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·····························My entire family lives in Toronto. After :being in the States for 11 years in private :practice, I am considering relocating to :Toronto area to re-unite with my family. ~·Lancelot K. Tin, MO, FACS,FRCSC :
Perrysburg,Ohio ~
······················
Dear Editor,Thank you for your recent letter concern-ing my contribution to the McGill SurgeryAlumni and Friends. I had a great time atMcGill during my residency trainingwhich had carried me well into my career.And I have a fond memory of you.
Currently, I am theChief of Surgery atSt. Charles Hospitaland enjoying my
practice with a group of dedicated sur-geons in Toledo, Ohio.
Dear Editor,I will be moving to Boston. I have com-pleted twenty years as a surgeon at theEtobicoke General Hospital, now calledthe William Osler Health Centre and I waschief of surgery from 1986 to 1999. I ammaking a career change out of active clin-ical practice of surgery. I hope to usewhat I've learned as chief of surgery tofacilitate the interface of physicians withthe administrative aspect of medicine.
On a personal note Wendy is fine. She isa senior vice president of State StreetBank in Boston. I have two grandchildrenaged eight and six who are well and arethe children of my daughter Jennifer. Ourson Wallace is working for Deloite con-sulting information technology and en-joying it very much. •
Wally W. Watson,Toronto,Ontario
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Memo From Chief
Division of General Surgery, MUHC
TO: Members, Division of General SurgeryRE: Surgical Grand Rounds, Morbidity and Mortality Rounds
Academic Half Day
The Division Educational and Mainte-nance of Competence Activities are con-stantly being upgraded, and I hope tosolidify these in a regular manner forSeptember 2001. In the meantime,there have been several changes. Thismemo is intended to inform all Mem-bers of the Division.
o Surgical Grand Rounds will beheld at The Montreal General Hospi-tal Site, MUHC,at 7:45 a.m. on Thurs-days. This will become a permanentfuture activity to serve as combinedrounds between the Department ofSurgery, Department of Anaesthesiaand other interested departments, aswell as slot in the Visiting Professorsfor the various departments and di-visions over the academic year. TheExecutive of the Department ofSurgery has approved this initiativeand has mandated myself and Dr.Franco Carli, Chair, Department ofAnaesthesia, to proceed with organi-zational plans. Surgical GrandRounds at the Royal Victoria Hospitalat 5:00 p.m. are, therefore, cancelledfrom hereon. Dr. Liane Feldman hasagreed to organize the Surgical GrandRounds at the MGH. In the interimperiod between now and September1, 2001, we will try to do the bestpossible job (given the time and re-source) to make these Rounds inter-esting and everybody is encouragedto attend.
f) Morbidity and Mortality Rounds.
As part of restructure of the Acade-mic Half Day,Morbidity and MortalityRounds are now alternating at eachsite every two weeks. When the Aca-demic Half Day activities are at the
Royal Victoria Hospital Site, M&MRounds for the two week period arepresented at that Site from 3:00 to4:00 p.m. Similarly, when the Acad-emic Half Day moves to The MontrealGeneral Hospital Site, a two weekperiod of M&M Rounds is carried onfrom 3:00 to 4:00 p.m.
8 Academic Half Day. I encourage allstaff to attend the Academic Half Dayactivities, especially if these are heldat their own Site. Certainly, M&MRounds should be attended by allGeneral Surgery Staff. By January 1,2001, I hope we can achieve 100%attendance at these Rounds. MO-COMP activities will be started withM&M's and Surgical Grand Roundsthen expand to other areas.•
N. V. Christou, M.D.October 71,2000
Three Wise
Women
Letters
to The Editor
"If there had been three wise
women instead of three wise
men, they would have asked for
directions, arrived on time,
helped deliver the baby, cleaned
the stable, made a casserole and
brought practical gifts. ~
- Mrs. Barbara Bush on"Women's Issues" whilst on thecampaign trail for her son n theU.S.Presidential election.
BUREAUCRACY GONETOO FARHave you ever sat in a committee room with about 20 othersdiscussing important health care issues and, when you look
around, realize that you are the only one whoactually sees patients? Clearly, the occupa-tional mix between physicians and adminis-trators has become unbalanced. We workunder a stifling technocracy. Canadians spent
an estimated $76.6 billion on health care in 1997, up from$75.5 billion a year earlier. Please see how the "pie" is split inthe accompanying diagram from The Canadian Institute forHealth Information (see Figure 1).
Editorial
The Provinces, in recent meetings with the federal govern-ment, demanded that Ottawa increase its Canada Health and
Percentage of total healtlH:are spending in Canada based on actual dollars
,..,.....Total: $47.1 billion Total: $76.6 billion
SOURCE: CANADIAN I~TtTUTE FOR HEALTH INfORMATION • Forecasts
Percentage of total health-care spending in Canada based on actual dollars.Source: Canadian Institute for Health Information *Forecasts
Social Transfer funding to 18.7 billion, up from the current 15.5billion. Of course, Ottawa wants to monitor how this moneyis spent and so it should. Quebec spends the lowest of allprovinces on health care - $2453 per person in 1999, whichwas $362 less than the national average of $2815. And yetwe in Quebec pay the highest taxes in the country!
There are enough signs to suggest that Canada'shealth spend-ing may be inefficient. In a comparison of 29 OECDcountries,Canada ranked fifth in terms of its per capita expenditure onhealth, but on other indicators we ranked much lower: 24th interms of practising physicians per population and 25th in thesupply of hospital beds.
In Quebec, there seems to be a disproportionate amount of
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3
non-medical interventionists. let us do the math. Accordingto the Coli ge des m decins there were 18,054 doctorsworking in Quebec as of December 31, 1999.
Specialists 8993Family Physicians 8584Biochemists 56Micr'lbiologists 174Pathologists 247
Add to this the number of Residents and Fellows. According toCREPUQ,as of October 4th, 2000 there were 2132 residentssponsored by the RAMQ. This includes 541 Residents in Fam-ily Medicine. It is noteworthy that there were 337 registeredin Post-Graduate Surgical Specialty Programs.
It is said that there are 2 administrators for every physi-cian/surgeon in our Province. We tried to get some data, butit is not easy. Perhaps some investigative reporter could pur-sue this. We do know that there are 17 R gies R gionales, andone Conseil R gionale. The Quebec Medical Association has,in its brief to the Clair Commission, requested that an inde-pendent body be set up. The latter would include doctors toreplace these boards and would be an independent body freeof government control. The RAMQalone has 1268 employees.There are 815 civil employees in the Ministry of Health andSocial Services (795 in Quebec and 20 in Montreal). When youadd the Conseil du Tr sor, the Office des Personnes Handicap-p s, and the Ministry of Education, you get a heavy work bodyindeed. Quebec remains strangled in rules, regulations andbureaucratic meddling .
Just recall the number of accrediting bodies to whom we mustreport; The Canadian Council on Health Services Accreditation;the Royal College; Coli ge des m decins du Qu bec; The Asso-ciation of Canadian Teaching Hospitals; ACGME. We also heedthe FMSQ; the FMOQ; the FMRQ; the Canadian Medical Pro-tective Association; the Ministry of Education's Conf rence desRecteurs et des Principaux des Universit s du Qu bec; theunions and the Quebec Hospital Association.
