Bouncing amund in the classicwhite Llnd Roverwith the huge Red Cmssemblazoned on the hood in the middle of a huge dust storm, it was all starting to sink in.I had voluntarily come to this place and was going to be here for three months.

On that first day,we performed 17 operations during the day and 4 overnight: two casesofobstructed labour (one had been obstructed for over ten days before arrival) both withruptured uterus and early sepsis, two severe crocodile bites, one snake bite with extensive

tissue necrosis in a six month old, numerous high poweredgunshot wounds, and a land mine injury in a 12 year old boy.This was going to be one hell of a ride.

An Experience

in The SudanOne year earlier, Dr. David Evans and myself had taken the

war surgery course offered by the International Committee for the Red Cross (ICRC) inGeneva. We had both envisioned a role for international surgery initiatives within therestructuring of the trauma program at McGill. This role includes developing a Canadiansurgical leadership in the structure and organization of both crisis intervention andeducational activities in the developing world.

McGill has a tremendous history of leadership in international surgical work and I have hadthe privilege to benefit from some of this mentorship. Drs. Peter Mclean and AntoineLoutfi introduced me to The Canadian Network for International Surgery (CNIS) andDr. Lett who is the current head.

Through the CNIS,I have been able to participate in surgical education projects in Ethiopiaand Tanzania in the last two years. This work has stimulated me to pursue even moreaggressively a structured program of international work within the confines of my McGillappointment. I felt, however, that I needed further exposure in the more difficultenvironment of a crisis or war to gain more experience in this field. The ICRCproved to bean excellent organization. I applied for and was posted Please see Sudan on page 4 ~

___ mm mm mm mmmmmmmmmmmmmmmmm mmm m m m mmm mmmmmm::I Letters to the Editor 2 PostGrad Medical Education at McGill~. Editorial 3 New McGill Anesthesia _.ca.. Kudos 6 First Joint Meeting: CHSSand ECHSSI'D ······················..··.········..mm.mm.m.mmmm ...

Achievements Residents and Fellows 7~~HCSuperhospital~e~~UHCAppointl11ents 8 .. Jal11eslyTrav~llin9~~II?~Dr.Loutfi Goes to the of Health 9 Visiting Professors

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Shriners - Canada 9 2"dA~nual~e~~ral~urgeryB~QSyl11p?siul11i~Solor~ctal~urgerym 10 ... Dr.Pet~r~etr~kos'~Xl11p?siul11mAnnual Welcome Dinner 12 New RCPSCAppointment

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DEPARTMENT OF SURGERY

NEWSLETTER

McGILL UNIVERSITY

141516192022232425

FALL2004

Mes Col/egues,Vous avez ecrit dans Ie journal de McGillau sujet de la chirurgie laparoscopique.Auparavant j'ai passe du temps commeresident au Herbert Reddy Memorial Hos-pital pres du Royal Vic.

Je vous ecris quec'est moi qui a inven-tee la chirurgie la-paroscopique et deI'invasion minima Ie.

Pour documentation: Clarke He, Adven-tures in the origin of Modern Operative

Laparoscopy, Gynaecologic Endoscopy,October 2002, Vol. 11 (5);223-230.Aussi traduction francaise:www.clarkescope.com Je cherche seule-ment "I'honneur" qui est du a moi.

Lettersto The Editor

Veuillez agreer, mes collegues, I'expres-sion de mes sentiments les meilleurs.

H. Courtenay Clarke

Dear Editor,I was very fortunate to have been able tocome to Montreal to attend the 100thAnniversary celebrations at the MontrealChildren's Hospital (MCH). As a Royal Vicsurgical assistant resident, some of ourrotations were at the MCH.

During this visit, I was very glad thatDr. and Mrs. Dobell came to the recep-tion and gala dinner. It gave me tremen-dous pleasure to talk to him again and tobe able to thank him for the teachingsand mentoring when I was a McGill stu-dent and RVH surgical assistant resident.To me, he looks great and very relaxed,not a lot different than 40+ years ago.

MCH was a place where I started to takean interest in the surgical management ofchildrens' problems which led me to trainand become a pediatric orthopaedist.

It was fun seeing the present MCH.However, one of the interests of some ofthe physician colleagues around me was

to revisit the building and place wherewe had our "on-call" rooms. We all knewwhere the place was, but could not findit. However, with a little bit of guidance,we were able to do so, crossing over thebridge from the cafeteria. The area hasbeen transformed into offices. Whatused to be the "living room" is still thereand although, as I recalled, had a grandpiano on one side, it appeared to be ad-equate for us to spend a few momentsto smoke a cigarette, a cigar and relaxbefore we got called again. Whatamazed me is the size of our "on-call"room. The "bunk beds" are no longerthere, but I could not believe that 4 of usshared the room and occasionally 2 or 3of us would be using it. Being a surgicalresident, it may be interesting to notethat the 4 of us who shared the room,myself from RVH and 3 MGH surgicalresidents all chose orthopaedics, and 3of us became pediatric orthopaedists.

William Mcintyre, M.D. went to Colum-bia University, NY, completed his or-thopaedic residency, then came back toOttawa, subsequently becoming Chief ofOrthopaedics at Children's Hospital, East-ern Ontario.

Tony Ashworth, M.D., my classmatefrom McGill, entered the Harvard Or-thopaedic Surgery training program, sub-sequently took a position at Queen's Uni-versity, Kingston and for most of hispractice career, took care of disabled andcerebral palsy children at their specialtyhospital. He had many other interests,took additional studies in financial prac-tice and subsequently became Treasurerof the Pediatric Orthopaedic Society,North America (POSNA).

Robert Fulford, M.D. continued in theOrthopaedic residency at the MontrealGeneral Hospital, then practiced for abrief period in Canada before going toHouston, Texaswhere he had a successfulclinical community practice with volun-tary academic commitments.

