A PPOINTED AS CHAIRMAN OF THE MCGILL DEPARTMENT OF SURGERY·The Meakins' tradition continues. On October 1st, Dr. Joe Meakins became the newChairman of McGill's Department of Surgery. There is a huge new implication to this

position as it automatically also meansthat he becomes the Surgeon-in-Chiefof the four Pavilions of the MUHC, that

is the RVH, the MGH, the MNH and the MCH. Also in theyear 2004, when the new "superhospital" opens, he willbe Surgeon-in-Chief.

Jonathan L.Meakins

He replaces Dr. David S. Mulder as Chairman who held thepost from 1993 to 1998 (also from 1982 to 1987). Joe waspreviously Chairman from 1988 to 1993.

After earning a B.Se.at McGill, Joe graduated from the Uni-versity of Western Ontario Medical School in 1966. He didhis residency in surgery at McGill (RVH) and then did a Fel-

Jonathan L. Meakins lowship at the University of Cincinnati with Dr.W.A. Alter-meier where he obtained his D.Se. in 1962 in Surgical

Infections and Immunobiology. He returned to the RVH in 1974 and became Professor ofSurgery and Microbiology at McGill in 1984. He did two sabbatical years in Paris, the firstin 1980-81 and the second in hepatobiliary surgery with Professeur Dominique Franco. In1985, he was the James IV Traveller for Canada. ~

(pleaseseeMeakins, pg.6)................................................................................. m •••••••••••mmmmmmm ••••••••••••••••••••mmmmmmm mmm mm •••••••••• mmmmmmmm •••••••••• mmmmmmmm ••••••••••••·········mmmmmmm

::::I New Chairman Appointed 1 Site Set-Up for MUHC~. L~tt~~~T~Th~Edit~r 2 MUHCSurgeonsHonouredi- Upcoming Events 3 Kudos

CanadianUrological Awards 3 Achievements Residents& Fellows...............................................

Editorial 4 MUHCPancreasTransplant ProgramFlexner& Maclean's Magazine 5 The HingstonsMessageFromTheChair 7 Visiting ProfessorsSites ForPerfusionTraining 7 Esophagus'98RoyalCollege& CAGSMeeting 8 AnaesthesiaProgram DirectorRoyalCollegeRe-organization 9 Accredited Clinician Investigator ProgramsNews FromThe Bench 10 Two-Tier Health CareSystemGuidelines - ResearchExperience 11 ObituaryHistorical Vignette 12 RVHHousestaff - 1960-61

131314

15

1618

19-2021212223

24

25

DEPARTMENT OF SURGERY

NEWSLETTER

McGILL UNIVERSITY

FALL 1998

Dear Editor,I enjoyed reading your editorial on theneed for a "P.R. spokesperson" for themedical profession. You cited some ex-cellent reasons to address this need.

? Lettersto The Editor

I believe strongly,however, that a re-active stance by a"P.R.spokesperson"

almost invariably fails to correct misper-ceptions and first impressions. It is es-sential that professionally based avenuesof communication be established withgovernments, the public, and the fifth es-tate. This approach builds credibility. Italso decreases risks of untoward criticism.Communications is about discussion - notjust the telling of a story.

Professional risk communication expertssuch as Dr.Peter Sandman(l) have scien-tifically assessed how risk is perceived.Sandman's formula states:"Risk = Hazard + Outrage"

Some of the examples in the editorialcould evoke an exaggerated response be-cause of high public "outrage" - despitethe fact that no real hazards or other neg-ative factors exist. In other examples, anappropriate level of concern (risk) is notexpressed - because the outrage factordoes not come into play or is misdirected.

Appropriate communication is the key tosuccess in dealing with perception - cor-rection of these difficult issueswill not oc-cur by simply"telling our side of the story':

Thanks again for a thoughtful - andthought provoking - editorial.1. Sandman, P:"Risk = Hazard + Out-rage - A Formula for Effective Communi-cation'; American Industrial HygieneAssociation, 1991.

Ian M.F. Arnold, M.D.(U.s.c. -197D-71,MGH SurgicalProgram 1977-73).Editor's Note: Or.Arnold also includeda generous donation.

Dear Editor,Enclosed please find a cheque for my sup-port of "The Square Knot'; which I enjoyreceiving.

As an update, I completed McGill Urologytraining in 1997, followed by one year ofresearch at the Montreal Children's Hospi-tal. I am presently in a 2 year PediatricUrology Fellowship at the Hospital forSick Children in Toronto.

I recently represented McGill and theMontreal Children's Hospital with apodium presentation at the AmericanAcademy of Pediatrics meeting in SanFrancisco, Oct. 17, 1998, entitled RenalFunction Before and After Pyeloplasty inAntenatally Versus Postnatally DetectedHydronephrosis.

1.P.Capo/icchio, M.D.

Dear Editor,I want to compliment you on the excel-lent editorial you wrote in the SquareKnot on the necessity for a PR person. Iwould urge you to send a copy of it to thePresident of the Quebec Medical Associa-tion, La Corporation du Quebec, QuebecAssociation of General Surgeons, theFMSQand any other Quebec Agency thatI omitted.

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Once again, congratulations on an excel-lent piece of writing.

Philip H. Gordon, M.D.

Letter from Dr.David R. Murphy,Kingston, Ontario: David indicates howpleased he is to receive "The SquareKnot" and he enclosed a generousdonation.

Dear Editor,I enjoyed the Square Knot and your out-standing journalism talent. I have knownyou as a wonderful friend and always ad-mired your multiple qualities especiallyas a sailor.

You managed to give heart and soul tothe news you published. I still have aboat - a 45 foot Jeanneau Sunkiss whichI sailed from France back in 1985 andwhich is stationed at the Naval Academyin Newport, Rhode Island. You are wel-come to come down and spend as muchtime as you wish on the boat. Please callme as soon as possible to this effect.

I have not seen Bernard Perey now foryears. It would be nice to get together onmy boat at one point, remembering theold days in the Bahamas. I was surprisedthat a young fellow like you could retire al-ready, but I know that the rules at theRoyal Victoria are very strict ~

A. Bourcier, Dr. G.Gonheim, Dr. Susset, Dr.Jean Frefin, Dr. Odile CotelleSan Diego, May 30, 1998.

2

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

···Dr. Larry Stein, Head of Radiology at the :RVH,called our attention to the following: l

··············· .· .......................................................................................... .·························

~ about age and surgery. I do notapprove of such rules. I am personally stillvery active although I limited my inter-ventions to specific areas. My practice isnot geared at saving life, but trying tomake old life more pleasant at least tostay dry and erect.

At the last AUA meeting I was given aLife Time Achievement Award "in recog-nition of significant contributions andleadership in the field of Neurourology"by the Urodynamic SOciety. I am send-ing you a picture to this effect and it maybe appropriate to publish it in the Square

Thank You to Our

Contributors

····Recently we have received very generous ldonations from:

Dr. Mohammed AI-Zahrani,Dr. Ian MJ. Arnold,Dr. J.R. Mackenzie,Dr. R.Midgley,

Dr. Joseph Stafford

We thank these alumni as well as our reg-ular members.

