240 35.8 3.99249 40.8 4.45367 34.9 3.80216 31.0 3.66312 35.9 4.72358 39.1 4.62226 42.3 4.77293 42.5 5.26385 38.1 5.05226 48.2 5.12238 43.3 4.91223 44.6 5.06273 42.5 5.19308 36.8 4.18251 42.7 4.82204 46.2 4.97

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1-

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COMPUTER LISTING OF 1995 RAW DATA

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QLT Hcr RBC HCV H(3B205 37.9 4.58 02.7 13.0327 40.0 4.82 02.9 14.0999 99.9 9.99 999.9 99.9343 41.3 4.69 88.1 14.3306 36.6 4.56 80.3 13.0105 38.0 4.55 85.2 14.3291 28.1 3.39 02.8 9.7999 99.9 9.99 999.9 99.9346 42.2 4.94 85.4 14.9176 48.0 5.22 91.9 16.6190 51.0 6.16 82.8 17.4244 44.8 4,91 9~,2 !S,n283 43.1 5.16 S3.5 15.7279 40.5 5.79 83.8 16.13278 44.6 5.29 84.3 15.2253 38.8 5.42 71.6 12.6282 46.7 5.07 92.2 16.0

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c SOSIc CvofI 9cor2 SCOIc 1001z 066I 186I IL6I 996C S96I C96t 0961 836t“ SS6I C?6t tb6r 6C6z ec62 ZC61 tC6?. 926z SZ6Z ZC6i orbZ b16t ii62 606C 968C 16S! 2981 188t 618I e9ez s9eI t9eI C9Br Sbuz CPUt I*St obet 6ceI eceI scet ccez CC8T rcer oret L2ez szet cze

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COHPUTCR L18TIN0 0? 1996 RAW DATA

PID22152217222022242225222622272228222922302231223222342235223622372219224222452247224822512254225522562257226022612268226922712273227422772279254830233042lnAd.“..30585021

5030505951429001

Scx22222222222

:11

:i12222

21

A(IE WBC75 io.463 9.767 8.673 7.640 10.444 7.246 9.350 12.260 7.355 10.143 6.044 9.454 8.049 7.553 6.549 7.845 10.642 7.042 6.050 7.457 10.947 10.847 6.442 9.547 8.849 7.042 8.567 8.241 9.442 6.541 8.142 10.741 6.942 7.840 6.641 7.155 8.4

999 7.5~aoa----

67 14.250 8.041 6.154 7.6

999 5.2999 99.9

SCOt BANb LXHtaY.u66.062.048.055.062.061.061.099.970.061.037.061.057.037.054.065.059.047.052.063.067.067.053.056.075.061.043.056.053.066.059.028.048.052.054.055.059.0aa az---62.064.067.064.099.999.9

Z.u Zu.u

0.0 26.00.0 30.0

10.0 28.019.0 18.06.0 21.0D.O 32.00.0 34.0

99.9 99.96.0 19.08.0 27.00.0 45.03.0 28.00.0 31.0

.4.0 50.02.0 41.00.0 29.02.0 28.06.0 30.00.0 39.05.0 18.05.0 25.00.0 32.04.0 35.08.0 24.00.0 21.00.0 31.01.0 28.04.0 32.07.0 30.03.0 22.04.0 28.01.0 63.00.0 39.0

13.0 34.05.0 31.01.0 37.01.0 25.0

aa a aa a.- . - .- . -4.0 26.00.0 24.0

0.0 18.00.0 28.0

99.9 99.999.9 99.9

HONt COStBAS\ PLAT HCT Rac HCV HOE TSH VTB12 HB8A7.0 4.0 0.0 387. 39.5 4.49 88.0 13.1 .73 759. 1.2.0 6.0 0.07.0 1.0 0.04.0 10.0 0.04.0 4.0 0.05.0 4.0 2.02.0 3.0 2.03.0 2.0 0.0

99.9 99.9 99.94.0 1.0 0.01.0 0.0 3.08.0 9.0 1.05.0 1.0 2.03.0 7.0 2.05.0 4.0 0.03.0 0.0 0.03.0 1.0 2.05.0 6.0 0.0

