Leland S. McKittrick

Carcinoma of the colon

Leland McKittrick was born in Thorp, Wisconsin, the eldest son of a town physician. He was reared to follow a similar path after graduating from the University of Wisconsin in 1915 and Harvard Medical School in 1918. McKittrick began his surgical postgraduate training at the University of Minnesota before transferring to the Massachusetts General Hospital as a surgical house pupil on the so-called East Surgical Service. After 18 months in Boston, he began his association with one of the pre-eminent surgeons of the day, Daniel Fiske Jones.

An Evaluation of the Anterior Resection of the Rectum and Low Sigmoid

CARCINOMA of the rectosigmoid area of the colon is of common occurrence and fortunately is productive of early symptoms. Carcinomas in this location account for 60 per cent of all cases in the colo...

To What Purpose

ALL your presidents have, in addition to surgery, one thing in common — the Presidential Address. The subject finally selected will, to no small degree, reflect the varying special interests and ac...

Resection of the colon for carcinoma.

SummaryRapid improvement in the safety with which intestinal resection and anastomoses can be done make it desirable to delineate the extent to which dissection should be carried out for carcinoma of the various segments of the bowel. This should be done on a basis of what is known of the anatomy of lymphatic drainage and the physiopathologic characteristics of the tumor, rather than upon technical feasibility alone.The early work of Jamieson and Dobson on the anatomy of the lymphatics, followed by the studies of Gilchrist and David, Coller and his associates, Grinnell and others, forms a background from which to develop sound practical anatomic delineation of the desirable lines of dissection for cancer in the various segments of the large bowel.Experience in the treatment of cancer and the problems of mobilization and removal of different segments of the colon, together with increasing information on venous spread and local implantation, should make it possible to develop an overall plan which would offer to the patient low mortality and morbidity rates with a maximal chance of permanent cure. Without discussing the details of the various surgical procedures an attempt has been made to correlate existing knowledge and experience into such a plan.The immediate results following resection and anastomosis in a small series of patients operated upon from 1948 to 1958 are reported.

To teach them this art

KNOWINGLY or unknowingly the young physician accepts responsibilities and obligations not equaled by those entering any other profession; responsibilities for the maintenance of high moral and ethi...

Trypsin Treatment of Superficial Gangrenous Lesions

TESTOSTERONE TREATMENT OF HEMOCHROMATOSIS In recent years there have been reports suggesting that in patients with hemochromatosis the use of testosterone may be of benefit, at least symptomatically, with apparent improvement in strength and sense of wellbeing. Such beneficial results have been thought to be related to the gonadal hypoplasia commonly seen in hemochromatosis and to the anabolic effect of testosterone on protein metabolism. Consequently, the paper of Pirart and Franken of the Brugmann Hospital in Brussels is of interest. They studied 9 patients with proven hemochromatosis of whom 7 were men aged 44 to 70 years and 2 were women aged 56 and 59 years, respectively. The iron content of the serum of the 9 patients averaged 225 gamma per cent (range = 40 to 360 gamma per cent) whereas that of 10 normal subjects averaged 84 gamma per cent. The oral administration of 176 mg. of bivalent iron as ferrous gluconate did not cause any elevation of serum iron during the 4 hours following ingestion. However, when 20 mg. of iron in the form of an organic compound only slightly ionizable, were given intravenously and the iron content of the serum determined at 5 and 120 minutes following injection, a characteristic curve was obtained in both normal subjects and in patients with hemochromatosis. Patients were then treated by injection of testosterone propionate in dosage of 50 mg. twice weekly for 3 weeks. No effect was seen clinically. At the end of the treatment period, iron was again injected intravenously in order to obtain tolerance curves to compare with those secured prior to testosterone treatment. A moderate though definite average lowering of the curves was obtained suggesting that, if anything, iron found its way more readily into the tissues following a course of testosterone treatment. As the result of these studies, the authors conclude that the giving of testosterone has no specific benefit in hemochromatosis and that it may even act deleteriously by favoring the transfer of iron from the blood into the tissues. However, since in the oral tolerance test, no change in serum iron was obtained and since there is no evidence that testosterone favors the absorption of iron from the intestinal tract, there would appear to be no basis for fearing aggravation of hemochromatosis by testosterone unless iron is being administered parenterally. The real value, if any, of testosterone in the treatment of hemochromatosis awaits further study. ALEXANDER MARBLE, M.D., Joslin Clinic, Boston.