Knot. I will try to call you soon but tryto call me too.

Jacques G.Susset, M.D.Clinical Professor of Surgery,

Brown University, Providence, Rhode Island.

Dear EditorI just wanted to send our a short note tolet everyone know that I have movedfrom the Astronaut Office to start a newcollateral duty assignment as Director ofthe Space and Life Sciences Directorateat JSc. For the duration of this assign-ment, I will remain on active flight sta-tus as a Canadian Astronaut. The website provides an excellent overview of

Erratum

In the Summer issue (1998) of "The SquareKnot': on page 34, a table from the RoyalCollege Credentials Section incorrectlystates that the American Board of Radiol-ogy does not accept Canadian Training. Infact, it does.

The Square Knot regrets this error.EDM

Canadian Urological Association AwardsJune 1998 - Halifax, N.S.

Prize Essay Contest WinnersDr.Tarek Abdel-8akey Basic ScienceDr. Pierre Karakiewicz Clinical

Research AwardDr. Denise Arsenault

Lifetime Achievement AwardDr.Mostafa M. Elhilali

Canadian UrologyOncology Group ScholarDr. Peter Chan

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the activities of the Directorate for thosewho are interested.:http://www.jsc.nasa.gov/sa/index.htm

I greatly appreciate all of the hard workfrom the many individuals at the CSAand NASA with whom I have worked onSIS-90 and OSM. Please accept mythanks for all of your hard work.All the best. •

Dave Williams, MSc, MDCM, FRCPDirector; Space and Life Sciences Directorate

Johnson Space Center

Upcoming

Events

December 3, 1998L.D.Maclean Day Mini Retreat "Vision forthe Future':

February 11-13, 1999Society of University Surgeons, New Or-leans, LA.

March 4-6, 1999Central Surgical St. louis, Missouri.

April 14-15, 1999E.J.Tabah Visiting ProfessorDr. Michael Baum, UClH\Middlesex Hos-pitals Trust University College of londonMedical School london, England.

April 15-17, 1999Annual Meeting of American Surgical As-sociation, San Diego, CA.

HAT ABOUT RE-CERTIFICATION?Are you competent? Well, perhaps you are competent but canyou prove it? It used to be simple - once you had your RoyalCollege Fellowship, you were considered a qualified specialist

for life. But nowadays, the public and thecourts demand evidence that Doctors main-tain competence. As an Academic Surgeon,

there is perhaps a complacent attitude that we "keep up" withthe current increasing volumes of new information, but whatabout Community Surgeons? Also, if you are a recently certi-fied specialist your knowledge is at its peak, but what aboutthe older surgeons?

Editorial

==~ In 1975, the Committee on Horizons influenced by the Amer-ican Specialty Boards recommended to the Royal CollegeCouncil that it support in principle, the recertification of Cana-dian Specialists as a goal. MOCOMP(Maintenance of Compe-tence) was introduced as a pilot project in 1991 and a creditsystem was introduced in 1993.

Though MOCOMPhas had its successes,participation by Sur-geons has been limited. In 1997, only 6% of General Surgeonshad registered. This is despite the fact that in a poll conductedthat same year amongst 30,000 Fellows, 3,655 responded and

liMy advice to you, Mr. Weston, is that you relax your vigilanceagainst Communism just a wee bit. II

- The New Yorker

THESQUARE..z!:l4

70% agreed that CME should be a regular requirement tomaintain their specialty certificate.

In the US,the American Board of Surgery applies the follow-ing rules. If you passed your exams before 1976, your certifi-cate is valid indefinitely. After 1976, your certificate is validfor ten years and if you wish to be recertified you must takenew written exams which again are valid for ten years. TheAmerican College of Surgeons in the 1980's instituted itsSESAPseries (Self-Evaluation and Self-Assessment Program)which are now into their 10th edition. In 1997, only 133 Cana-dian Surgeons registered. Dr. Max Aebi informs us that theAmerican Academy of Orthopedic Surgery asks for credits andone may be required to produce these.

In February of 1998, a Conference of Specialties was called bythe Royal College to explore options for a partnership with theNational Specialty Societies and the Federation of MedicalSpecialists of Quebec to design and implement a program ofmaintenance of certification. Because of increasing demandsby licensing bodies and credentialling committees, the RCPSCStrategic Review recommended that mandatory maintenanceof certification be introduced on a national basis within 5years. The Surgical Specialties were well represented at themeeting. Present with the other attendees were:

Attendees

Dr. Peter Olley Canadian Cardiovascular Society

Dr. David Petrie Canadian Orthopedic Association

Dr. Audley Bodurtha Canadian Society of Surgical Oncology

Dr. David Girvan Canadian Association of Pediatric Surgeons

Dr. Roger Keith Canadian Association of General Surgeons

Dr. Gerald Moysa Canadian Society of Plastic Surgeons

Dr.Terence S. Myles Canadian Neurological Society

Dr. John A. Sullivan Canadian Society of Cardiovascularand Thoracic Surgeons

Dr. Dylan Taylor Canadian Society of Vascular Surgery

Dr. Ernest Wiens Canadian Society of Colonand Rectal Surgeons

It is noteworthy that a Task Force on this matter had been es-tablished (Chair Dr. J. W. D. McDonald) to do the groundworkbeforehand. Drs.John Duff and David Pichora are members ofthis committee.

After two days of discussions during which the systems inother countries were reviewed (US, Australasia, United King-dom) and various other options were debated, the followingagreement was reached: ~

~ Continuing professional development (CPO)

must be organized for all medical specialists in

Canada. Maintenance of certification must have stan-

dards, accountability, transparency, and validation of

records. It must be developed by a partnership of the

Repse with NSS and the Federation of Medical Spe-

cialists of Quebec (FMSQ). There must be sanctions for

non-compliance.

Note that re-examinations are not implicated and that the Na-tional Societies playa major role. In the re-organization of thegovernance of the Royal College (see elsewhere in this issue),Dr. John Parboosingh has been named Chairman of the Pro-fessional Affairs Committee and Dr. Jack McDonald has beenappointed to Vice-President Professional Development. Dr.Parboosingh informs us that CPDextends beyond CME. It isactually an "offshoot" of the Royal College's CanMEDS 2000project - Skills for the New Millenium. CPDactivities utilize awide variety of education formats (including self-directedlearning, traditional courses, and self-assessment programs)and delivery methods (including hospital rounds, journalclubs, CD-ROM,videotapes, regional and annual meetings andinternet based CME) to meet the learning preferences of all

THE SQUARE..z~5

specialists. These initiatives are supported by the Associationof Canadian-Medical Colleges and by the Federation of Med-ical Licensing Authorities.

All this will take a while to develop, but the system will have"teeth': One spin-off will be that of an increased importanceof the NSSand perhaps an influx of new members. This is be-cause the Specialty Society will playa major role in the liai-son between its members and the Royal College and it willalso be part of the mechanism to obtain credits, that is, at-tendance at meetings, CME courses, interactive programs andself-assessment tools such as the CAGSexam.