A Surgeon is not independent!
Happily some good tidings are now coming our way. For onething, due to the public's hue and cry some new money ispending. In mid-September a new federal-provincial deal onhealth care was signed and 6 billion more dollars will bebrought to Quebec's coffers over the next five years. HealthMinister Pauline Marois is promising to spend this money on"crisis areas" i.e. primary ambulatory care, ClSe's, emergencyrooms, radiation therapy, heart surgery and re- ~
~ search. Hopefully, we will not hire any more public servantsto oversee these expenditures. Patient-rights advocates haveadvised the government to spend its health care dollarswisely. Also the Federal Government has made it a conditionthat it will monitor how the money is spent.
Another bit of welcome news is that the Quebec Govern-ment seems to be freeing itself from the dictates of theBarrer-Stoddart Report of 1990, and it has decided toincrease by 30 the number of admissions to Quebec'sMedical Faculties for 2000-2001. We wanted 55 but30 is a start. Quebec's four faculties now have 501students in the first year of Medicine .
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We need to have a trustworthy mechanism that would allowCanadians to keep track of health care spending so that it maybe directed to the health care providers .•
Dr.Gulliver andthe bureaucrats.
............................................................................................................................ ..
Update on
Undergraduate
Education
LAST SPRING, McGill Universitywas subjected to an accreditationprocess and I am pleased to reportthat the Undergraduate Surgeryprogram passed with flying colors.There were only a few comments
~ made with regard to the standardisation of seminars and the~ introduction of short answer questions in the ICM-C exam;I::;;; these are being addressed presently. Several recommenda-5: tions from the Undergraduate Surgical Education Committee<g: were prepared and given to the Department Head and theseI::~ are being considered.
The Surgical faculty at all four sites has been active in deliv-ering top quality seminars and the feedback from the stu-dents generally has been very good.
The Undergraduate Surgery Committee is in the process ofanalysing the objectives of both the ICM-C and POM's pro-gram, and will try to harmonize these objectives with a prob-lem based approach in the form of seminars given at thevarious sites. In general, it is safe to say that McGill studentsdo very well in the surgical component of the Medical Coun-cil of Canada examination and the USMLE.
I wish to personally acknowledge the contribution of each andevery surgical faculty member who hasdevoted energy and timeto the delivery of high quality seminars and ward teaching .•
Paul Belliveau, M.D.,Program Director, Undergraduate Surgery
Stipends
THE FEDERATION of Medical Resi-dents' collective agreement is beingrenegotiated, including the salary scale.
Uniforms and laundry of uniforms are supplied. There are fourweeks of paid vacation annually as well as provision for studyleave to attend conferences and to write exams.•
THE SALARY SCALE
1999-2000 Academic Years
Resident 1 $34,611.00
Resident 2 $37,981.00
Resident 3 $41,883.00
Resident 4 $45,767.00
Resident 5 $48,873.00
Resident 6 $51,327.00
Resident 7 $53,894.00
fDM
4
Over the past decade, more than 6000 laparoscopic chole-cystectomies have been performed at McGill. Data on thesepatients and the collaborative energy of the laparoscopicgroup have allowed us to make several important contribu-tions to the literature and the practice of this procedure.Some of the highlights were the first randomized controlled
trial of laparoscopic vs open cholecys-tectomy, published in the Lancet in1992. Or. Jeffrey Barkun was an in-vited participant in the NIH consensusconference on laparoscopic cholecys-
tectomy. The paper presented at the American Surgical As-sociation in 1992 entitled Cholecystectomy without operativecholangiography: Implications for common bile duct injury andretained common bile duct stones, and published in the An-nals of Surgery in 1993, has been an important contributionsupporting the safety of laparoscopic cholecystectomy with-out routine operative cholangiography. Another paper, pre-sented to the Society for Surgery of the Alimentary Tract byOr. Gerald Fried and published in the American Journal ofSurgery in 1994 entitled Factors determining conversion tolaparotomy in patients undergoing laparoscopic cholecystec-tomy has been widely quoted. Several other important pub-lications have allowed McGill to be recognized as a centre forexcellence in this field.
Minimal Access(continued from pg.l)
Shortly after the introduction of laparoscopic cholecystectomy,McGill surgeons explored more advanced laparoscopic proce-dures, and held hands-on courses for surgeons to enhancetheir skills. Some of these early courses were held in con-junction with our colleagues at the Universit de Montr al.We added laparoscopic inguinal hernia repair, colon surgery,vagotomy, appendectomy, and antireflux surgery to our arma-mentarium in the early to mid 1990's. We carried out a ran-domized controlled trial of laparoscopic vs open inguinalhernia repair and this has been presented and published.
Some of the highlights of the McGill Program in Minimally In-vasive Surgery are described below.
CLINICALMinimal access surgery (MAS) has been established as a pri-ority program for the MGH site of the MUHC. As a conse-quence, a decision was made to commit dedicated time forthese innovative operations. The time is being allocated cur-rently to general surgery, thoracic surgery and urology on a ro-tational basis. The goal is to utilize this time to develop newprocedures and to introduce them into clinical practice atMcGill. A similar arrangement has been in place for a fewyears at the Jewish General Hospital site and has been ex-tremely effective. Since new MAS procedures frequently take
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more time to perform than the equivalent open procedures,surgeons have been somewhat discouraged from trying to ad-vance the field.
Currently the procedures being performed by the McGill MASteam include laparoscopic cholecystectomy, appendectomy,inguinal and incisional hernia repair, esophageal myotomy forachalasia and esophageal spasm, fundoplication,paraeosophageal hernia repair, thoracoscopic vagotomy, la-paroscopic colectomy, adrenalectomy, splenectomy, smallbowel resection and adhesiolysis, and nephrectomy, radionu-clide-guided parathyroidectomy under local anesthesia andimage guided minimally invasive breast surgery.
Laparoscopic general surgery currently includes foregut proce-dures (fundoplication, achalasia, and gastric surgery), solidorgan procedures (spleen/hematologic, adrenal, and kidney-inconjunction with urology), colorectal, hernia (inguinal and in-cisional), biliary. Over 100 advanced general surgery laparo-scopic procedures were done last year and the numberappears to be doubling every 6-9 months. Other minimallyinvasive general surgery procedures include probe-guidedparathyroidectomy under local anesthesia and image-guidedminimally invasive breast surgery.
The Division of Thoracic Surgery team of Drs. David Mulder
and John Vee are performing Video-Assisted Thoracic Surgeryat the Montreal General and Jewish General sites.
The Department of Urology has enthusiastically embraced la-paroscopic surgery. They will work with the general surgeonsand transplant team to establish a laparoscopic live donornephrectomy program at McGill within the next few months.Laparoscopic radical prostatectomy is now being offered atMcGill under the leadership of Or. Maurice Anidjar
(recently recruited from Paris), Or. Simon Tanguay, andOr. Jacques (orcos.
