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We compare the mortality experience of medical school graduates from Loma Linda University (LLU [n = 4342]) and the University of Southern California (USC [n = 2832]) with each other and with that of contemporaneous, white, American men. When compared with US white men from the general population, both USC and LLU graduates had below expected deaths for all causes (USC, standardized mortality ratio [SMR] = 76; LLU, SMR = 56), although deaths due to cerebrovascular disease, airplane accidents, and suicides were elevated for USC (SMRs = 132, 360, and 218, respectively). The LLU graduates had a risk similar to that of the USC graduates for fatal cancer, with a mortality ratio (MR) of 0.92 (95% confidence interval, 0.67 to 1.26); but half the risk of fatal atherosclerotic disease, with MRs of 0.58 (0.46 to 0.73) and 0.66 (0.43 to 0.99) for coronary and cerebrovascular disease, respectively; and three times the risk of fatal airplane accidents. The overall mortality rate of LLU physicians was only 75% as high as that of the USC physicians and only 56% as high as that of the US male population at large. We attribute this reduced mortality mainly to the low cardiovascular mortality rates, which may be accounted for by the life-style of the substantial proportion of Seventh-day Adventists among LLU graduates.

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In search for an alternate treatment for inoperable cancer of the lung in humans, we investigated the possibility that introduction of radioactive material into a selected lobe of the canine lung would effectively destroy that lobe without systemic effects or radiation injury to adjacent organs. Ten million ion exchange microspheres labeled with 740 MBq of phosphorus-32 (32P) were injected through a catheter placed in a selected lobar branch of a pulmonary artery in 12 anesthetized dogs. Six additional dogs served as controls and received 10 million microspheres not labeled with 32P. Organs were harvested from 1 wk to 12 mo after injection and examined grossly and histologically. There was progressive organization and contraction of each necrosed 32P treated lobe which was reduced to a scarred remnant by 12 mo, whereas only minimal inflammatory changes occurred in controls. Of the 32P injected dose, 94% remained in injected lobe, 4%-5% in nontargeted lobes and less than 0.08% in blood. Radioactivity in liver, kidneys, spleen, heart, and bone marrow was less than 0.1% for each organ. Thus, large doses of radiation in the order of 1,500 Gy can be effectively delivered to a selected lobe to produce a "radioisotopic pulmonary lobectomy."

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The authors report two cases of sclerosing lipogranuloma of the scalp diagnosed postmortem. The first was suspected to have acquired the lipid material from a grease gun injury to the scalp, while the second had received injections of an unidentified lipid for treatment of baldness. In each, the resultant sclerosing lipogranuloma extended laterally beneath the scalp from the vertex of the skull. The histologic reaction was round to oval cystic spaces within a dense collagenous stroma typical of the "swiss cheese" pattern of sclerosing lipogranuloma. Punctate, ringlike, or globoid densities were seen on roentgenograms of a 5-mm-thick transmural section of scalp in the first case.

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Little is known about the rate of endothelialization of venous thrombi. This study was performed to determine the time required for complete endothelialization of the head of standardized thrombi in medium-sized veins (4 to 5 mm) in dogs. This information was sought to help determine the optimal duration of anticoagulation therapy in patients with acute venous thrombi. While endothelial growth was observed as early as three days, endothelialization of the head of the thrombus was not complete until 14 days in seven of eight venous thrombi. These experimental findings suggest that therapeutic anticoagulation should be continued for at least ten to 14 days if maximum benefit is to be achieved.

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The authors report the occurrence of fatal embolism as a complication of a LeVeen peritoneovenous shunt performed four months previously in a 67-year old man with ascites. Air embolism was caused by perforation of the cecum following cauterization of a vascular malformation of the mucosa through a flexible colonoscope. An autopsy demonstrated air within the peritoneal cavity, the LeVeen shunt and both ventricles of the heart. In the patient with a LeVeen shunt, gastrointestinal perforation from any cause is an indication for immediate closure of the shunt.

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Two patients with systemic lupus erythematosus, who had striking angiographic abnormalities of venous contour, are presented. Both cases also had communicating hydrocephalus. Postmortem examination of one patient led to a histological explanation of the venous changes observed radiologically. Previous radiological reports have shown involvement of arteries but not veins with lupus erythematosus. The angiographic signs of phlebitis may signify a meningeal reaction which, when combined with ventricular enlargement, should suggest communicating hydrocephalus.

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