Where do you stand on this subject? The Royal College hasrequested the participation of its Fellows .•

His appraisal of Canadian Medical Schools may be para-phrased as follows:

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

In the past few years, there has been g~at intere~ inthe Report by Maclean's Magazine of its assessment of Cana-dian Colleges and Universities. There is precedent to this by

the Flexner Report of1910.Flexnerand

Maclean's Magazine At the turn of the cen-tury, the American Med-

ical Association was concerned about the uneven quality ofeducation in U.S.Medical Schools. It requested the CarnegieFoundation to look into this unsatisfactory state of affairs andto make recommendations.

Canadian Medical Schools

The task was given to Abraham Flexner, a louisville schoolteacher who made the survey. He reviewed all the AmericanMedical Schools of the period and he visited the eight Cana-dian Faculties of Medicine as well. The standards were basedon John Hopkins Medical School. This is probably the first timethat Accreditation Visits were carried out.

School Comments

McGillToronto

First class schools.

Queen'sManitoba

Making a good effort. He consideredQueen's had no future since theschool was isolated, the clinical basetoo small and there was no stablefunding.

Laval, MontrealLaval, Quebec

Feeble, no present function. Oneschool should be saved to educateFrench medical students. Recom-mended Laval, Quebec.

Western OntarioDalhousie

Feeble proprietary schools."Western University is as bad asanything this side of the line'~

N. Tait McPhedran, M.D., Canadian Medical Schools, HarvestHouse, 1993, pages 12-13 .•

EOM

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His outside interests are many and erudite. He has held im-portant positions with the Montreal Museum of Fine Arts andhas been a trustee since 1997. He and Jackie cultivate beesand apples in their orchard at Covey Hill in the Eastern Town-ships. He is an aficionado of fine wines and gourmet cooking.

~ He is a Regent of the American College of Surgeonsand is a member of the American Surgical Association, theCanadian Association of General Surgeons, the Central Surgical,the Society of University Surgeons, the Surgical Infection Soci-ety, the International Federation of Surgical Colleges, the Cana-

dian Society of Academic Medicine, and theMeakins Society for Surgery of the Alimentary Tract.(continued from pg.l)

As Surgeon-in-Chief of the MUHC, he has daunting tasksahead. This is a time of hospital mergers, budget cutbacks,ambulatory surgery, shortage of anesthetists and insufficientO.R.time for his surgeons yielding long wait lists. But he fol-lows in the steps of giants in Canadian Surgery: DoctorsThomas Roddick, Edward Archibald, Donald Webster, FraserGurd, H. Rocke Robertson, L.D. Maclean and David Mulder.

He has been the Co-Editor of the CanadianJournal of Surgery since 1992.

His publications are extensive. There have been 194 peer re-viewed articles, 70 chapters in prestigious medical textbooks,and 15 editorials. Of his 5 books, one was written with hiswife Dr. Jacqueline McClaran and is entitled - Surgical (are ofthe Elderly, Yearbook Publishers, Chicago, 1988 .

The Square Knot wishes him well. •

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

D.Donald R. W.bst.r, Surgeon-in·Chi.f ofthe Royal Victoria Hospital from 1953-62 and Professor of Ex-perimental Surgery, McGill University was awarded an Hon-

orary Fellowship of the RoyalCollege of Surgeons of England, forcontributions tosurgery, research andmedical education.

This was a high honour as there had only been 60admitted, including the reigning monarch, sincethe honorary category was founded in 1900.

Were You There?1962

Other Montreal surgeons who had been giventhe Honorary Fellowship in the past wereSir Thomas Roddick, Dr. Edward Archibald,and Dr. Gavin Miller of the Royal Victoria Hos-pital, Dr. Wilder Penfield of the MontrealNeurological Institute, and Dr. FJ. Shepherdof the Montreal General Hospital.

Dr.Webster graduated in Medicine from Dalhousie Universityin 1925 and received a Ph.D. degree from McGill University in1932. He served as a Surgeon-Captain with the R.C.N.V.R.from1939-46, was awarded an O.B.E.and appointed Honorary Sur-geon to the Queen in 1953.

Dr. and Mrs. Webster went to london for the official ceremonywhich took place in August. •

Sir Arthur Porritt (left), President of the Royal College of Surgeons, shaking hands with Dr.Webster. Vice-President Sir Clement Price-Thomas (centre) looks on.

6

e live locally and globally in an era of po-litical and economic change with health care delivery under-going sea-order re-engineering, all of which can producesignificant uncertainty about the future. Add to these con-

cerns, a major change in organiza-tion - The McGill University HealthCentre (MUHC); the administrativemerging of four hospitals with dis-tinct cultures and traditions and a

change in leadership, individual surgeon's anxiety about thefuture and their role in the Department or Divisions is under-standable. For a while, Prom may be the only answer, as thevarious threads of administration, budgets, problems andcrises get prioritized and sorted into some order.

Message FromThe Chair

There are two major components to this new position of Chairat McGill and Surgeon-in-Chief at the MUHC. The first is theacademic mission of the Department and relates to our edu-cational and research mission. On the educational side, a Di-vision has been created and its Director is Ron Zeit. Theresponsibilities for the various educational roles are beingthought through at this moment, but will include our partic-ipation in the three components of Undergraduate Teaching(introduction to Medicine, Introduction to Clinical Medicine,and Practice of Medicine); and Postgraduate Education (CoreProgram, and the individual specialty programs with their di-rectors). Research continues to have a strength in some butnot all of our divisions or sections. McGill has been surpassedby Toronto as the academic centre of Canadian Surgery andour mission will be to reverse that situation. A Division of Sur-

THE SQUARE...z5l7

gical Research has always existed, but has now been formal-ized with Dr. Lorrie Rosenberg as Division Head. A depart-mental surgeon scientist program is about to begin which willsignificantly support residents in all specialties to developtheir research careers.

The other component to the position is the management ofthe Surgical Services in the hospitals. Increasingly, these arebeing molded into a single budget which will permit cost sav-ings in one area of surgical practice - say same day admission,day surgery and decreased length of stay - to remain withinthe surgical budget and be transferred to the operating room,intensive care or surgical clinics rather than into the pool ofglobal deficit reduction.

Key components of these two somewhat different job descrip-tions are recruitment and retention of young academic surgeonsand shaping our clinical activities to move to a single building,the site for which has been identified. Duplication of servicesand equipment means less resources for all of surgery and forthe services surgeons provide. There is no question of down-sizing our clinical volume, in fact the objective by managing ourresources better is to increase volume but through changes inpractice and methods of delivering care.

Our future as a first-class Department of Surgery is in ouryoung faculty. Recruitment of new surgeons and retention ofour present cadre is crucial. The new building is for them, notfor today's senior surgeons. Working conditions, clinics, acad-emic time and accessto the ORmust be equitably distributed.Resources are for the community of surgeons not for individ-uals. This is not socialism, but common sense democracy. Weneed the next generation in order to move to a single site .•

...............................................................................................................................MCHIMGH DESIGNATED CLINICAL SITES FOR CARDIOVAS-CULAR PERFUSION TRAINING IN QUEBEC.The Montreal Children's and The Montreal General Hospitals

have been desig-nated affiliatedclinical sites forthe Cardiovascu-lar Perfusion

Training (CVT) program of the Michener Institute for AppliedHealth Sciences. The MCH is now Montreal's first CVTsite forpediatric care. The Toronto based Institute is only one of twoin Canada to offer perfusion training. Medical Directors for theMCH-MGH Perfusion Program are Dr. Christo Tchervenkov forpediatric CVTand Dr. Ray c.-J. Chiu for adult CVT.