16.0 0.0 1.06.0 3.’0)0.05.0 8.0 1.01.0 2.0. 0.01.0 0.0 0.04.0 3.0 1.03.0 8.0 1.02.0 2.0 0.08.0 0.0 0.04.0 23.0 1.05.0 3.0 0.02.0 8.0 0.04.D 4.0 1.06.0 1.0 2.02.0 6.0 0.06.0 7.0 0.01.0 0.0 0.06.0 2.0 1.04.0 3.0 0.07.0 7.0 1.0

aa a aa a QQ-Q------ . .2.0 5.0 1.03.0 8.0 1.0

10.0 5.0 0.04.0 3.0 1.0

99.9 99.9 99.999.9 99.9 99.9

220.265.291.258.279.339.209.223.259.478.208.298.229.258.352.324.216.239.200.367.350.300.176.345.213.322.187.234.246.315.258.244.185.302.226.310.260.aaa..-.459.280.262.376.215.999.

36.4 3.87 94.0 12.545.0 4.76 95.0 15.634.6 3.63 95.0 11.732.0 3.01 84.0 10.633.3 4.75 70.0 10.434.2 4.50 77.0 11.241.3 4.75 86.9 14.041.7 4.63 90.0 13.941.9 5.00 83.7 13.933.6 5.00 63.0 10.053.3 5.52 96.4 18.845.7 5.09 89.8 15.742.1 4.52 93.2 14.344.1 5:10 86.5 15.142.1 4.64 91.0 14.638.1 4.20 90.7 12.844.6 4.72 95.0 15.245.1 4.60 98.0 15.542.5 4.86 88.0 14.640.7 S.03 81.0 13.843.1 4.71 91.6 14.738.8 4.13 82.0 13.239.9 4.37 91.0 13.528.0 3.13 89.0 9.542.8 5.04 85.0 14.342.1 4.78 89.3 14.652.6 5.52 95.2 18.250.6 6.00 84.4 17.045.7 4.85 94.0 16.146.8 5.18 90.5 16.052.6 6.02 87.4 18.344.2 5.15 85.7 14.938.2 5.12 75.0 12.344.2 5.52 80.0 15.145.2 4.88 92.7 15.838.2 4.35 88.0 12.740.5 4.58 89.0 13.7aa a a aa ggg.g g~cy.- . - - . -c36.9 4.30 86.0 12.549.0 5.44 90.0 16.743.4 5.32 81.6 14.341.8 4.47 93.4 14.334.5 3.37 102.4 11.199.9 9.99 999.9 99.9

.21 761. 0.4.56 716. 0.1.49 557. 0.1.60 398. 0.4.82 659. 1.1.54 654. 0.

99.99 999. 0.1.53 999. 0.

99.99 999. 0.1.51 798. 0.

99.99 999. 0.8.83 999. 0.

99.99 999. 9.5.78 999. 0.2.15 391. 0.

99.99 999. 9.2.13 676. 0.1.75 552. 0..691083. 1.

99.99 999. 9.39.32 999. 0.5,19 487. 0..40 999. 1.

1.61 904. 0.1.33 415. 1.

99.99 999. 0.4.89 497. 0.

99.99 999. 0.2.99 667. 1.

99.99 999. 9.99.99 999. 9.99.99 999. 9.1.78 975. 0.

55.37 711. 0.99.99 999. 9.

●03 603. 0..03 988. 0.,~~ 9qg: (),

7.58 576. 0.1.17 966. 0.

99.99 999. 9.99.99 999. 9.99.99 999. 9.99.99 999. 9.

PSA NAIC99.9 7.799.9 99.999.9 6.999.9 99.999.9 99.999.9 99.999.9 99.999.9 5.899.9 99.999.9 12.199.9 99.999.9 6.099.9 99.999.9 99.999.9 99.92.0 5.4

99.9 99.9.4 99.9.9 99.9

99.9 11.499.9 17.699.9 7.599.9 99.999.9 9.799.9 8.41.1 99.9

99.9 99.9.7 99.9

99.9 10.6.7 99.9

99.9 11.299.9 99.999.9 8.599.9 7.5

.7 11.699.9 99.999.9 11.699.9 99.999,9 99.999.9 4.81.2 12.9

99.9 14.399.9 99.999.9 99.999.9 99.9

#