Advanced minimally invasive surgery procedures are currentlybeing performed at the Montreal General Hospital and Mon-treal Children's Hospital sites of the McGill University HealthCentre, and at the Jewish General Hospital. The Jewish Gen-eral Hospital was the first in our area to build an advancedlaparoscopic operating room, with boom mounted equipment.Or. Sigman, as Head of General Surgery at the Jewish, estab-lished dedicated time for advanced laparoscopic surgery, andthis is organized by Or. Jacob Garzon. The model of desig-nated O.R.time and a specially designed operating suite hasbeen instrumental in advancing the frontiers of minimally in-vasive surgery. In September 2000, the Montreal General Hos-pital established dedicated time for MIS. This will ~
~ be shared between general surgery, thoracic surgery,and urology to start, and hopefully expand among other sur-gical specialties once anesthesia and nursing manpower prob-lems are resolved.
Plans are currently being finalized to build a new MIS Oper-ating Suite and Video-conferencing facility at the MGH site.This will be possible thanks to very generous donations fromthe Cedar's Cancer Institute, the J.w. McConnell Family Foun-dation, the Steinberg-Bernstein Endowment Fund, and theMcGill University Health Centre.
LAPAROSCOPYCENTRE
The Steinberg-Bernstein Centre for Laparoscopic Surgery wasestablished at the Montreal General Hospital site in 1995 thanksto an extremely generous endowment established by Mrs. Flo-renz Steinberg-Bernstein and her family. The goals of this cen-tre are to measure outcomes in laparoscopic surgery and todevelop a model for education of surgeons in this new field.
In December, 1996, the McGill Laparoscopy Group wasawarded a generous unrestricted educational grant from AutoSuture Canada (Tyco Healthcare/United States Surgical Corpo-ration) to develop a Centre of Excellence in LaparoscopicSurgery. This support led to a fellowship, allowed us to hire afull-time nurse-coordinator, and supported a number of edu-cational and research programs in minimally invasive surgery.This support continues to this day and a contract has beensigned to ensure continued support through 2003.
Storz Endoscopy Canada made a major contribution of capitalequipment to outfit our laparoscopic centre, providing us withhigh quality optical systems and instrumentation for the O.R.and the lab.
EDUCATION - MISTELS TO FLS
The McGill Centre for Minimally Invasive Surgery considerseducation as one of its major missions. Donna Stanbridge,
R.N., is the nurse-coordinator of this program.
In the beginning, our responsibility was primarily to train ourfaculty in basic laparoscopy though a series of courses com-bining theory and hand-on training. The success of these firstcourses led to a strong demand from surgeons beyond theMcGill hospitals for such courses. The courses continued to beoffered on a regular basis as long as demand was there. Oncemost surgeons were comfortable in performing laparoscopiccholecystectomy, interest extended to learning more techni-cally demanding MAS procedures. We then put on a series ofadvanced laparoscopic surgery courses covering advanced dis-secting skills, suturing and knot tying, and the performance of
THE SQUARE""z~6
inguinal hernias, vagotomy and fundoplication. We invited acadre of famous leaders in laparoscopic surgey to visit and tohelp us enhance our skills. These visitors included Dr. Namir
Katkhouda from Nice, Dr. Bernard Dallemagne from Brus-sels, Drs. Henry Laws, Bob Fitzgibbons, Maurice Arregui,
and Barry McKernon from the U.s.
Residents were trained with structured courses, skills labs andwithin their residency programs. Once the Auto Suture sup-ported centre of excellence opened in December 1996, wewere able to hire a nurse to help train residents and visitingsurgeons in basic skills. We established an inanimate skills labwith models that have proven extremely valuable in trainingin laparoscopic skills. We developed a fellowship program andsince its inception, 4 fellows have completed training inlaparoscopy. This program emphasizes not only acquisition ofclinical skills, but also development of an inquiring mind witha significant component dedicated to performance of out-comes or educational research.
Several practicing surgeons from rural communities and for-eign countries have spend extended time periods visiting ourcentre, taking advantage of our skills lab and observing theexperience in the operating rooms. This continues to be pop-ular and has led to close links between our department andthose of our guests.
One of the most productive of our educational strategies hasbeen the development of the MISTELSprogram. This is a se-ries of 7 "exercises" or drills performed in an inanimate train-ing box. This was developed mainly through the work ofDr. Anna Derossis, our first laparoscopic fellow. Each of theseexercises can be evaluated on the basis of precision and speed.We have shown that this system provides scores that are validmeasurements of laparoscopic skills, and sufficiently sensitiveto distinguish expert from novice surgeons. Practice in theMISTELStraining system accelerates the acquisition of skills inactuallaparoscopic surgery. This system has now been incor-porated by SAGES(Society of American Gastrointestinal Endo-scopic Surgeons) as the model that they will use for skillsevaluation and credentialing in their Fundamentals of La-paroscopic Surgery Program.
QUALITY ASSURANCE
It is imperative to evaluate the impact of the new technologythough a program of technology assessment whenever a newinnovation is introduced into clinical practice. Just because aprocedure is new and in demand does not necessarily implythat it is better than the gold standard, nor that it is cost ef-fective. From the outset it was a goal of our group to trackoutcomes and establish a program of continuous ~
~ quality improvement. We have done this in variousways. These include designing prospective databases, andmeasuring patient based outcomes, quality of life, and patientsatisfaction. We have studied costs, examined resource impli-cations of the new technology, and of course evaluated tradi-tional measurements of morbidity and mortality.
VISITING PROFESSORSHIP PROGRAMIn 1998, Dr. Michel Gagner, Professor of Surgery and Direc-tor of Minimally Invasive Surgery at Mt. Sinai Hospital in NewYork was our first MIS Visiting Professor. The attendance byMcGill faculty and residents was superb and it was really aninspirational day.
Dr. Namir Katkhouda was the second McGillAuto Suture Canada/ Steinberg-Bernstein VisitingProfessor in minimal access surgery (photo). Hisvisit took place on September 14-15,2000 andwas generously sponsored by the Auto SutureCanada/ United States Surgical Corporation Educa-tional Grant for a Center of Excellence in Laparo-scopic Surgery. Dr. Katkhouda is currentlyProfessor of Surgery and Head of the Division ofLaparoscopic and Ambulatory Surgery at The Uni-versity of Southern California. He had visitedMcGill in 1990 and 1993 when he was still in Nice,
France to participate in our early courses in Basic and AdvancedLaparoscopic Surgery. He was here at the beginning and wewere truly delighted to have him return to see what we haveaccomplished at McGill and to stimulate us to advance further.Dr.Katkhouda is one of the pioneers in laparoscopic surgery. Hisinnovations have helped advance the boundaries of what is pos-sible using minimal access surgery techniques.
Dr.Namir Katkhouda
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The visit was begun by his lecture at Surgical Grand Roundsentitled Laparoscopic Surgery of the Spleen held in the OslerAmphitheatre at the Montreal General Hospital. The atten-dance at his lecture was excellent, including surgeons frommost disciplines and across hospital sites, residents, medicalstudents, and nurses. This lecture was followed by presenta-tions from several members of the McGililaparoscopic group.The presentations are summarized below:
A lunch was then served for attendees at the day's activities.