Cardiovascular PerfusionTraining in Quebec

The recruitment of these cardiovascular perfusionists meets acrucial need in both hospitals for specialists in a field wherethere is a chronic shortage of experts in Canada, and particu-larly in Quebec. Dr. Francoise Chagnon, Acting Director of Pro-fessional Services at the MGH stated that "This designationwill help us to fulfill a manpower training vacuum that haslong existed in this province and will make it easier for theMUHC to attract new perfusion recruits': •

EKL

(GILL SURGEONS IMPRESS AT THEMEETING OF THE ROYAL (OLLEGE AND C.A.G's.IN TORONTOIN SEPTEMBER.On the first day, September 23rd, a well attended post-gradu-ate course was held on Surgery in the Elder/y and Ear/y Breast

Cancer: Current Manage-ment and New Ideas.Dr. J.L. Meakins gave apaper entitled Preopera-tive Planning, Avoiding

Complications, Optimizing Recovery. Or. A.P.H. McLean ad-dressed the group on The 'jkute Abdomen" in the Elder/y. Inthe afternoon session, Dr. Yves Leclerc, an alumnus of McGill,chaired the session on Ear/y Breast Cancer.

Meeting at The RoyalCollege and C.A.G.S.

At the meeting of the Surgical Biology Club on September25th, Dr. Nicolas Christou presented a paper on Mechanismsof Organ Injury in the Critically JII Patient.

Later in the morning at an Awards Session for Frontiers inSurgery and chaired by Dr. John Marshall of Toronto, the fol-lowing work was honoured. Report of the 1997 Bayer Fellowin Surgical Infectious Diseases: The Second Front Hypothesis inIntraabdominallnfections: Role of 6CSF in Neutrophil Deliveryand Survival in Mice with Peritonitis and Infection at a RemoteSite, D. Swartz and N.V. Christou, RVH.

Dr. David Mulder introduced the Guest Lecturer for C.A.G.5.,Sir Miles Irving, Professor of Surgery, University of Manchesterwho spoke on The Continuing Challenge of 6./. Fistulae.

At a well received seminar on Surgical Infection in Critical Care,Dr. Nick Christou presented two papers, one on NecrotizingFascitis and the other on New Antibiotics in Surgery.

Some video presentations were made in the Toronto Conven-tion Centre. Dr. Gerry M. Fried presided and showed a videoentitled Pitfalls of Laparoscopic Cholecystectomy. Dr. RogerTabah also presented a video on the management of lenker'sDiverticulum.

At the paper session of Frontiers in Surgery, the following pa-per was well received. A Longitudinal Follow Up of LaparoscopicSkill Evaluation in a Residency Training Program, authored byA.M. Derossis, M. Antoniuk, H.H. Sigman, G.M. Fried.

On Saturday, September 26th, at the C.A.G.S.paper session,

THE SQUARE..zs:Drs. C.D. Baldry and G.M. Fried discussed Predictors of Out-come After Percutaneous Cholecystostomy in Critically JII Pa-tients. Also, a paper entitled Percutaneous Lavage for InfectedPancreatic Necrosis was presented by Drs. D. Sleeman, A.Echenique, J. Yrizarry, T. Scagnelli, J. Guerra, J. Casillas,D. Shatz, E. Russell, J. Levi, A. Livingstone.

UNEXPECTED FINDINGS IN SURGERYWith the age of touch responders, the audience was able toparticipate in this excellent seminar chaired by Drs. RogerTabah and Frederic Hould of Quebec.

On Saturday noon, residents attending the meeting had theopportunity of "Meeting the Professors" at a lunch session inthe Exhibit Hall of the Metro Convention Centre. Of the fiveprofessors present, two were from McGill: Dr. G.M. Fried todiscuss Pitfalls of Laparoscopic Cholecystectomy and Dr. NickChristou whose subject was Surgical Infection.

C.A.G.S. Self-Assessment Exam was held during which acomputerized audience response system was used. The panelconsisted of Dr. Jeff Barkun, Dr. Joe Mamazza, andDr. E.D. Monaghan.

Dr. Philip Gordon chaired a symposium for the Canadian So-ciety of Colon and Rectal Surgeons.

THE FOLLOWING PAPERS WERE GIVENON SEPTEMBER 27TH:

• Suppurative Anal and Rectal Crohn'sDisease - Phil Gordon, JGH.• Laparoscopic VSOpen Inguinal Herniorrhaphy: A Randomized

Controlled Trial - J.S. Barkun, MJ. Wexler, M. Fernan-dez, J.L. Meakins.

• Is an Upper Abdominal Incision a Contraindication for La-paroscopic Cholecystectomy - H.H. Sigman, M. Antoniuk,G.M. Fried.

• Preoperative Predictors of Conversion in Laparoscopic Chole-cystectomy - G.M. Fried, M. Antoniuk, H.H. Sigman.

THE FOLLOWING SUBJECTS WERE PRESENTED IN THE(.A.G's. POSTER SESSION:

• Evaluation of the Advanced Breast Biopsy InstrumentationSystem - F. Sampalis, D. Fleiszer, J.S. Sampalis.

• Merkel Cell Carcinoma - A. Linjawi, B. Jamison, S. Me-terissian, RVH.

• Evaluation of 9m TcTetrofosmin Imaging in the Assessment ofBreast Tumours - F. Sampalis, C. Zerva, C. Markopoulos,D. Fleiszer, J. Gogas, J.S. Sampalis, McGill University,MGH and University of Athens Medical School, Greece. •

EDM

8

Royal CollegeRe-Organization

After a strategic review, President LucDeschenes reported some majorchanges at the RCPSCAnnual BusinessMeeting in Toronto in September.

a) New Mission Statement

"An organization of medical specialists dedicated to ensur-ing the highest standards and quality of health care':

b) Council adopted a revised organization structure which re-flects the RCPSC'score business and activities:• Education• Professional Development• Fellowship Affairs• Corporate Affairs

c) Consistent with the new governing structure, council mod-ified the Vice Presidential positions. Persons appointed tothe new positions are as follows:

THESQUARE..z~

RCPSCCommittee

Organizational Structure

9• Vice-President, Education

Dr. Jacques Desmarchais, Sherbrooke

• Vice-President, Professional DevelopmentDr. Jack MacDonald, London

• Vice-President, Fellowship AffairsDr. Mohan Iype, St. John, N.B.

• Vice-President, Corporate AffairsDr. Stuart Hamilton, Edmonton

Note that these Vice-Presidents sit on Council and replace theold designations Vice-President (Medicine) and Vice-President(Surgery), etc.

d) There is a new RCPSCCommittee Structure (see chart)• Dr. Nadia Mikhail is the Chair of the Education Commit

tee and replaces Dr. J.P.DesGroseilliers.