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As for myself, I took another year of Gen-eral Surgery at the Royal Vic, thenentered the Johns Hopkins HospitalOrthopaedic residency program, complet-ing in 1967. This was followed by aUSPHS"career development" award tostudy the Basic Sciences. On completion,I joined the University of Souther Califor-nia's teaching program, was a rotatingTrauma attending at Los Angeles CountyGeneral Hospital. At Rancho Los AmigosMedical Center, most of my practice is intaking care of the physically disabled per-son, especially children with neuromus-cular disorders, congenital, traumatic anddevelopmental orthopaedic disabilities,TBI and cerebral palsy. In 1988, I becameChief of Orthopaedics and Chair of theDepartment of Surgery, Rancho and atthat time we had our own full and part-time staff of 150 surgeons and physia-trists, 32 residents and 10 fellows .•

John D. Hsu, M.D., F.A.C's.Emeritus Clinical Pro fessor, Orthopaedics,

USC,KeckSchool of Medicine,Downey, California

.....................................Thanks to Our

: Contributors: We wish to: qenerouslv··

··

··

thank these contributors whomade donations to McGill

Surgery Alumni and Friends. This helps tokeep TheSquare Knot in print.

Dr. B.S. BilfieldDr. Gianpaolo CapolicchioMrs. Susan E. GledhillDr. John D.W. HsuDr. Clarence E. JamesDr. Ahmed JamjoomDr. Enn JommDr. Edwin R. LafontaineDr. Ramesh LokanathanDr. Marvin J. WexlerThe Orthopedic Group PC

EDM

LEnNOTLfTTHETRAUMA TEAM OlEACCIDENTALLY

In late September, the M.G.H. disbanded its Trauma Team.In the past five years, there have been increasing problems inmaintaining the service. Decreasing resources due tounderfunding by the Provincial government, and an increasingnumber of complicated cases such as penetrating injuries, adiminishing number of traumatologists and poor workingconditions for doctors were cited as the principal reasons. Thedecision means that the Montreal General will no longer have

a dedicated Trauma Service to respond tomultiple injuries. A general surgery teamfrom throughout the hospital, however, will

continue to be dispatched to the Emergency Room wheneverthe need arises. The M.G.H. is one of two Levell Trauma Centresin Montreal along with Sacre Coeur Hospital.

This should not be the end of an era. Too much history wouldcount for naught were this to be left as is.

Just think of the early 1960's at the R.V.H. when Dr. FredMoseley started an Accident Service in the 9-E SurgeryPavilion. Some of the earliest residents were Drs. NelsonMitchell, Giuliano Maximo luccioli, Taffy Siapak, PeterMclean and M. Chughtai.

Remember the work of Dr. Fraser Gurd on shock and trauma.Remember Dr. Rea Brown and his course on Advanced TraumaLife Support (A.T.L.S.l. Remember Dr. David Mulder giving theScudder Oration at the American College of Surgeons. We alsohave had the H.R. Robertson Annual VisitingProfessorships. Both the Royal College and theQuebec College have been pleased to accredit theTrauma Service asan excellenttraining program forsurgical residents. Over the years our hospitalsdistinguish themselves in their response to massdisasters such as the Bluebird Cafe fire and theaftermath of the Ecole Polytechnique massacre onDecember 6th, 1989.

Editorial

Quebec Health Minister, Philippe Couillard, hasordered an independent analysis of the TraumaService at the Montreal General and he haspledged to put more money into the Trauma CareSystem especially since his government has beenaccused of not providing enough resources. It hasbecome evident that Quebec's Trauma System

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lags behind Ontario's. According to Dr. Michael Churchill-Smith, Associate Director of Professional Services at theM.G.H., Quebec needs at least twelve more traumatologists tobe able to respond adequately to victims of car accidents,gunshot wounds and other life threatening injuries. Dr.Couillard, in defense of his Ministry, avowed that the previousgovernment had underfunded health care, but his governmenthad invested an additional 2.2 billion dollars into the system.

A major problem, however, is the lack of surgical staff. In recenttimes, only three surgeons were members ofthe M.G.H.TraumaTeam, Dr. David Evans, Dr. Tarek Razek and Dr. SuneelKhetarpal. Not enough general surgeons were taking calls onthe Trauma Team. Also, Dr. Peter Richardson, neurosurgeon,had gone to England and Dr. Bob Ford passed away.

It would be a shame to let things continue this way. Hopefully,Dr. Couillard's mission will find ways to improve the workingconditions of doctors to attract and retain more trauma-tologists and other specialists in this field. "I hope you canmake a positive change in Quebec because their TraumaSystem needs some attention'; said Dr. Fred Brenneman,Chief of Trauma at Sunnybrook Hospital in Toronto. Dr. TarekRazek, the new Head of the Trauma Team (see elsewhere inthese pages), affirms that "There is a tremendousunderfunding, and to maintain the level of service to thatdegree is impossible for us to do': He said "We really don't wantto have any significant downgrading of patient care eventhrough these difficulties':

There is much work to be done. Though the M.G.H.Trauma staffright now is in a "fragile" state, it is hoped that with everybodypulling together, it will be able to restore it to its excellent LevelI designation .•

"I'mnever having kids. I hear they take nine months to download."

~ to the field hospital in Lokichokkio (Loki), whichserviced the ongoing civil strife in the southern Sudan. I arrivedfor a three-month mission in February of 2004.

The ICRC'smandate is asa guardian of the Geneva Conventions.This is a separate entity from national Red Crosssocieties. TheGeneva Conventions ensure specific rights in a zone of conflict.One of these is the accessto medical care. A military surgeon

established the ICRC to try to cope with theproblem of poor surgical services provided inareas of conflict in the 19th century.Sudan

Continued from page 7

The days in Loki were very long and repetitive. Themedical staff consisted of two team surgeons each with ananaesthesiologist. The hospital itself had the capacity forapproximately 750 patients in tent wards and one permanentstructure, which held the OR's,the triage and recovery area.There were many expatriate nurses covering the wards alongwith many outstanding Kenyan nurses who staffed both thewards and the OR's. Each team (surgeon and anaesthesi-ologist) covered alternate night calls and we used a VHF radiosystem to keep in touch with the hospital staff at night. Mycolleagues were from Russia,Ghana, Switzerland, Australia, etc.