The afternoon featured live surgery broadcast from the Oper-ating Room of the Montreal General Hospital to the Osler Am-phitheatre. Dr. Katkhouda, assisted by Dr. Fried, performedlaparoscopic bilateral inguinal hernia repair using the totallyextraperitoneal technique, fixing the mesh using fibrin glue.Dr. Harvey Sigman moderated questions from the Osler am-phitheatre to the O.R. and Dr. Liane Feldman moderatedquestions in the O.R. The technology worked extremely well,thanks to the support of John Labelle from the AudiovisualDepartment.
That evening the McGill Laparoscopy Group joinedDr. Katkhouda in a dinner at Les Chenets (photos).
On Friday, September 15th Dr. Katkhouda performed a handassisted laparoscopic splenectomy assisted by Drs. Jacob Gar-zon and Gabi Ghitulescu at the Jewish General Hospital.Again, arrangements were made to distribute the O.R.detailsby a video-conferencing link to a teaching room at the Jew-ish. This again was an outstanding educational opportunityfor all that participated. ~
PRESENTER
Maurice Anidjar, M.D. (Urology)
TITLE
The technique of laparoscopic radical prostatectomy
Jacob Garzon, M.D. (General Surgery)
Liane S. Feldman, M.D. (General Surgery)
The McGill technique of laparoscopic splenectomy
Outcomes and Qulaity of Life after Laparoscopic Surgery for GastroesophagealReflux Disease:The McGill Experience
Dr. Kashif Irshad (Resident, General Surgery) Results of Laparoscopic Antireflux Surgery for Patients with Barrett's Esophagus andLarge Hiatal Hernias
Donna Stanbridge, R.N. (Nursing) Planning and Design of an Operating Room for Endoscopic Surgery
Gerald M. Fried, M.D. (General Surgery) The "MISTELS" Program for Training and Evaluation of Laparoscopic Skills
Gabriela Ghitulescu, M.D.(Fellow, Minimally Invasive Surgery)
Validation of the MISTELSProgram for Assessment ofTechnical Skillsin Laparoscopic urgery
7
~ Dr. Katkhouda's enthusiasm and innovations in the
field of Minimally Invasive Surgery were greatly appreciated
and inspiring for all that attended.
Enthusiasm and innovation continue to attract the best and
the brightest to McGill. We are pleased that Dr. Liane Feld-
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""zS
man has joined the Division of General Surgery and Dr. Mau-rice Anidjar has joined the Division of Urology, both with a
special interest in minimal access surgery .•
Gerald M. Fried, M.D.Professor of Surgery, Director,Steinberg-Bernstein Centre for Minimally
Invasive Surgery at McGill University
8
Chairman's Message- By Jonathan L. Meakins, M.D., D.Se., F.R.C.S.C., F.A.C.S.
Tcoming academic year has a full agenda as theDepartment moves into the first decade of the next millen-nium. Electronic communication is very much a part of our
lives and the way we work now and into thefuture. For some, e-mail, computers, theWeb, and all its ramifications are second na-ture and easy. For many, however, it is not sosimple and in fact is not only difficult to mas-ter, but often represents a black box. It issupposed to be easy, this electronic commu-nication. These last two weeks Drs. Pierre
Guy, Ed Harvey, Anie Philip and Peter
Metrakos have been struggling to submitDr.lonathan L. Meakins their applications to the FRSQ via the Web.
We finally succeeded, but it took hours. In re-flection on this experience, it will work bet-
ter next year for both the FRSQ and us - their serversoverloaded and decompensated - a most human reaction fora computer.
It is clear that the Department needs an integrated web sitewith a webmaster and a co-ordinated way to use this as a toolfor internal as well as external communications. Many divi-sions: Urology, Orthopaedics, General Surgery, Plastics as wellas the Core Program have web sites. They are maintained withvarious levels of efficiency. All established by busy surgeons,it is very time consuming to maintain them. Dr.Christou is co-
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i:!~
9
ordinating a Departmental work group to develop our site andhow to optimize its value to everyone.
One of its most important applications will be to help main-tain and collate the records for our individual Maintenance ofAccreditation slate. Not many have taken seriously this pro-gram of the Royal College. It is, however, a serious issue. If nodata has been kept for this year, the extra year given at thefront end of this will evaporate. By January 1st 2006, we willall need 500 points accumulated via one of the six routes out-lined. These are an outgrowth of the MOCOMPprogram. Ourconferences, rounds, teaching exercises, Journal Clubs etc. needto be identified and/or codified as eligible for credits. Then at-tendance needs to be recorded and maintained. When dis-cussed at the Departmental Executive, a web site is an easyway to co-ordinate these activities for each of us. Four per-cent of all specialists will have their records checked and iffound wanting, they will lose their specialist accreditation. Wehave somewhat over 200 clinicians in the Department. Atleast eight of us will be screened. The Department wants tomake this as easy as possible. The web site will help.
There will be two search committees ongoing this fall. Thefirst is for Cardiac Surgery as Dr. Chiu has stepped down, andit has already met four times and interviewed in a general wayall members but one of the Division. The second is in for headof Plastic Surgery; Dr. Brown is stepping down next summer.Your thoughts regarding either of these two important posi-tions would be welcome. +
...............................................................................................................................
As of August 1st, 2000,Dr. Carolyn C. Comp-ton, M.D., Ph.D., is thenew Professor and Chairof the McGill Depart-
ment of Pathology and Pathologist-in-Chief at the M.U.H.C.
New MUHC
Pathologist-in-Chief
Dr.Compton was born in Philadelphia and was educated at theJohn Hopkins Hospital, the University of Geneva, the BrynMawr College of Pennsylvania, and Harvard Medical School.She took her Pathology training at the Brigham and Women's
Hospital in Boston, Massachusetts.
She has been at Harvard since 1985 and since 1998 has beenProfessor of Pathology there.
Her interests are many, but her major expertises are in Gas-troenterology and Oncology. +
EOM
DIVISION OF OPHTHALMOLOGYDr. Rosanne Superstein has joined the Attending Staff inthe Division of Ophthalmology at The Montreal Children's Hos-
pital. Dr. Superstein received her M.D.CM. atMCH N McGill University in 1994 where she also com-ews pleted her postgraduate educational training.
She has just completed a Paediatric Ophthal-mology and Strabismus Fellowship at the Kellogg Eye Centreat the University of Michigan. She is a Fellow of the Royal Col-lege of Physicians and Surgeons of Canada. Dr. Superstein isthe recipient of the J.w. McConnell Award at McGill. She willbe a full-time clinician with a major interest in clinical re-search. Her special expertise is in the treatment of retinal dis-ease and malignancy of the eye.
H. Bruce Williams, M.D.
DIVISION OF UROLOGYTWO NEW PEDIATRIC UROLOGISTSThe Division of Urology at the Montreal Children's Hospital hasrecently recruited two additional Pediatric Urologists, Drs. J.P.Capolicchio and Roman Jednak. They joined our Divisionafter respectively completing a two-year Fellowship TrainingProgram at the Hospital for Sick Children in Toronto and Chil-dren's Hospital of Michigan, Detroit. The addition of these twoyoung Pediatric Urologists will reinforce the team of Drs. J.L.
...............................................................................................................................