Bylaws Committee

Committee on

Committees

Health & PublicPolicy Committee

Nominating

Committee

Past-Presidents

Advisory Committee

Corporate Affairs

Committee

Compensation & Human

Resourtes Committee

Development Committee

Laboratory Medicine

Advisory Committee

Equity Issues

Advisory Committee

Professional

DevelopmentCommitteeEducation Committee

Fellowship Affairs

Committee

• Dr. John Parboosingh is the Chair ofthe Professional DevelopmentCommittee.

• Dr. James Hickey is the Chair of theFellowship Affairs Committee.

• Mr. Glen McStravick, CA. is theChair of the Corporate AffairsCommittee.

e) The new Chief Executive Officer isDr. Michel Brazeau. •

EDM

CMEProviders Accreditation

CommitteeAccreditation Committee Annals Editorial Board

Archives & libraryCommittee

Credentials Committee Information Management

Committee

Awards Committee

Committee on Specialties

- Specialty CommitteesNSSCommittees

Biomed;,al Ethics CommitteeEducation & Research

Development Committee Standards Committee

Annual Meeting Committee

- Scientific Program CommitteeEvaluation Committee

- Examination Boards

- Examination Committees

RACs (5)

T.DIVISION OF SURGICAL RESEARCHThe Graduate Program Committee of the Division has beenpreoccupied this past year with a reorganization of the courseand program structure of the graduate program in Experi-

mental Surgery. OldNews From the Bench courses are being phased

out and new ones will beadded over the next 18 months. The first of these new offer-ings is entitled Signal Transduction. Another part of the on-going restructuring is a new diploma program in surgicalepidemiology that is designed exclusively for surgical resi-dents. This 6 month (30 credit) program will emphasize tech-nology assessment and health care economics, and will bedirected by Dr.John Sampalis. This proposal is currently mov-ing through the University's approval process, and more detailwill be provided when it becomes available. It is our desireto make this new program available for the academic year be-ginning July 1999.

The Division is undertaking a public relations campaign to raiseits visibility within the Department, the University and the aca-demic community at large. This will be accompanied by afund-raising campaign that is currently in the early stages ofplanning. An integral part of this effort is the creation of a Di-visional web site, which is currently under construction. As partof this activity, the Division Executive is offering a cash prizefor the best design of a logo for the Division of Surgical Re-search. The prize will be awarded at the first annual surgicalresearch reception to be held tentatively on December 7, 1998.Further details will be forthcoming. The logo contest is opento all staff and students of the Division of Surgical Research.

Finally, this issue of the Square Knot inaugurates a new fea-ture from the Division of Surgical Research - an overview ofthe work being conducted in the surgical research communityat McGill. This issue's column highlights work in the Divisionof Plastic Surgery in the laboratory of Dr. Anie Philip.

Lawrence Rosenberg, M.D., Ph.D.

Director, Division of Surgical Research

DIVISION OF PLASTIC SURGERY

ANIE PHILIp, Ph.D.

Transforming Growth Factor-b actin in the skin:

Growth factors are acknowledged to play critical roles in tissuerepair events. Of the many growth factors, transforming growthfactor-b (TGF-b) is remarkable in its potential to influence al-

THE SQUARE..z5':

most all aspects of wound healing, and has recently gained at-tention as an important regulator of skin tissue repair. Al-though topical application ofTGF-b to promote wound healingand neutralization of TGF-b activity to reduce scarring havebeen shown in animal models, the clinical results in the humanhave been less than encouraging. The possible reasons includethe high levels of protease activity and decreased mitogenic ac-tivity in chronic wounds. Topical application of TGF-b to thewound may be futile since the increased protease activity maydigest the factor. Intravenous administration is not desirabledue to unwanted side effects. An interesting alternative wouldbe to regulate TGF-b action locally using regulatory agents andthereby to manipulate specific wound healing events.

Our research is focused on studies of the regulation of TGF-baction at the level of its bioavailability and its receptors in theskin. Our objectives are to identify agents that may regulateTGF-b activation and thus its bioavailability, and to character-ize novel TGF-b receptors that may modulate TGF-b signallingin skin cells. We are currently investigating the effects ofsteroids, retinoids and extracellular matrix components on theregulation of TGF-b availability, and TGF-b receptors. Also, weare characterizing novel receptors which form complexes withthe TGF-b signalling receptors. These studies employ skin tis-sue and cultured skin fibroblasts, keratinocytes and endothe-lial cells. These basic studies are aimed at developing agents

TISSUE REPAIR EVENTS

that modify TGF-b action in the skin, and thereby promote im-proved healing of chronic wounds and reduction of scarring.

This work is supported by the Medical Research Council ofCanada, Heart and Stroke Foundation, Quebec, and FRSQChercheur Boursier Award. Trainees involved with these projectsinclude two Ph.D. students (B. Tam and R.Haghighat), one M.5c.Student (S. Wong), one medical student (M. Kungurov) and onesurgical resident (K. Khiabani). Dr. H. Brown, Chairman, Divisionof Plastic Surgery at McGill provides both collaborative and ad-ministrative support. •

10

Research undertakenotherthanina recognizedresidency or a higher degree program in an approved univer-

sity will be considered for a maximum of one year of credit insome specialties, atthe discretion of

the Credentials

Committee, where

the specialty train-ing requirements permit, and where the specialty residency

program director can provide assurance that the minimum

postgraduate clinical residency requirements can appropri-

ately be reduced. Such credit will be considered only wherethe research experience is of outstanding quality.

Guidelines for a One-Vear

Research Experience

The research must be done in an academic centre as part of a

program in which research methodology is taught. There must

be a designated research supervisor who has an established

research record in the field, and who is responsible for the re-

search experience outlined below. The applicant must play or

have played a significant role in the research project, and the

results must be documented. The subject ofthe research must

have some explicable relationship to the specialty in which the

applicant seeks certification.

At the end of the period of research training, the individual will

be expected to have been introduced to the scope of research

and concepts of critical appraisal, knowledge, skills and attitudes

fundamental to embarking on a career in health research.

The one-year research experience must provide primarily a re-

searchopportunity. Clinical activity, if any,must not exceed 20%.

Credit for research should preferably be sought in advance.

In the courseof the researchexperience,the applicant must attain:

KNOWLEDGEThrough a specific project and a formal outline of necessary

reading, the candidate will be introduced to:

a) general principles (basic experimental design, clinical trial

design, critical appraisal of the literature, biostatistics, med-

ical and research ethics, etc.);

b) knowledge relevant to the specific area of research, as well

as general knowledge relating to the clinical and research

aspects of the chosen field of study.

No formal course work is required.

THE SQUARE

~!:l

11

SKILLS

a) participate in the research project and develop an under-

standing of the necessary techniques;

b) acquire skills relevant to the specific area of research, as well

as general skills relating to the clinical and research aspects

of the chosen field of study;

c) develop the ability to present information in a formal set-

ting and to defend such a presentation and discussion;

d) develop the ability to write a report suitable for publication

in a peer reviewed journal;

e) develop an understanding of the sources of research funds

and of the development of a research grant application.