Every day the radio room received requests for transfers to thehospital from various smaller relief stations throughout theSouthern Sudan run by various relief organizations. Flights (UNWorld Food Program, ICRC or MSF, etc.) would transportpatients who required emergency surgical assistance on theirreturn from planned supply drops. Every morning we would

O.R. Team

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drive from our compound living area (a walled and guardedenclave) to the hospital (about ten Km's). We operated sevendays a week on all the new cases. On average we performed300 cases per month and received 10-15 new patients everyevening. As this is the only surgical facility for a very large area,we also received many patients from the local region (manywalked in from the Ugandan border). The work was splitbetween emergency obstetrics, orthopedics and generalsurgery cases with many pediatric patients in the mix. I nolonger complain about a lack of elective ORtime here at homeafter operating every day solid for three months (at least notfor this year). One of the more difficult tasks was that of triage- we had to do this every evening as the flights rolled in. In theaustere environment, triage was very challenging andemotionally draining.

The boy I mentioned at the beginning, struck by a land mine,lost his brother in the incident and arrived to us ten days afterthe event with gangrenous limbs bilaterally. The upwardnature of the mine blast injury caused significant injury to bothhis limbs. He ended up with bilateral below knee amputations.This little boy's bravery and overall attitude was over-whelming. He smiled much more than he cried and submittedto over five redebridements of his wounds with a strength I'mnot sure I possess. He recovered extremely well and returned tohis village on my last day. He will be sent back in a few monthsto receive his prosthetics. The prosthetic program run by theICRCwas very impressive - born out of a terrible need in theseenvironments due the impact of land mines on civilianpopulations.

This work experience was extremely rewarding. Theone thing I found most surprising was how well Icould adapt to the work environment. The extremespecialization that is occurring in general surgery hasmade it difficult for the ICRC to find surgeonscomfortable in this kind of environment. Their pool ispredominantly European. A previous surgeon had tobe repatriated, as he could not function effectively.I envisage a tremendous opportunity here to con-tribute as Canadian surgeons.

The international organizations have a difficult timefinding appropriate staff to do their work; and thereare many interested surgeons (old and new) whohave an interest in this work but are unsure how topursue it. Canadian surgeons have, as a group (eitherrural or academic trauma/emergency surgery), mostof the skills to be very effective in these types ofenvironments. There is some confusion as to who orwhat is a general surgeon. I find this ~

4

~ ridiculous. In both our rural and academicenvironments we exist. In the rural context, there is a broadskill set that must be met; and in the academic context,trauma/emergency surgery encompasses the management ofsurgical shock (often with an overlap in the ICU). This field wasdeveloped by surgeons and can only be handled properly bysurgeons (intra-abdominal catastrophe/sepsis, major burn,andmajor trauma). This evolving tertiary academic pursuit defineswhat a general surgeon does in the urban setting. It representsa clinical pursuit that involves the whole body (vascular,thoracic, cardiac, and abdominal - everything in it).

I propose an office of international surgery to be housed withinthe trauma program. Through the creation of internationalsurgical initiatives within academic programs of trauma/emergency surgery, we could facilitate the interaction betweeninternational groups with a proven track record and interestedsurgeons. We would facilitate the small amount of training

Traction

Triage

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Housing

that would be required for many so that all Canadians whoparticipate would function effectively. We would also assist inresearch and educational activities beyond crisis interventionwork through such organizations as the CNIS.

Why do this through a trauma/emergency surgery program? Ibelieve that this structure has embedded in it the skills thatdefine general surgery. The properly trained trauma/emergency general surgeon should have the skills required toperform in this context. This training should re-invigorate theconcept of the "traditional" general surgeon in both theacademic and rural environments. As well, trauma and injuryrepresent, according to the WHO, the number one cause ofyears of life lost and disability in the world. This is a massivepublic health issue, which has gone largely ignored. Assurgeons, we have the skills to begin to deal with this issue.Work in the field of surgical education is badly needed, assurgical skills are largely not available to a majority of theworld's population.

An institute of international surgery, embedded within atrauma/emergency surgery program in a University setting,with support for this role, could begin to address many of theseinitiatives.

I strongly believe that it is one of our major responsibilities, asan academic Department of Surgery and asCanadian surgeons,to contribute to the development of surgical educationinternationally and to surgical relief efforts in crisis scenarioswhen needed. We are failing to accomplish what we arepotentially capable of in this arena at this time .•

Tarek Razek, MD,

Director, Adult Trauma Program, MUHC

DPot.. (han of the Divi-sion of Urology of MUHC and Drs. MarcGoldstein and Zev Rosenwaks from

Cornell Institute of

KU DOS II Reproductive Medi~ine,.. New York, have Just

.e'" ~ launched their bookentitled "Reproductive

Medicine Secrets" published by Hanley &Belfus (Philadelphia). This 440 page refer-ence provides comprehensive coverage,from basic science to the latest clinicaladvances, of male and female reproduc-

tive medicine. He alsoreceived the First PrizePaper Award from theSociety for Male Repro-duction and Urologypresented at the 60thAnnual Meeting of theAmerican Society forReproductive Medicinein Philadelphia this year.This honor was given toDr. Chan for his recentwork entitled Compari-

son of patency rates, pregnancy and latefailures in four techniques of vasoepididy-mostomy in 743 consecutive patients.