Mead JohnsonMedical Award of Excellence
T.Mead Johnson M.di .. 1Award of Excellence is awarded to a physi-cian who has distinguished himself/herselfthroughout the years by providing exceptionalcare, demonstrating superior knowledge andteaching abilities and by being accessible tothe hospital community with particular gen-erosity. This was presented to Dr. H. Bruce
Williams, MCH Surgeon-in- Chief. •
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Pippi Salle and Alex Brzezinski. Both urologists will be fullyinvolved in teaching, clinical and laboratory research and teach-ing. We can now consider ourselves one of the few fully staffedDivisions of Pediatric Urology in Canada. Roman and J.p. will beinvolved in the development of laparoscopic urological surgeryas well as renal transplantation, including laparoscopic donornephrectomy. In addition, they will carry out experimental re-search in congenital kidney obstruction and novel laparoscopicurological procedures. They hope to identify genetic polymor-phisms associated with obstructive nephropathy, the largest sin-gle cause of renal failure in children.
Additional activity within the Division of Urology includes,Dr. J.L. Pippi Salle, Chief of Pediatric Urology at the Mon-treal Children's Hospital, was a Visiting Professor to the H pi-tal Trousseau, Paris - France June 2000 and Porto Alegre -Brazil in August 2000. Other Visiting Professorships havebeen confirmed in Malaga - Spain in November as well aslecturing at the 25th Congress of the Soci t Internationaled'Urologie meeting in Singapore - October 2000. Lily Chin-Peuckert and Dr. J.L. Pippi Salle presented a paper entitled AModified Biofeedback Program for Children with Detrusor-Sphincter Dyssynergia - 5 Year Experience, and a video on ANew Approach for Penile Chordee Correction at the prestigiousmeeting of the American Academy of Pediatrics in Chicago- October 2000 .•
J.L. Pippi Salle, M.D., Ph.D.
10
IQaluit (formerly Frobisher Boy) is s,,,ted on Baffin Is~land a few hundred miles from the Arctic Circle. It is 2,060 airkilometers from Montreal with the Hudson Straight between
the most northern shore of Quebecand Baffin Island. The annual snow-fall in Iqaluit is 255 cm and the an-nual rainfall is about 19 cm. InJanuary, normal temperatures range
between a low of -40 and a high of -22 degree Cwith a meanof -26 degree C. In July, the normal temperatures range be-tween a low of 3.7 degree C to a high of 11.4 degree C, witha mean of 6.2 degree C. Freeze up starts around the end ofOctober. Spring thaw begins around mid-June and the ice ofFrobisher Bay begins to melt around mid-July. The amount oflight in the winter decreases to about 4 hours of daylight aday by mid-December and then increases to nearly 21 hoursof daylight by mid-June. Most of the supplies are brought inby sealift during the 4 summer months, but all perishablesmust be flown in on a daily basis.
General Surgeryin the North
..
Iqaluit (population 4,500) isa medical referral center forthe 12 settlements on theisland. The most northerlysettlement is Grisefiorid(population 170) and is1,5000 kilometers north ofIqaluit. Until 1998, McGillUniversity had the contractto supply medical specialtyservices in all disciplines tothe population of the re-gion. McGill lost the con-tract to the University ofOttawa 2 years ago whonow supply these services.
The 34-bed hospital inIqaluit services the whole
Dr. John Hinchey population of Baffin Island(13,000) and is the only
hospital with surgical services in the entire area includingnorthern Quebec. Staffing is variable, but usually includes 6family practitioners, 2 general practitioner anesthetists andone surgeon. There is no radiologist, but skilled radiologytechnicians provide diagnostic x-ray and ultrasound services.There is a well-equipped operating room and delivery suite.
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The latest video equipment is available for gastroscopy,colonoscopy and laparoscopic surgery. A full-time dedicatedmedivac team is available since many patients are flown downto the hospital from settlements up island.
Dr.Hreno and I have been spending 2 weeks every summer asthe sole surgeon in Iqaluit since 1983. We were originallyasked to do this so that Dr. Terry Watts (a McGill ResidencyProgram Graduate) could have a well-deserved holiday. Andyand I both had had good general surgical training, but at thetime lacked the wider range of skills necessary to function insuch an environment. Some of the problems we have en-countered over the years include burr holes, complicated Cae-sarian section, ruptured ectopics, twisted ovarian cysts, carpaltunnel and trigger finger release, tendon repairs, gunshotwounds to all regions including a blowout of the tibia-fibulaand anterior compartment of the leg in a 16 year old. We hadto learn gastroscopy and colonoscopy which at the time of ourtraining did not exist except for rigid gastroscopy.
The management of frostbite, hypothermia and closed reduc-tion of fractures are not uncommon problems. In addition tothe above, one must be able to recognize and deal with a fullrange of pediatric surgical problems.
The Inuit are excellent surgical patients. They want to get outof hospital as soon as possible post-op, so are up and aboutand very active even after major surgery. Appendicitis is avery common problem in the North and because of the needto medivac patients long distances by air often in badweather, perforation and generalized peritonitis are not un-common. Even so, the post-operative course ofthese patientsis usually smooth, I think in large part due to their general at-titude and early ambulation.
Through the kindness and help of our colleagues at the MontrealGeneral, Dr.Hreno and I have acquired most of the skills we orig-inally lacked. I think if a resident chooses this type of career thathe/she should spend an extra year doing rotations in Gynecology,Orthopedics, Plastics,Neurosurgery and Endoscopy.
Why do we continue to go north? It is stimulating and excit-ing to be called upon to deal with the whole spectrum of sur-gical emergencies in all disciplines. There is the sense of a"last frontier" about it which appeals to the surgical person-ality. There are many jobs for well-trained general surgeonsin all provinces. From the number of calls Andy and I get fromOntario and the Maritimes, it would seem that a crisis in gen-eral surgical manpower is developing .•
More photos: ~
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It is both an honour and a pleasure to PilY tribute to Dr.Gordon Stanley Foxwho has contributed so significantly to ourDepartment. Dr.Fox received his medical degree from the Uni-
versity of Toronto inDr. Gordon Fox Retires 1960, which was fol-
lowed by a one yearrotating internship at
~ the New Mount Sinai Hospital in Toronto. His anaesthesia res-:: idency was done at McGill University, and a one year Clinical1: Fellowship followed at the Royal Victoria Hospital. Dr. Fox re-~ mained at the RVH for some 19 years, and his duties included;' a five year stint as Director of Obstetrical and Gynaecological~= Anaesthesia. From 1985-1989, Dr. Fox was the Anaesthetist-:::I in-Chief at the Sir Mortimer B. Davis-Jewish General Hospital,
after which he returned to the RVH as the Anaesthetist-in-Chief until April 2000. He served as Acting Chairman of theMcGill Department from 1992-1994, and as the Acting Anaes-thetist-in-Chief at the MNH from 1992-1993. Other appoint-ments include Professor in the Faculty of Medicine, and Fellowin the Senate at McGill. Dr. Fox served on numerous commit-tees at the Hospital and University level, and has lecturedwidely on subjects concerned with conduction anaesthesia,the parturient, and the elderly. He has published 46 full-length manuscripts on a variety of issues, including foetal con-centration of xylocaine during continuous epiduralanaesthesia, the effects of anticholinesterases on heart rate inthe cardiac transplant and the dynamics of breathing in in-fants, just to name a few! Dr. Fox has a long-standing fasci-nation with the morbidly obese and, in addition to numerouspublications on this subject, he has prepared a movie andvideotape (rated R,most likely). Dr. Fox is a member in good
standing of the Quarter Century Club, McGill University andthe RVH.