ATTITUDES

a) demonstrate behaviour consistent with an understanding

of the need to re-examine accepted beliefs through a spirt

of inquiry;

b) demonstrate behaviour consistent with an understanding

of the importance of absolute objectivity and honesty in

the conduct and reporting of research;

c) an in-depth knowledge of the ethical issues relevant to the

conduct of research in human subjects;

d) an in-depth knowledge of the ethical issues relevant to the

conduct of research in animal models;

e) an ability to work effectively as part of an inter-disciplinary

team;

f) an understanding of the needs for continuing self-education.

CLINICAL OR BASIC RESEARCHThe maintenance of quality in medicine requires scholarship

based on scientific principles. Therefore, the College encour-

ages research experience. Residents, especially those intend-

ing to pursue a full-time or part-time academic career should

consider the desirability of spending at least a year in research

related to the specialty. The advice and support of the pro-

gram director must be sought.

An advanced degree or full-time training in a relevant disci-

pline taken before or after graduation in medicine can be con-

sidered for a maximum of one year of credit in some

specialties, at the discretion of the Credentials Committee,

where the specialty training requirements permit, andwhere the specialty residency program director can provide

assurance that the minimum postgraduate clinical residency

requirements can appropriately be reduced. Documentation of

the advanced degree or full-time training must be provided,

together with evidence that such study or research was rele-

vant to the objectives of the specialty in which the candidate

is seeking certification.

Research undertaken other than in a recognized

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

~ residency or a higher degree program in an approveduniversity will be considered for a maximum of one year ofcredit in some specialties, at the discretion of the Creden-tials Committee, where the specialty training require-ments permit, and where the specialty residency programdirector can provide assurance that the minimum postgradu-ate clinical residency requirements can appropriately be re-duced. Such credit will be considered only where the researchexperience is of outstanding quality.

Credit will be considered if the research has been done in anacademic centre as part of a program in which researchmethodology is taught, and where the research supervisor or

T.FIRST APPENDEaDMY IN CANADASubmitted as an item of interest by Alex K. Paterson

On May 10, 1883, Dr. Abraham Groves made Canadian med-ical history. After travelling by horseback through the backconcessions of midwestern Ontario to tend to a farmer's 12

year old son, he arrived to find theboy doubled over in pain. Followinga quick examination, Groves madethe momentous decision to operate.As far as he knew, it was the first ap-pendectomy in the world. (Appen-

dectomy gained status when Mr. Frederic Treves [Ligament ofTrevesl in 1901 operated on the Prince of Wales at Bucking-ham Palace - editor's note).

In medical school, Groves had been taught that the appendixhad "no uses and no diseases'; but his observations as a youngpractitioner suggested otherwise. What has since been recog-nized as the first appendectomy in Canada, and probably inNorth America, was not immediately appreciated as an innov-ative lifesaving treatment. Upon his return to the farmhousethree days later, Groves found his patient healing well, but theboy's father greatly perturbed. Since the operation, the farmerhad learned that a neighbour had seemingly been cured of thesame symptoms by the application of poultice. He believed thedoctor had put his son unnecessarily at risk and threatenedthat "all would not go well" for Groves if the boy did not re-cover. Fortunately, the patient survived. •

Jennifer Williams,

THEBEAVER,April-May 1998, pages 28-29

··············

THE SQUARE...z~12

mentor has an established research record. The applicant forcredit must play or have played a significant role in the researchproject. The results of the research must be documented. Thesubject of the research must have some explicable relationshipto the specialty in which the applicant seeks certification. Theguidelines for a one-year research experience are available fromthe Office of Education - Credentials .•

Sheila Waugh, Head, Credentials Section

Royal College of Physicians and Surgeons of Canada

The MUHC Staff:

Caring, Compassionate,

Gentle, Kind, Principled,

Role Models, Mentors**

** does not apply when wearing hockey skates

December 15, 1998 - 8:00 P.M.-

McConnell Arena, McGill University

Residents take on the staff in ice hockey

for the tie-breaker

third annual

Rea Brown Cup.

This is not a game

... it's WAR.

All spectators

welcome.

Tsquare Knot has leamedthat a s.e hasbeenfound for the proposed McGill University Health Centre whichis to be built by 2004. The 17 hectare area in Notre Dame de

Grace is bounded by Decarie Blvdto the west, de MaisonneuveBlvd and St. Catherine St. to thenorth, St. Jacques St. to thesouth, and Glen Road to the east.

The whole land area is known as the Glen Yardsand now be-long to c.P. Rail and the cost price is 23 million dollars. Theproperty is being acquired by McGill University through pri-vate sector donations targeted for this initiative.

Site Set for MUHC

"Super Hospital"

This is happy news for West Island Montrealers because thissite is near the closed Queen Elizabeth Hospital.

It is estimated that is will cost between 4 to 8 million dollarsto clean up the Rail pollutants in the 43 acres of those yards.However, this work will be done by c.P. and it will assume allof the costs incurred.

Accesswill be by Vendome Metro and there will be parkinglots along Decarie to the west and Claremont Ave. to the east.It is next to the Ville-Marie and Decarie expressways.

Doctors Hugh Scott (Executive Director of the MUHC) and NickSteinmetz (Planning Director) hope to have a number of low-

THE SQUARE:~13

rise buildings strung over a single site much like the DukeUniversity Campus.

There are still many hurdles in the timetable however. Firstly,the project has yet to be approved by the Regional HealthBoard of Montreal. Secondly, there is the Provincial Electionlate on November 30th which will delay proceedings. Thereis the question of the $300 million dollars that Quebec haspromised McGill. Dr. Hugh Scott met with Health MinisterJean Rochon on October 26th and, amongst other items onthe agenda, asked that the designated MUHC hospitals bedesignated as a "University Health Centre':

What will happen to the Vic, the General, the Neuro and theMCH? These aging institutions are slated to close and to besold and refurbished into offices or condominiums.

One might find it interesting at this time to recall a histor-ical footnote to be found in Dr.Tait McPhedran's book "Cana-dian Medical Schools - 1822 to 1992': In 1947, as a directoutgrowth of the wartime collegiality, Cyril James, Principalof McGill, spearheaded a drive to unite the MGH and the RVHto create a single superior teaching hospital - a "Mayo Clinicof the North". The medical profession was solidly behind theproposal. Ninety-six percent of the staff in the tWI) hospi-tals voted in favour. It failed because the MGH board couldnot agree with the RVH board on governance of the amal-gamated institutions! •

...............................................................................................................................MUHC Surgeons HonouredMUHC SURGEONS HONOURED BY THE MONTREAL GENERALHOSPITAL RESEARCH INSTITUTE.

The recipients of the 1998 awards presented at a dinner at theSt. James Club were as follows:

Dr. Denise Arsenault

The MGH 175th Anniversary FellowshipDr. David Evans

Dr.Alan G.Thompson Fellowship in SurgeryJohn Dobson Award in Surgery

Dr. Gerald M. Fried

The Florenz Steinberg Bernstein and David Bernstein AwardDr. Pierre Guy

The MGH 175th Anniversairy Fellowship

Dr. Edward Harvey

The MGH 175th Anniversary FellowshipDr. Lawrence Rosenberg

Nesbitt-McMaster Award for Escellencein Medicine & Surgery

Dr. John Vee

Herbert S. Lang AwardDr. Ron ZeIt

The Honourable Hartland Molson Fellowship

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-~dun~"81''II'r'0iisoon>l

~ tee of the Canadian Associationof General Surgeons in September.