Dr. Ray (hiu was a Visiting Professor atDrexel University College of Medicine inHahnemann Hospital in Philadelphia onJune 26th, 2004. He served as an InvitedLecturer at the Taiwan Society of Cardiol-ogy in Taipei, Taiwan on July 24th; and atthe Society of Thoracic Surgeons spon-sored symposium entitled "CurrentStrategies in Heart Failure Management:Drugs to Devices" in Louisville, Kentuckyon August 28th. Dr. Chiu also served asthe American College of Cardiology Foun-dation (ACCF)/ Pfizer Visiting Professor,sponsored by the Brody School of Medi-cine, East Carolina University inGreenville, North Carolina on September20th to 22nd. During the AnnualCongress of the Japanese Thoracic Society

in Sapporo, Japan on October 19th to20th, he gave two Invited Lecture, one onCardiac Surgery Training and another onStem Cell for Myocardial Regeneration,and participated in a meeting as a mem-ber of the Advisory Board for the NationalStem Cell Research Center in Taiwan.

Dr. E. John Hinchey was awarded anhonorary fellowship in the CanadianAssociation of General Surgeons at theSeptember meeting of the CanadianSurgery Forum in Ottawa. He had alsopreviously received the Queens' GoldenJubilee Medal in recognition of his contri-butions to Canadian society.

Dr. Fred Inglis now retired in Belleville,Ontario was awarded an honorary fellow-ship in the Canadian Association of Gen-eral Surgeons last September in Ottawa.Fred is ar:1Emeritus Professor of Surgery atthe University of Saskatchewan. He stillassists 2 or 3 times a week in the O.R.atthe Belleville General Hospital. His chil-dren and 5 grandchildren visit him andCarole regularly in Belleville. His hobby isradio controlled model airplanes.

Dr. J-M. Laberge is a co-investigator forthe CAPSNet [Canadian Perinatal SurgicalNetwork (Multicenter)] trial, which wasawarded a total of $213,280.00 over aperiod offour years from the CIHR.The goalof this clinical research is to collect datafrom all pediatric centers acrossCanada onhigh-risk malformations (initially startingwith congenital diaphragmatic hernia andgastroschisis) in order to establish bestpractices and improve outcome.

Dr. Kevin Lachapelle has beenappointed Program Director of the McGillDivision of Cardiac Surgery effectiveNovember 1st, 2004.

Dr. Sarkis Meterissian was recentlyfunded by the Association for SurgicalEducation for his grant entitled "Is theScript-Concordance Test a Valid Measureof Intra-operative Decision MakingSkills?" In collaboration with researchers

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at the University of Montreal, Sarkis istrying to develop a test that could oneday, if successful, subplant the oral exam-ination. The test is going to require thecollaboration of at least 10 McGill generalsurgeons to be the reference group andthen it will be given to the surgical resi-dents to assess its construct validity.Sarkis was also funded by the RoyalCollege for two projects, one to assesscommunication skills across disciplines asa teaching tool for the CanMeds role, andanother Royal College grant looking atfaculty development in the area ofdesigning workshops. Sarkis has been amember of the Faculty DevelopmentAdvisory Committee of McGill Universityunder the Chairmanship of Dr. YvonneSteinert since September 2003. On Octo-ber 1st, he presented a workshop at theRoyal College meeting entitled "TeachingResidents How To Teach': During thisworkshop, he shared his knowledge andteaching techniques with other ProgramDirectors in the area of teaching skills.

At the Canadian Society for VascularSurgery meeting in Quebec City on Octo-ber 23-24, 2004, Dr. Patrice Nault washonored with the Blair/Gore ResearchAward for MOLIERE:Modification of Out-comes by Lowering the Ischemic Eventsafter the Reconstruction of ExtracranialVessels. Moliere involves 50 vascularsurgeons and neurosurgeons workingmostly in community hospitals in Quebecand more recently from the Atlanticprovinces. These surgeons are puttingprospectively in a secure and confidentialwebsite the outcomes of their carotidendarterectomy (CEA). Results will bepresented next year at the annual meet-ing of the Canadian Society for VascularSurgery in Toronto. Dr. Nault is an Assis-tant Professor at McGill and is working atthe CHVOin Gatineau.

Congratulations to Dr. Steven Paras-kevas and his wife Line on the birth oftheir daughter, Juliette Kleo, on July 16th,2004, weighing 7 pounds, 9 ounces.

6

Dr. Pramod Puligandla was awarded$25,000.00 from the Montreal Children'sHospital Research Institute for his researchon The Role of Surfactant Proteins A and Din the Development of Ventilator-AssociatedPneumonia in a Pediatric Intensive CoreUnit. We also congratulate him for passinghis Quebec French test on his 1st try!!!

Drs. Pramod Puligandla and Jean-

Martin Laberge have contributed to thechapter "Infections and Diseases, Lungs,Pleura and Mediastinum" for the 6th edi-tion of the 2-volume textbook PediatricSurgery which will be published in 2005.

Dr. Tarek Razek participated, as aninvited speaker, at an internationaltrauma conference. He participated inthe Southwestern Australia Network(SWAN) Trauma conference in SydneyAustralia this past July. It was his thirdtime participating as an invited speakerat this meeting. Tarek also participated asa faculty member in a Definitive SurgicalTrauma Care (DSTC) course in Sydney,Australia this past July as well. This washis third DSTCcourse as an instructor. Hehad previously been an instructor withthis trauma surgery technical skills coursein Sydney (07/2002) and in Porto, Portu-gal (12/2003). Obviously, he completed amission with the war surgery field hospi-tal in Lokichokkio servicing the southernSudan for the International Committee ofthe Red Cross (02/2004 - 0512004).

Congratulations to Dr. Lawrence Rosen-

berg who received his M.Eng. Degree inManagement of Technology conferred bythe University of Waterloo. He wasawarded a grant from Genome Quebec toidentify novel candidate genes related toislet differentiation that could be used toscreen for, or to diagnose Type-2 diabetes,or as possible drug targets for therapy.Also, he was awarded a grant from theCanadian Diabetes Association to studythe regulation of islet neogenesis.Dr.Rosenberg made the cover of the sum-mer 2004 issue of the JDRF(Juvenile Dia-betes Research Foundation International)

Countdown Toa Cure for his work in devel-oping and testing a compound known asINGAP (islet neogenesis gene associateprotein) - a native pancreatic protein thatappears to be involved in normal islet cellneogenesis. He published a paper in theNovember issue of the Annals of Surgeryentitled A Pentadecapeptide Fragment ofIslet Neogenesis Associated Protein (INGAP)Increases Beta-Cell mass and Reverses Dia-betes in C57BU6J Mice. At the 12th Euro-conference on Apoptosis, he presented apaper entitled A Peptide Inhibitor of BaxProtects Isolated Islets of Langerhans. Dur-ing the annual meeting of the CanadianDiabetes Association, he presented twopapers entitled Novel Pathways of fJ-cellMass Expansion and Expression and Actionof Islet Neogenesis Associated Protein(lNGAP) During Islet Neogenesis.