The positive influence of Dr. Fox on our Department cannot beoverstated. He was committed to providing outstanding pa-tient care and his enthusiasm for anaesthesia was remarkableand most infectious. He was untiring in his effort to supportall academic activities, and served as an exemplary role modelfor residents and staff. I think it is fair to say that his pres-ence in our Department is sorely missed!
On behalf of the members of the Department of Anaesthesiaat the RVH, I would like to thank Dr. Fox for all he has doneand wish him and his wife, Estelle, the very best. •
Steven B. Backman
Clinical Director, RVH Department of Anaesthesia
One Million Dollar
Donation to M.N.I.
The Montreal Neurological Institute has received a milliondollar grant from Mr. A.Jean de Grandpr ,C.R. for its BrainTumour Research Centre. The plan is to set up an interna-tional telemedicine and teleconferencing centre thanks tothis generous donation.
Philanthropist de Grandpr , former CEOof Bell Canada,was President ofthe MNH from 1970-1977. His portrait byBuckman is in the main hallway at the Neuro .•
EOM
12
T definition of (alot's triangle, the region in thehepatobiliary system so important during cholecystectomy, iswell known to general surgeons, but is controversial among
anatomists as well assurgeons.Does Everyone.Agree
About the Triangleof Calot?
The definition most com-monly used is that of thecystic duct, the commonhepatic duct and the
liver. It is, in fact, defined as such by Grays,Sabiston' and inthe early editions of Schwartt and Dorland2• In 1988, Dorlandmodified the definition to be that of the cystic duct, the cys-tic artery and the hepatic ductJ• This is also the definition usedin the Atlas of Biliary Tract Surgery by the late Dr.Frank Glenn4
•
The "delicate" hepatobiliary triangle as described by JeanFran~ois Calot' in his doctoral thesis in 1895 was -
"The triangle is not exactly equilateral, but more like an
isosceles triangle. The superior and inferior sides repre-
sented by the cystic artery and the cystic duct being
equal and slightly longer than the part of the hepatic
duct which enters into the formation of the triangle~
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REFERENCES
o Calot JF: Le dispensaire H. de Rothschild a Berck-sur-Mer
(Pas de Calais). Essai sur I'assistance medicale et chirurgiegratuite. G. Masson, Paris, 1895.
@ Dorland's Illustrated Medical Dictionary - 24th edition, p.1611, W.B. Saunders Co., Philadelphia, 1965.
@) Dorland's Illustrated Medical Dictionary - 27th edition, W.B.Saunders Co., 1988.o Glenn, Frank: Atlas of Biliary Tract Surgery, p. 4, The MacMil-
lan Company, New York, 1963.o Gray, Henry: Gray's Anatomy - 29th edition, Charles Mayo
Gross (editor), p. 633, Lea & Febiger, 1973.o Rocko JM, Swan KG, DiGloria JM: Calot's Triangle Revisited.
The Surgeon's Library. Surg.Gyn.& Obst.153:410-414,Sept.1981.
fj Sabiston DC: Textbook of Surgery - 15th Edition, p. 1118,WB. Saunders Co., 1997.o Schwartz SI:Principles of Surgery - 3rd Edition, p. 1269, Mc-
Graw-Hili Book Co., New York, 1979 .•EOM
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The Canadian Surgery WeekSeptember 6-9, 2001 - Quebec City
The September 2000 meeting in Edmonton was the last onefor CAGS in association with the Royal College. The Sep-tember 2001 meeting will form part of a Canadian SurgeryWeek together with the Society of Colorectal Surgeons, theThoracic Society, the Canadian Society of Surgical Oncolo-gists and possibly the Vascular Society and the CanadianSociety of Pediatric Surgeons. The Trauma Association ofCanada will join in 2002, but they have a joint meeting inAustralia in 2001. In future years, the Royal College will holdan annual meeting in Ottawa restricted to matters of edu-cation, program accreditation and certification.
The transition for CAGSmay be difficult financially, but thenew arrangement is more attractive to members of our Cor-porate Council. •
EOM
r:8..•.._....I~
"Yes, Isee. Well, there's a lot of it going around.Takea couple of aspirins, get a good night's sleep,
and call again in the morning."- TheNew Yorker
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His name was Flemin~ and he was a poor Scot-tish farmer. One day,while trying to eke out a living for his fam-ily, he heard a cry for help coming from a nearby bog. He
dropped his tools and ran to thebog. There, mired to his waist inblack muck, was a terrified boy,screaming and struggling to free
himself. Farmer Fleming saved the lad from what could havebeen a slow and terrifying death. The next day, a fancy carriagepulled up to the Scotsman's sparse surroundings. An elegantlydressed nobleman stepped out and introduced himself as thefather of the boy Farmer Fleming had saved. "I want to repayyou'; said the nobleman. "You saved my son's life':
son came to the door of the family hovel. "Is that your son?"the nobleman asked. "Yes';the farmer replied proudly. "I'll makeyou a deal. Let me take him and give him a good education. Ifthe lad is anything like his father, he'll grow to a man you canbe proud of': And that he did. In time, Farmer Fleming's songraduated from St. Mary's Hospital Medical School in London,and went on to become known throughout the world as thenoted Sir Alexander Fleming, the discoverer of Penicillin.
ASuccess Story Years afterward, the nobleman's son was stricken with pneu-monia. What saved him? Penicillin.
The name of the nobleman? Lord Randolph Churchill. Hisson's name? Sir Winston Churchill. •
Gustavo A. Duque, N.M.D.Geriatric Medicine Fellow, McGill University
"No, I can't accept payment for what I did'; the Scottish farmerreplied, waving off the offer. At that moment, the farmer's own
...............................................................................................................................LORRAINE PETERS -KIDNEY TRANSPLANT CO-ORDINATOR,MCGILL UNIVERSITY HEALTH CENTRERecently, The Transplant Clinic held a re-ception honoring Lorraine Peters of the
Transplant Clinic who celebrated her 25th year anniversary of
working at the Royal Victoria Hospital and her birthday. Lor-raine began her nursing career in Dialysis in 1974, and wasone of the pioneers of the Kidney Transplant Program. Since1974, she has been co-ordinating transplants and followingthe post-transplant population .•
2S-YearAnniversary
Front Row: Dr.Jean Tchervenkov, Lorraine Peters, Dr.Dana Baran; Back Row: Dr. RolfLoertscher, Dr. Peter Metrakos
14
D.Paul B.lliv ... pre·sented a well received study at the meet-ing of the Canadian Society of Colon and
Rectal Surgeonson September23rd in Edmonton(at the same timeas the meeting of
the Royal College) entitled Conformal Pre-operative Endorectal Brachytherapy for Pa-tients with Locally Advanced ResectableRectal Cancer:Preliminary Results. The co-authors were: T. Vuong, Ren Michel,L. Souhami, B. Hoftah, J. Parent,Judith Trudel, C. Reinhold,Dave Evans, E. Begin.
KUDOS !!