1i

The third edition of Surgical Research -

Basic Principles and Clinical Practice ofwhich Dr. David S. Mulder is a co-edi-tor is available through Springer-Verlag,New York, Inc. David's co-editors in this675 page book are his friend Hans Troidlfrom Cologne, Germany, Martin F. McK-neally of the Toronto General Hospital,Andrew S.Wechsler of the Medical Col-lege of Virginia, Bucknam McPeek ofHarvard, and Walter O. Spitzer ofMcGill. "This practical book covers theentire gamut of surgical research and hasbeen carefully re-organized to include astronger focus on the needs of youngacademic surgeons': A film was pre-sented at the Film Festival of the A.C.S.Management of the Airway in I.CU. Pa-

tients by Dr. Mulder and the late Dr. H.Rocke Robertson.

Dr. Lawrence Rosenberg was a VisitingProfessor in the Department of Anatomyand Cell Biology at the Universite du Mon-treal. He has successfully renewed his op-erating grant from the Canadian DiabetesAssociation (COA) and competed success-fully for a new grant from the Juvenile Di-abetes Foundation International (JDFI).Dr. Rosenberg also presented a paper atthe Canadian Diabetes Association (Scien-tific Section) on TheNatural History of the

Islet Following Isolation.

,I

1

Dr. Stanley C. Skoryna was recentlyhonored at a reception by PrincipalShapiro for 50 years of service at McGillUniversity.

Dr. Jean Tchervenkov has been made aFellow of the American College of Sur-geons. Jean informs us that the 4th An-nual Liver Transplant Fundraising dinnerwas held at the Milos Restaurant on No-vember 29th, 1998. The Honorary Presi-dent this year was Mark Recchi of theMontreal Canadiens Hockey Team.

Dr. Carol-Ann Vasilevsky has beenelected President of the Canadian Societyof Colon and Rectal Surgeons.

AchievementsResidentsand Fellows

Tcolleagues of Dr. Mario A.Alonso-Vanegas have drawn to the at-tention of The Square Knot, some inter-esting biographical data. Mario comesfrom Baja California Sur,Mexico. In 1986,he graduated from the Uni-versidad Autonoma deGuadalajara Medical Schoolfollowed by an internship ingeneral surgery at the Hos-pital General de Mexico. Dr.Alonso completed Neuro-surgery residency at theHospital Juarez de Mexico(National Institute ofSurgery) and is a certifiedneurosurgeon. He came tothe Montreal NeurologicalInstitute and Hospital (MNI/MNH) atMcGill University in 1994 and completeda Fellowship in Epilepsy and FunctionalNeurosurgery under Dr. Andre Olivier.He is now completing his Ph.D.Thesis inthe Cone Laboratory for Neurosurgical Re-

search under Dr. Abbas Sadikot. His re-search goal is to understand the basicmechanisms of epilepsy and neurode-generative disease, in particular Parkin-son's disease. He has received numerousawards including the 1996 Jeanne Tim-mins Costello Fellowship and the 1997and 1998 Preston Robb Fellowships, bothof which are awarded by the MNI. Aftergraduating, he will resume his neurosur-gical practice at the prestigious NationalInstitute of Neurology and Neurosurgery

THE SQUARE...z~15

in Mexico City. During his stay in Mon-treal, Dr.Alonso became a proud father oftwo beautiful children.

Congratulations to Dr. Fawzi AI-Jassir andLina AI-Rassan on their marriage whichtook place on July 1, 1998 in Saudi Arabia.

Dr. Aayed Alqahtani presented a paperat the Canadian Association of PediatricSurgeons on 25 Years Experience with

Lymphangiomas in Children.

Dr. Peter Chan was invited to representthe McGill Urology Resident Group to at-tend the 1998 Conference on Issues and

Controversies in Prostate Cancer, held atWhistler last March. Along with otherUrology residents across the nation. Pe-ter presented the results of the first na-

tional survey on resident'sview point on medical edu-cation and health-care sys-tem. This survey wasconducted by Dr. MostafaElhilali, the Chairman ofthe Department of Urology,at the beginning of thisyear. At this conference, Pe-ter was also awarded the1998 grand prize in basicscience and clinical re-search for his recent work

entitled The use of a Cytoprotective Lipid

Peroxidation Inhibitor in Preservation of

Penile Erectile Function Post-Prostatec-

tomy in Rat. The co-author of this workwas Dr. Gerald Brock of the Depart-ment of Urology, with whom Peter isworking on several projects aimed atminimizing erectile dysfunction after ex-tensive pelvic surgery.

Peter Chan,M.D.

Congratulations to Dr. Antonio Di-Carlo and Laura Panarello who weremarried here in Montreal on Saturday,Sept. 26, 1998.

Dr. Hussein Hayati and Nehad areproud to announce the birth of their babyboy. Ali was born on June 24, ~

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~ Some adjustments were needed to make thingswork, but the end result was a renewed and vigorous pro-gram. The Pancreas Transplant Clinic is located on the secondfloor of the Ross Pavilion alongside the Liver, Kidney, andHeart Clinics. The clinic coordinator is Michelle Fortier, a B.Se.Nurse, who joined the transplant program last year and hasbecome invaluable to the program. The pre-transplant recip-ient assessments are carried out by the recipient coordinatorMaria Poloni, a very experienced and capable transplantnurse, who has streamlined the work-up process. We followthese patients with medical transplant expertise provided byDr. Marcelo Cantarovich and Dr. Roman Mangel whohave developed a keen interest in pancreas transplantation.Dr. Mangel was previously involved with the pancreas trans-plant program at the MGH.

The program has begun to thrive becauseof the increasing inter-est of the transplant and medical community in and around McGillUniversity. Three pancreas transplants were performed in 1997,and this year as of September 1998, eight transplants were per-formed. One graft has been lost due to unrecognized rejection 6

THE SQUARE""z~

months post-transplant. As of July 1997, a transplant waiting listof 15 to 20 recipients is maintained and the list is steadily grow-ing with a significant increase in referrals for PTAs.

The program is pushing the frontiers of pancreas transplanta-tion by focusing on expanding indications for PTAs. These arepatients who are not dialysis dependent, but have labile dia-betes, early nephropathy, and/or severe autonomic or periph-eral neuropathy. These patients will be intensely studied todetermine the effect pancreas transplantation has on their di-abetic complications. Other studies that the program is cur-rently in the process of defining, in collaboration with otherpancreas transplant centers, include the use of new immuno-suppression regimes, specifically Rapamycin, and new ways todetect rejection. •

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

Pancreas Transplant Program Team

Lt. to Rt.: Maria Poloni, B.ScR.N., Dr.Marcelo Cantarovich, Dr. Peter Metrakos, Dr. Roman Mangel, Michelle Fortier, B.ScR.N.

17

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fST ANTHONYR.C.D08Ell ANNUALVISITINGPROFESSOR OF CONGENITAL CARDIAC SURGERY

On October 5th, 1998, Dr. Richard A. Jonas was the firstA.R.C.Dobell Visiting Professor of Congenital Cardiac Surgery.