Dr. Judith L. Trudel completed herMaster's Degree in Health ProfessionsEducation (MHPE) at the University ofIllinois at Chicago in the Fall of 2003, andwas awarded the "2004 Best MHPEThesisAward" by the Department of MedicalEducation of the same institution in Julyof 2004. The title of her thesis was Reli-ability and Validity of Key Feature Casesfor the Self-Assessment of Colon andRectal Surgeons. •

Achievements

Residents

and Fellows

-w:Canadian Association of• ~:diatric Surgeons held its 36th

Annual Meeting in Winnipeg from Sep-tember 30 to October 3,2004. Dr. loana

Bratu had an abstract accepted for pre-sentation entitled Video Of A Laparo-scopic Morgagni Hernia Repair: EmphasisOn The Endoscopic Suture Passer -Authors: loana Bratu, Thomas Hui, J-

M. Laberge, L.T. Nguyen, H. Flageole,

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K.S. Shaw, P.S. Puligandla, Division ofPediatric General Surgery, Montreal Chil-dren's Hospital. loana, who is our gradu-ating fellow, has accepted a position atWinnipeg Children's Hospital, Division ofPediatric General surgery. We congratu-late her and wish her much success.

Two abstracts were accepted for presen-tation at the Canadian Association ofPediatric Surgeons meeting b Dr. An-

dreana Butter entitled Melanoma inChildren and The Use of Sentinel LymphNode Biopsy - Authors: A. Butter,

T. Hui, J. Chapdelaine, M. Beaunoyer,H. Flageole and S. Bouchard, H6pitalSainte-Justine and Montreal Children'sHospital. The second abstract presentedby Dr.Andreana BUtter was entitled Post-natal Pulmonary Distension For the Treat-ment of Pulmonary Hypoplasia: PilotStudy In The Neonatal Piglet Model - Au-thors: A. Butter, Bruno Piedboeuf, H.

Flageole, B. Meehan, J-M. Laberge,

Montreal Children's Hospital and CentreHospitalier Universitaire de Quebec.

Dr. Robert Baird was awarded theMcGill University Department of SurgerySurgical Scientist Scholarship. Hisresearch will focus on The Effect of FetalTracheal Occlusion on the Lung BranchingMorphogenesis in the Rat and Rabbit CDHModels (supervisors Drs. H. Flageole,

J-M. Laberge and P. Puligandla, Pedi-atric General Surgery and Dr. M.

Anselmo, Pediatric Respirology).

Dr. Miroslav Gilardino (Plastic Resi-dent) was awarded the 2004 Lyndon PeerFellowship for his research on SuturalDistraction Osteogenesis for the Treatmentof Cleft Palate Disease.

Dr. John Martinie (HepatopancreaticFellow) and his wife Janet proudlyannounce the birth of their seconddaughter, Grace Catherine, born at theRVH on September 2nd at 1:35 a.m.,weighing 6 pounds, 14.5 ounces. Con-gratulations! •

New Appointments

Deptartment of Surgery, MUHC

DR. MOSTAFA ElHILAU, Chairman of the McGill Departmentof Surgery, has announced the following new meritoriouspromotions:

DR. ARMEN APRIKIAN has been appointedHead of Urology at McGill and the MUHC. Hewas born in Alexandria, Egypt and graduatedfrom the Universite of Sherbrooke in Medicinein 1985. He joined the Urology Program atthe Universite of Sherbrooke and thentransferred to the McGill Urology ResidencyProgram graduating in 1990. Armen then dida fellowship at Memorial Sloan-KetteringCancer Center in New York before joining theMcGill Faculty in 1993. He is currently anAssociate Professor in the McGill Division of

Urology and Program Director of the Urology ResidencyTraining Program. He is also an Associate Member of the McGillDepartment of Oncology. Armen sits on many committees andis a member of numerous professional societies. He is adedicated teacher, and gives numerous lectures. He is involvedin many research activities both basic and clinical, and is widelypublished as judged by his c.v.

DR. BENOIT DEVARENNES has been appointedHead of the Division of Cardiac Surgery atMcGill and the MUHC. He replaces Dr. DavidMulder. Benoit graduated from McGill in 1984and trained in General Surgery at McGill until1989. He completed his training in CVT in1991, and did a fellowship in transplantationat McGill. Benoit is currently an AssociateProfessor in the McGill Department ofSurgery, and Clinical Director of the Division ofCardiothoracic Surgery at the RVH. He is amember of the Comite sur la Cardiologie

Tertiaire - Health Ministry of Quebec - Task Force on utilizationof left ventricular assist devices in the Province of Quebec. Aswell, he is a member of SGAS(Service de Gestion de I'AccesauxServices) - Establishment of Computerized Waiting ListDatabase in Cardiac Surgery for the Province of Quebec. Hismajor interests are in complex valvular surgery especially invalve repair and he has also developed a strong interest in Riskand Outcome Analysis in Cardiac Surgery Patients.