I~
Dr. Pnina Brodt was the recipient of theTerry Fox New FrontiersInitiative Program grantfor 2000-2003. The co-applicants were Dr.Jacques Galipeau of theLady Davis Institute andBernard Massie of the Biotechnology Re-search Institute. The project is entitledCancer Gene Therapy: A Comprehensive,multi-pronged Strategy for Growth FactorReceptor Targeting. It is noteworthy thatDr. Brodt is also a Guest Editor of the Sur-gical Oncology Clinics of North America -special issue which is to be published inthe spring of the year 2001. The themewill be Metastasis: Biological and ClinicalAspects. Throughout the year, Dr.Brodt wasGuest Speaker at the following symposia:In January in Luxemburg for an interna-tional meeting on Signal TransductionPathways. In May in Montreal, she chaireda session on the Molecular and Clinical As-pects of Metastasis from Colorectal Carci-noma. Again, in May, she was a VisitingScientist to the Singapore Medical Re-search Council. In June, she was an InvitedSpeaker to an International Symposium onMolecular Cell Biology of Macrophages2000 in Kyoto, Japan.
Dr. Miguel Burnier has recently receivedthe Rio Blanco Medical,Order of Brazil (equiva-lent to the Order of I .~~
Canada).
Dr. Ray Chiu was a Visiting Professor atthe Clinical Research Institute of ChengGung Memorial Medical Center in Kaoshi-ung, Taiwan, April 20 to 26. He was in-vited to give the Aaron BrownDistinguished Lectureship at the Phi DeltaEpisolon Medical Fraternity of McGill onJune 7. Dr. Chiu was a "Grand Invit "andserved as Session President at Chirurgie2000, Congr s Internationale de la Soci tde Chirurgie Thoracique et Cardio-Vascu-laire de langue fran~aise in Paris, June 26to 28, where he also served as a VisitingProfessor to Laboratoire de Chirurgie Car-diovasculaire,l'h pita I Brussais in Paris onJune 28th. He became a Scientific Advi-sor for Paracor Surgical Incorporated, amedical devices company for heart failuretherapy, and invited to serve as an Asso-ciate Editor for cardiac surgery in the newjournal "New Surgery" to be published byLandes Publishing Company of Austin,Texas. He served as an advisor to the"Xenotransplantation Advisory Commit-tee for the International Society for Heartand Lung Transplantation'; which draftedthe official position of this internationalorganization on issues involved withxenotransplantation. Dr.Chiu was also aninvited speaker at the Yale UniversitySymposium on "Technically ChallengingProcedures in Adult Cardiac Surgery" onSeptember 16th, 2000.
Dr. Patrick Ergina has been appointedthe Program Director forthe McGill CardiacSurgery Residency Pro-gram in September 2000.
Dr. Liane S. Feldman presented a paperon Laparoscopic Splenectomy at themeeting of the Canadian Association ofGeneral Surgeons on September 23rd inEdmonton. She was also the lead author
THE SQUARE""z~15
of a poster entitled Does Experience WithAdvanced Laparoscopy Improve Outcomein the Treatment of Acute Cholecystitis?along with Drs. LE. Medeiros, J.S.Barkun, Harvey Sigman, J. Garzonand G.M. Fried.
June 20th marked the launching of theMcGill Fetal Diagnosis and Treatment Cen-ter. Dr. H I ne Flageole has been ap-pointed Co-Director of Fetal Surgery forthe Center. The detachable balloon tech-nique developed by Dr. Flageole toocclude the fetal trachea and make thelungs grow is now used clinically to treathuman fetuses with Congenital Diaphrag-matic Hernia at UCSF,the Center with thelongest experience in Fetal Surgery.
Dr. Philip H. Gordon was the HonoraryChairman of the 3rd Annual Con-ference for the United OstomyAssociation of Canada heldin August in Montreal. Atthis session, he made apresentation entitledSecond Opinions - WhenMedical Experts Disagree -Whats a Patient ToDo? Philip was also aVisiting Professor at the University ofSouthern California at Los Angeles in Sep-tember where he gave a talk entitledGenetics of Heritable Colorectal Carci-noma. At the Royal College, Philip was re-appointed as Chairman of the SpecialtyCommittee in Colorectal Surgery and alsowas re-appointed as Member of the Spe-cialty Committee in General Surgery. Aswell, he has been elected President for asecond term of the American Board ofColon and Rectal Surgeons. At the annualmeeting in June in Boston of the Ameri-can Society of Colon and Rectal Surgeons,the McGill Colorectal Group presented animportant paper entitled The Value ofSpecialization - Is There an Outcome Dif-ference in the Management of Compli-cated Diverticulitis? The authors wereA. DiCarlo, R. Andtbacka, I. Shrier,P. Belliveau, J. Trudel, B. Stein,PH Gordon, CA Vasilevsky. ~
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~ Speaker at the Annual Meet-ing of the European Association forCardiothoracic Surgery where he pre-sented: Single Ventricle with Systemic Ob-struction in Early Life: Comparison ofPulmonary Artery Banding versus theNorwood Operation in Frankfurt, Ger-many, October 2000 as well as a GuestSpeaker at the International Symposiumon Double Outlet Right Ventricle inMoscow, Russia at the end of October2000. Dr. Tchervenkov is currently theChairman of the Examination Board inCardiac Surgery of the Royal College ofPhysicians and Surgeons of Canada.
Dr. Jose M. Tellado, a former fellow inthe L.D. Maclean Surgical laboratories,along with Dr. Nick Christou, co-edited abook entitled Intra-abdominal Infections.
At the interim meeting of the AmericanBoard of Colon and Rectal Surgery inMarch 2001, Dr. Judith Trudel will bethe organizer of a Question Writers'Work-shop to be co-sponsored by the ABCRSand the ASCRSwhich will be held in thespring of 2001. She is also an AssociateExaminer on the ABCRS.
Dr. Carol-Ann Vasilevsky presented apaper on Intestinal Pseudo-obstruction atan afternoon session of the CanadianAssociation of General Surgeons meetingon September 21st in Edmonton.
Dr. H. Bruce Williams was a VisitingProfessor at the long Island Jewish Med-ical Center in New Hyde Park, New York inMarch. He presented a paper entitled TheInterface Between Plastic Surgery andMedicine. He was also a Visiting Profes-sor at the University of Kentucky in lex-ington last April. Here he presented twopapers entitled: 1) Vascular Malforma-tions, and 2) Electrical Stimulation Fol-lowing Nerve Injury and Repair: Useof anImplantable System. For his excellentclinical and scholarly achievements overthe years, Bruce was awarded the Med-ical Award of Excellence presented by the
Montreal Children's Hospital Foundationon June 8th•
Dr. John Vee has accepted a position asa thoracic surgeon on the staff of Dr.MarkOrringer at the University of Michigan inAnn Arbor. John trained in GeneralSurgery at McGill and in Thoracic Surgeryat Michigan with Dr. Orringer. He alsotrained for one year with Dr. Richard Fin-ley at UBC. McGill wishes him well.
AchievementsResidentsand Fellows
D.loana Bratu P"~sented at the Canadian Association of Pe-diatric Surgeons. Topics of herpresentation were Pulmonary ArteryRemodeling After Reversible TrachealOcclusion in Diaphragmatic Hernia andPulmonary Sequestration Revisited. Forthe former presentation, she wasawarded the resident prize for best basic
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17science research paper.