Dr. Benoit Devarennes

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DR. GERALD M. FRIED has beenappointed Director of theDivision of Surgical Education atMcGill and the MUHC andnominated to the Ross AdairChair in Surgical Education.Gerry was born in Montreal,Quebec and graduated fromMcGill University in Science in1971 and Medicine in 1975. Hethen completed his residency inGeneral Surgery at McGill

University in 1980. As part of the McGill program, he waschosen to do one year of his training at Ohio State Universityunder the supervision of Dr.Larry Carey and Dr.Robert Zollingerto further his education in gastrointestinal surgery. Heobtained his Royal College fellowship in General Surgery andQuebec certificate of specialization in 1980. Dr. Fried thenadvanced his interest in gastrointestinal disease by doing aresearch fellowship in gastrointestinal endocrinology andphysiology at The University of Texas Medical Branch,Galveston, under the direction of Dr. James C.Thompson. Hereturned to McGill University in July 1982. He has maintainedresearch funding for most of that time for basic or clinicalresearch, and has been involved actively in surgical education.He was Program Director for General Surgery from January1991-December 1996, and Fellowship Director in EndoscopicSurgery since 1996. Dr.Fried is currently Professor of Surgery atMcGill University and Director of the Minimally InvasiveSurgery Program. He was awarded the Steinberg-BernsteinChair of Minimally Invasive Surgery at the McGill UniversityHealth Centre in 2000. He is also Director of The Florenz-Steinberg Bernstein and David Bernstein Centre for Researchand Education in Minimally Invasive Surgery, and Director ofTyco Healthcare Centre of Excellence Program at McGillUniversity. His innovative work in surgical simulation, andteaching and measurement of technical skills in surgery hasbeen widely recognized. He is the Past President of theCanadian Association of General Surgeons.

Dr. Gerald Fried

DR. TAREK RAZEK has beenappointed Head of the DivisionofTrauma Services at McGill andthe MUHC. Tarek graduatedfrom McGill in 1993 and also didhis General Surgery Residencytraining at McGill, graduating in1998. He then did a 2-yearfellowship in the Division ofTrauma and Surgical Critical Careat the University of ~

Dr. Tarek Razek

8

~ Pennsylvania Medical Center in Philadelphia. Hejoined the McGill Faculty as an Assistant Professor of Surgery inthe year 2000. Through the Canadian Network for InternationalSurgery (CNIS), he has participated in surgical educationprojects in Ethiopia and Tanzania in the last 2 years. Tarek also

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took the war surgery course given by the InternationalCommittee for the Red Cross (ICRC) in Geneva. He recentlyspent 3 months working in a field hospital servicing theongoing civil strife in the southern Sudan with otherinternational colleagues .•

...............................................................................................................................EKL& EDM

Dr. Antoine LoutfiDirecteur de lutte contre Ie cancer

DR. LOUTFI, a senior surgeon at the RoyalVictoria Hospital siteof the MUHC and Director of Surgical Oncology at McGillUniversity, has accepted a new position at the Quebec Ministryof Health. He has been appointed "Directeur de lutte contre Iecancer': His role is to coordinate the delivery of cancer carethroughout the province. A plan has been established to helpdeliver appropriate and timely care to cancer patients whereverthey are. Quality indicators are being developed and data onpatients receiving care will be gathered and evaluated in orderto improve their care. More specifically, cancer in Quebec will beintegrated in the new health care delivery plan at 3 levels: local,regional and supraregional. At the local level, oncology teamswith a coordinating nurse will help patients and their familiesget the necessary information and support throughout theirinitial and subsequent care. At the regional level, each agency

with its respective hospitals willprovide the required specializedcancer services to patients. Thesupra-regional care for cancerpatients is integrated within thenewly established universitynetworks called RUIS: (ReseauUniversitaire Integre de Sante).Their mandate is to establishteams of cancer experts who willdevelop and disseminate practiceguidelines, thus improving the

care of cancer patients at all 3 levels of delivery of care. Inaddition, Dr. Loutfi will represent Quebec at national andinternational cancer agencies. In this role, he will be sharingexpertise, finding solutions to common cancer problems, andhelping to establish cancer priorities .•

Dr.Antoine Loutfi

EDM

...............................................................................................................................Shriners Hospital - Canada

The Shriners Hospital-Canada is a 40-bed pediatric or-thopaedic hospital providing comprehensive orthopaedic careto children at no charge. The hospital is one of 22 Shriners Hos-pitals throughout North America. The Shriners Hospital-Canada accepts and treats children with routine and complexorthopaedic problems, utilizing the latest treatments and tech-nology available in pediatric orthopaedics, resulting in earlyambulation and reduced length of stay.

Chairman, Board of Governors: Ronald S. SnowAdministrator: Maureen BrennanChief of Staff: Francois Fassier, M.D.Director of Nursing & Patient Care Services:Sharon Brissette, R.N.Director of Research: Francis H. Glorieux, M.D., Ph.D.Research Administrator: Paul RichardOpened: February 18, 1925

Shriner's Hospital on CedarAvenue in Montreal

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THE SQUARE""z~11

Panel Lt. to Rt.: Dr. Paul Belliveau (Queen's), Dr. Victor Fazio (Cleveland Clinic), Dr. LeeSmith (Washington Hospital), Dr. Gordon at dais,

Professor Normal Williams (Royal London), Dr.Douglas Wong (Sloan Kettering Memorial Cancer Center), Dr.Robin K.S.Phillips (St.Mark's Hospital)

Symposium Faculty

Symposium Faculty

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THE SQUARE::0:::z

~13

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~ reports in order to address the issues that need to becorrected prior to the official 2006 visit.

In the fall of 2004, the Medicine and Pediatrics programs arescheduled to undergo their internal reviews. The lab programswill be reviewed in the winter of2005. Between 2005 and 2006those programs where a repeat visit or an external review willbe needed will then undergo this process so that we are readyfor the April 2006 accreditation.

For this process in particular, I would like to thank all ProgramDirectors for the professionalism with which they areundergoing the reviews. It is hoped that very few loose ends

THE SQUARE::0:::z!::15

will be left following the internal reviews because of theseriousness with which the process is being taken by concernedindividuals.

As you can see,the four challenges are well interrelated and theprocess is very dynamic. I am lucky to be able to count on a veryreinforced Postgrad Office team of devoted individuals who helpthe Faculty of Medicine at McGill remain at the forefront ofpostgraduate training in Quebec,Canada, and internationally .•

Jean-Pierre Farmer,MD,eM, FRese

Associate Dean,

Postgraduate Medical Education and Professional Affairs

...............................................................................................................................

A s everyone is probably al~ady aware, in July ofthis year, the McGill Anesthesia Department's chairmanshipchanged hands. Dr. Franco Carli's ten year term came to an

end, the role of Chairmanand MUHC Anesthetist-in-Chief was appointed toDr. Steven Backman.

New McGill AnesthesiaChairman

~ Without the Department's administrative responsibilities to~ look after, Dr. Carli is enthusiastic about the possibility of::s1[ dedicating more time to research and teaching. Over the past~ ten years, Dr. Carli has devoted countless hours, often in theS- evening and during weekends, to build a stronger Department,.?- both for the clinical aspects and in research. He has strongly~ upheld the academic program with a belief that McGill• Anesthesia staff and residents deserve a first rate continuing

medical education program. On behalf of the all the membersof the McGill Department of Anesthesia, I would like to thankFranco for his hard work, perseverance and dedication to McGillAnesthesia.

Dr.Backman was appointed to McGill as an Assistant Professorin the Department of Anesthesia in 1993 and has been on staffat the Royal Victoria Hospital since his appointment. He waslater promoted to Associate Professor and in 2000 took over therole of Clinical Director at the Royal Victoria Hospital.

An enormous task is awaiting Dr. Backman over the next fewmonths and years. Even though I am convinced that Stevenwill expertly handle the multiple challenges a Chairman andChief may face, I encourage everyone to support him. In order

to achieve excellence, our Department needs not only anoutstanding leader with an academic vision, but also memberswho share that vision who are ready to implicate themselves. Itake this oppor-tunity to congratulate and wish Dr. Backmanthe best of luck as he begins this important new role .•

Dr. Franco Carli Dr. Steven Backman

--------~:r-\- 'I=. ~~")i-.~~--- I, 11:1 ~

, ~~_j r ilil ~' , '"Efi.--~.·'~~;'~p:~~~', t~-IIy~~~~ ~- n~c--

"Is there a doctor in the house?That's the call Harold's been waiting for since he started practice,

twenty-five years ago."

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THE SQUARE:00::z~

A plaque was presented to each member of the Joint CHSSand ECHSAProgram Committee in appreciation of their workMarshall L. Jacobs, Philadelphia, USA(CHSS)Ex-Officio, Erie H. Austin, Louisville, USA (CHSS)

Carl L. Backer, Chicago, USA (CHSS),Bohdan Maruszewski, Warsaw, Poland (ECHSA)Giovanni Stellin, Padova, Italy (ECHSA),Jeffrey P. Jacobs, St.Petersburg, USA (ECHSAand CHSS)

Christo I. Tchervenkov, Montreal, Canada (CHSSand ECHSA)Chairman

Christo I. Tchervenkov, Constantine Mavroudis and Giovanni Stellin presented a plaqueto the Guest Speakers; Dr. Eugene Blackstone and Dr. James K. Kirklin

Christo I. Tchervenkov, Montreal, Canada (CHSSand ECHSA)Eugene Blackstone, Cleveland, USA, (CHSS)

Guest Speaker,James K. Kirklin, Birmingham, USA,(CHSS)Guest Speaker, Giovanni Stellin, Padova, Italy, President - ECHSA

Constantine Mavroudis, Chicago, USA,President 2004-2006 - CHSS

Connie (foutier, a long standing pediatric cardiac nurse at theMontreal Children's Hospital, presented a plaque to

Dr. Anthony R.C Dobell, Honoured GuestChristo I. Tchervenkov, Montreal, Canada (CHSSand ECHSA)Chairman

Connie Cloutier, Montreal, Canada, Retired Nurse, TheMontreal Children's HospitalAnthony R.C.Dobell, Montreal, Canada, Honoured Guest

Audience looking at the specimen of the preserved Holmes Heartafter the presentation given by Dr. Anthony R.C Dobell

Christo I. Tchervenkov, Montreal, Canada (CHSSand ECHSA)ChairmanTatiana Blazevic, Montreal, Canada (patient with CHD)

Gary Silverman, Montreal, Canada, President - Heart of Life parent groupGeorge Trusler,Toronto, Canada, Honoured Guest

17

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Since the early1990's when Dr,Nimlas Steinmetzinitiated a project to build a new "superhospital'; muchplanning and effort has been expended and these are finally

coming to fruition.After repeated delaysbut stimulated by theMulroney-Johnsonreport, Quebec Health

Minister Philippe Couillard in June approved 1.1 billiondollars each for the construction of the McGill University HealthCentre and the Centre Hospitalier de Universite de Montreal.Both are to have the synergy between the University and astate-of-the-art new Hospital Centre. Decontamination of theoily 17-hectare Glen railway yards site straddling Westmountand Notre Dame de Gracewill begin in 2005 and will last from6 to 9 months. Construction should follow by the end of 2005,and the new hospital should be opened by the year 201O.Thereis room on the site for the Shriner's. This charitable fraternitywould provide 100 million dollars towards this end. Montrealhas been the home of the Shriner's Hospital (the only one inCanada) since 1925. It treats more than 6,000 Quebec childrenannually as well as many others from across North America.There is some concern that the Shriner's might move to Ottawaor London, Ontario, but at a meeting in mid October,Mr. GeneBracewell, the Imperial Treasurer of the Shriner's met withMinister Couillard, Dr. Arthur Porter, CEOof the MUHC,Mayor Gerald Tremblay and William Pickard, Chair Personof the Board of the Montreal Shriner's. The result was optimismthat the Shriner's might be built inassociation with the Montreal Children'sHospital on the Glen site after all. TheMCH will keep its 144 beds. This wouldstart in the spring of 2006.