Dr. A. DiCarlo along with Drs. AJ. Tec-
tor, M. Tan, LA. Fridell, S. Liu, C.
Soderland, J.S. Barkun, P. Metrakos
and J.I. Tchervenkov presented a posterat the CAGSmeeting in Edmonton enti-tled Endothelial Activation Results in Up-regulation of Interleukin-l A andEndothelin-l MRNA in Pig-to-HumanLiver Xenotransplantation.
At this years 320d Annual Meeting of theCAPS, Dr. Sherif Emil presented Clinicalvs Sonographic Diagnosis of AcuteAppendicitis in Children: A Comparison ofPatient Characteristics and Outcomes.
Dr. Abdulrahman Hagr presented a pa-per on September 220d in Edmonton atthe meeting of the Canadian Associationof General Surgeons entitled ProbeGuided Parathyroid Adenectomy Per-formed with Local Anesthesia. The co-au-thors were D. Anderson and RJ. Tabah.
Dr. Atif Khan along with Drs. I. Shrier
and P.H. Gordon of the JGH presented apaper at the meeting of the Canadian As-sociation of General Surgeons entitledDistal Adenomas Mandate TotalColonoscopy. ~
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ANNUAL ANTHONY R.C. DOBELL VISITING PRO-FESSOR OF CONGENITAL CARDIAC SURGERYDr. Constantine Mavroudis, Division Head and Willis J. Potts
Professor of Surgery at Chil-dren's Memorial Hospital inChicago, was the A.R.C.DobellVisiting Professor this year,
which was held on Monday, October 2nd. The academic day be-gan with Surgical Grand Rounds at the Montreal Children's Hos-pital, where Dr.Mavroudis talked about Coronary Artery Surgery
Visiting Professors
THE SQUARE...z!:l19
in Children. This was followed by presentations by residents andstaff along with special guests. Of the two special guests whopresented were Dr. Marshall Jacobs of Philadelphia whospoke on Decreasing the Risk of Fontan's Operation for HLHS; andDr. Jeffrey Jacobs of St. Petersburg, Florida who spoke on Ex-tracorporeal Membrane Oxygenator (ECMO), CardiopulmonarySupport (CPS),and Ventricular Assist Device (VAD). Later that dayat McGill University Grand Rounds, Dr.Mavroudis gave a secondtalk on Redo Fontan with Maze Procedure.
That evening, a banquet in honor of Dr. Mavroudis was heldat the Mount Stephen Club.•
Lt. to Rt. TopRow: Dr.Jeffrey Jacobs, Dr. Dominique Shum- Tim, Dr.Stephen Korkola, Dr.Marshall JacobsLt. to Rt. Bottom Row: Dr.Jean Perron, Dr. Christo Tchervenkov, Dr.A.R.C.Dobell,
Dr. Constantine Mavroudis
DDan Croitom, who ilan Assistant Professor at the Eastern Vir-ginia Medical School, Norfolk, Virginia,was a Visiting Professor at The MontrealChildren's Hospital. His presentation toMedical Grand Rounds was entitled Ad-vances in Pectus Excavatus Repair. •
H. Bruce Williams, M.D.
EKL
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1....'At the close of the dinner, Dr. Richard L. Cruesspresented theflowers which decorated the table to Miss Ernestine McLeod,Head Nurse on 9 East on behalf of the members of the Service.
Were You There?
1966ACCIDENT SERVICE DINNER At a din-ner held in December to mark the FifthAnniversary of the Accident Service of theRoyal Victoria Hospital, Dr. Lloyd D.
Maclean, Surgeon-in-Chief, presentedDr. R.A. Fuller of Johnson and Johnson
Co. with the three books on AccidentSurgery produced by the Service andedited by Dr. H.F. Moseley, Director ofthe Accident Service and published byAppleton- Century-Crofts. The publica-tion of these books was made possible bya grant from John and John to the Acci-dent Service. •
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THE SQUARE!:!~
Madeleine Poirier and Prosanto Choudhury
TheRozek Clan Vadim Sherman, Gabriel Chan and Moishe Liberman
21
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Oliver, Or. John Arthur
On September 25,2000, beloved father of Catherine (Franklin),Peter (Sophie), Susan and Sarah (James), and loving grand-dad to Samantha, Nicholas, Scott and Christopher. He is pre-deceased by his dear wife Jean Crawford Oliver. His best friendJane was a dear and wonderful companion. John graduatedfrom McGill in 1956. He had been a Urologist on staff at theRVH since 1962. He was an Associate Professor. He was amember of the Renal Transplant Team in its early days. He willbe sorely missed.
Salgado, Or. Isidro
On January 24, 2000 after a brief illness in Rothesay, NewBrunswick. Dr. Salgado was born in Munilla, Spain. He was aMedical Officer with the Department of Veteran's Affairs, amember of the Royal College of Physicians and Surgeons ofCanada, and a fellow of the American College of Surgeons. He
Help Us Find
the Following Alumni
Dr.Z. Arekat (General Surgery)Dr. Ram Aribindi (Orthopedic Surgery)Dr.Michel Bazinet (Urology)Dr. R. Bend-JabalDr. Richard Berkowitz (Orthopedic Surgery)Dr. Shayne Burwell (Plastic Surgery)Dr. Peter J. Capello (General SurgeryDr. Dan Deforno
Dr. Ezat Hashim (Plastic Surgery)Dr. Irwin Paul Enker (Orthopedic Surgery)Dr. J. Fleming (General Surgery)Dr.G. GhazalDr. Bryant Joseph Gilot
Dr. Jonathan D. Glassman (Orthopedic Surgery)Dr. R.W. GoldlustDr. Tom Konowalchuk (Urology)Dr. Robert S. Kurtz (Pediatric Surgery)
THE SQUARE...:z5122
practiced at Soldiers Memorial Hospital and Hotel Dieu Hospi-tal in Campbellton. Dr. Salgado was an honorary member ofthe Saint John Medical Society and worked at the Worker'sCompensation Board and the Department of Veteran's Affairs.He is survived by his wife Susan (Snow), his sons Dr. David Sal-gado (Sally) of Hampton, Dr. Michael Salgado (Colleen) ofSaint John, his daughter, Dr. Lydia Salgado-Kroetsch (Vincent)of Rothesay, and eight grandchildren.
Sandison, John Westwood, M.B.Ch.B., (Edin)
Professor of Anesthesia and former Anesthetist- in-Chief, RVHdied in Oakland, Lunenburg County on September 13,2000 atthe age of 72 years. Funeral was held in Mahone Bay on Sep-tember 18.•
Dr.Marc Lanser (General SurgeryDr. Ronald R. Lett (General Surgery)Dr. Shaun MacDonald (Vascular Surgery)Dr. Janet Mackenzie (Plastic Surgery)Dr. Paul Manner (Orthopedic Surgery)Dr.Michael Munz (Neurosurgery)Dr. James F. Murray (Plastic Surgery)Dr. J. TarbetDr. D.C. Wood (General Surgery)Dr. Thierry Yandza (General Surgery)