Plans for New MUHC

Soon Coming to Reality

An announcement by Treasury BoardPresident, Monique Jerome-Forget,scared everyone however in earlyOctober when she affirmed that theremight be a delay in funding the wholeproject since it was necessary tonegotiate a public-private partnership orP3. Dr.Arthur Porter exclaimed that thiswas "unacceptable" and as a result of themeeting with Mr. Bracewell, it seemsthat this hedge was put aside andMinister Couillard re-assured the MUHCand Mr. Bracewell that planning could go

THE SQUARE:0::zo....19

ahead. According to the revised plans, Dr.Porter maintains thatthe complex will be more like a health care village with fewerbeds than had originally been proposed. There will be from 500to 550 beds, about 332 less than initially projected. TheMontreal General will remain open as a complementary sitewith approximately 300 beds. The Neuro will keep its 60 beds.This new Glen site will offer services in Medicine, GeneralSurgery, Oncology,Women's Health Care,Organ Transplantation,Cardiac Surgery, Vascular Surgery, Plastic Surgery, Urology,Geriatrics, Mental Health, Intensive and Coronary Careaswell asthe aforementioned Pediatrics. Services that will remain at theMontreal General are Medicine, General Surgery, Trauma (seeelsewhere in these pages), Intensive and Coronary Care,Neurological Care for Stroke and Spinal Patients, RespiratoryCare,Orthopedics and Oral and Facial Surgery. Both sites willhave 24-hour Emergency Departments. Dr.Timothy Meagherhas accepted the newly created role of Chief of ClinicalDevelopment.

The MGH is 6 kilometers away from the Glen Yard site so ashuttle service will have to be established. Some are alsoconcerned that transit to and from the new hospital will be aproblem, but efforts are being made to solve this.

The Centre Hospitalier de Universite de Montreal also has plansto develop a 700 bed facility at the current St. Luc Hospital indowntown Montreal at the corner of Rene Levesque Blvd. andSt. Denis St. As we go to press, however, the authorities atCHUM are considering a new proposal to construct the CentreUniversitaire at the railway "triage" yards in northernOutremont. •

fOM

View of the Glen Yards,future site of the MUHC superhospital

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~ well as the good will of my partners and family. Thetask fell to my fellow three Purple Service colleagues to coverboth my daily, and dreaded on-call duties. Similarly, my wife'sfamily, my brother Alan (whom many of you know as Head ofGastroenterology at McGilIl, and my father Harvey (whommany knew as Associate Dean at McGill), covered the daily andequally dreaded homework duties with respect to our twoyoung children, Kate and Nicolas.

As well as a lesson in history, my travels were also about toprovide me with a real-life, albeit forbidding lesson ingeography. I learned that the terms Southeast Asia andOceania do not refer to obscure neighboring southeasternpictures on a world map, but rather represent a very large areacrossing mUltiple time zones, and requiring dozens of hours ofinterior travel time.

Having initially flown from Montreal to Vancouver, my wifeSusan and I enjoyed the pampering of a 13-hour Cathay Pacificflight to Hong Kong where Professor John Wong, true to form,had arranged for an unforgettable experience. Ten hours afterhaving been driven to our hotel,l gave the first of two lecturesat the 07:00 am Saturday morning departmental rounds. I wascertainly surprised to see a nearly full auditorium, but perhapseven more impressed by the absence of nodding-off heads andsnores, which have come to sometimes characterize our ownrounds. Over the next six days,l had the privilege of attending

THE SQUARE:0::zo....21

rounds, visiting wards, and partaking in biliary Endoscopy, aswell as several operations including a living-related liver donorhepatectomy. I should point out that the Queen Mary Hospitalgroup, headed by Professor S.T.Fan,has published over the past15 years what have become the landmark articles related tothe endoscopic early treatment of cholangitis and acute biliarypancreatitis. Moreover, they performed the first successfulliving-related right liver transplantation and have developedone of the largest such experiences in the world. They have alsojust completed over one hundred living-related donor liveroperations without a significant bile leak, a true technical feat.When I left Hong Kong six days later, I had been thoroughlyimpressed with the grueling work ethic (all surgeons areexpected on a daily basis), the technical meticulousness oftheir operative skill, and the humanity with which theyconduct their professional and research activities. I believe Iwill also always remember a dinner at the reputed "China Club';remnant of a now distant glorious colonial era, where paintingsand pictures of Chiang Kai-Shek's widow, Mao Tse Tung andTianimen Square adorn the walls side by side in seeminglypeaceful equanimity.

I look forward to relating my experiences in Australia andfuture James IVth travels in upcoming Square Knot issues.•

Jeffrey Barkun, M.D.

Dr.Barkun and Asian O.R.team in action

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THE SQUARE:0::

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23Annual BBQlSoccerGame i\fIOOd. The residents played soccer against each other with Drs.

G I S R-d t Meterissian, Salasidis and Shaw keeping up. There wasenera urgery eSI en S I storytelling of residents' hilarious experiences. Thanks to all

who participated in making this an exciting event and

Dr. S. Meterissian and his wife Mrs. Marcelle Lavoie "::2 special thanks to Marcelle Lavoie for being a gracious host. We

hosted their 1st Annual BBQ/Soccer Game for the Generaff1can't wait for next year. • . ... RIta PICCIone

Surgery Residents on Saturday, August 28, 2004. It was an

amazing summer day filled with fun and an abundance of

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E.D. Monaghan, M.D.Editor

THE SQUARE=-=Zo-I~

Emma LisiAssistant Editor

Marie M. CimonCopy Editor

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All photographscourtesy of TheMcGillSurgery Department

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or suggestions, we want to hear from you!

Contributions of $50.00 are appreciatedin ensuring the continued publicationof "The Square Knot" and supporting McGillSurgery Alumni activities. Pleasemakecheque payable to the McGill Departmentof Surgery and forward to Maria Bikas,McGill Surgery Alumni & Friends,TheMontreal General Hospital,1650 CedarAvenue, Room: 19-420,Montreal (Quebec) CanadaH3G1A4Telephone: (514) 934-1934, ext.: 42028Fax: (514) 934-8418.

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