Dr. Jonas is Cardiovascular Sur-geon-in-Chief at the Children'sHospital in Boston and theWilliam E. Ladd Professor ofChild Surgery at Harvard Med-ical School. He is one of themost sought after surgeons inthe world today and is an Hon-orary Professor of Surgery at theShanghai Second Medical Uni-versity. He is one of the fewtruly outstanding congenitalcardiac surgeons, particularly inneonatal and infant cardiacsurgery. In addition to histremendous clinical output, Dr.Jonas has maintained an ex-

tremely active research lab and is a leading expert in the areaof brain protection during pediatric cardiac surgery. He haspublished over 170 original papers, co-authored 4 major text-books in cardiac surgery and written over 25 book chapters.At Surgical Grand Rounds at the Montreal Children's Hospital,his talk was entitled "New Strategies in Cerebral Protection Dur-

ing Pediatric Cardiac Surgery". At McGill University CVTGrandRounds also at the MCH in the afternoon, he spoke on

Visiting Professors

='<....:I:II»....ia:

Dr.Anthony R.C Dobell

The Anthony R.C.Dobell VisitingProfessorship of Congenital Car-diac Surgery is a fitting tribute

Dr.Richard A.Jonas to his invaluable contributionsto the field of congenital car-diac surgery as well as his cru-

cial role in the training of numerous cardiac surgeons. In the1960's, he established the training program in Cardiovascu-lar and Thoracic Surgery at McGill University, and was Chair-man of the Division of CVTSurgery for almost 20 years, from1973 until 1992. He was Surgeon-in-Chief at the MontrealChildren's Hospital from 1974 to 1992. In 1993, Dr. Dobellbecame a Professor Emeritus of Surgery at McGill.Dr.Dobell's contributions to cardiac surgery in general and topediatric cardiac surgery in particular are too numerous tomention. He is a pioneer, a scientist, an outstanding surgeonas well as a great teacher. Most of all, Dr. Dobell possessestremendous human qualities and is revered by his patients,colleagues and students. He always reminded those inter-acting with him that in today's world of technology and in-novation, one should not forget the patient as a humanbeing. It is not surprising that the title of his PresidentialAddress to the Society ofThoracic Surgeons in 1982 was "The

Human Touch", reflecting the type of individual he is. In1997, he was awarded the Order of Canada. An outstandingrole model, he will thus continue to inspire us and futuregenerations of surgeons .•

THE SQUARE1:~

"pH Management During Hy-

pothermic Cardiopulmonary By-

pass". That evening, a dinnerreception was held at the MontStephen Club.

19

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

Were You There? Opening of RVH Transplant Service 1971

Dr.J. Knaack and Dr.K. MacKinnon Dr.Jean-Guy Beaudoin and Dr.Ronald Guttmann

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

DVISION OF(ARDIOTHORAC/(SURGERYVISITING PROFESSOR

On November 5th, 1998, Dr. Thomas J. Stegmann was the1998 Visiting Professor in the Division of Cardiothoracic

Surgery. Dr. Stegmann is Pro-fessor of Surgery and Chairmanof the Department of Thoracicand Cardiovascular Surgery at

Fulda Medical Center in Germany. He has distinguished him-self in several areas of surgical research, including experimen-tal studies on coronary and cerebral air embolism, cardiaccatecholamine levels, acute aortic dissection, heart transplantsurgery and neo-angiogenesis. Dr. Stegmann has receivedseveral distinctions including the Rudolf Nissen Memorialprize of the German Society for Thoracic and CardiovascularSurgery. His talk at Surgical Grand Rounds at the MGH wasentitled "New Aspects of Treatment of (oronary Heart Disease:

Visiting Professors

A Proud Moment

Dr.Thomas1.Stegmann

THE SQUARE...z~

Neo: Angiogenesis". At the RVHRounds in the afternoon, his lec-ture was "Acute Aortic Dissection:

New Aspects of Surgical Treat-

ment~ A reception was held inhonour of Professor Stegmannat the home of Dr. StanleySkoryna that evening.

This event was supported by theRideau Institute Advanced Re-search Center for Physical andBehavioral Sciences. •

Dr.Dave Williams, astronaut, McGill M.D.CM., 7983 visits MUHC Here he is with Drs.Michael Churchill-Smith and David S.Mulder.

20

oSeptember 1-4, 1998, the International So-ciety for Diseases of the Esophagus (lSDE) held its seventhworld congress at the Montreal Palais des Congres. The meet-ing attracted over 1100 gastroenterologists, surgeons, oncolo-

gists and radiotherapists from 40Esophagus '98 different countries.

Drs. Serge Mayrand (Gastroenterology at MUHC) and DavidMulder (CVTSurgery at MUHC) were members ofthe local or-ganizing committee and together with Dr. Duranceau (Tho-racic Surgery at Universite de Montreal and Conference Chair)offered a superb conference to the Esophagus 98 participants.

The Palais des Congres provided a wonderful setting to hold aconference of this magnitude. The morning plenary sessionsoffered a selection of high caliber work on Barrett's esopha-gus, esophageal cancer, motor disorders, reflux disease as wellas addressing quality of life issues. The afternoon symposiaallowed more participant discussion on these multiple facetsof esophageal disease and function.

THE SQUARE:~21

Two presentations were made by McGill participants.Dr. Serge Mayrand presented the results of his studyAssociating Helicobacter Pylori Eradication with SubsequentDevelopment of Endoscopic Esophagitis. His presentation wasvery well received by the plenary session chairs (Dr. ChrisJamieson, Department of Surgery, Dalhousie University andDr. Michel Boivin, Department of Medicine/Gastroenterol-ogy, Universite de Montreal).

Dr. Talat Chughtai (McGill General Surgery chief resident)presented the first long-term follow- up study of Myotomy forMuscular Disease of Pharyngo-Esophageal Junction (supervisedby Dr. Duranceau, Universite de Montreal). His presentationwas part of a symposia featuring Dr. P. Kahrilas (USA) andDr. T. Lerut (Belgium) as chairmen.

Other McGill physicians attending the conference included GIresidents Khalid AI-Mekhaizeem, Vicky Battis, KrishnaMenon and Mark Ropeleski. Surgery delegates includedresidents Patrick Charlebois, Eric Kaiser-Gauvin and staffGerald Fried and David Mulder. All agreed that the meet-ing was excellent and offered the opportunity to listen to animpressive array of world renown clinicians. We extend ourthanks to the Organizing Committee. •

Dr. Patrick Charlebois,General Surgery Resident

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

NEW RESIDENCY PROGRAM DIRECTOR APPOINTEDDr. Ruth Covert assumed the position of Residency ProgramDirector on July 1, 1998. Dr.Covert is admirably suited to thisposition, as she has always had an interest in teaching and ed-

ucation since she began her anaes-Anaesthesia thetic consul~ant. career at the Jewish

General Hospital In 1986.

Dr.Covert completed her Master's Degree in Health ProfessionalEducation from the University of Chicago in 1994. She has beenat the Jewish General Hospital as a consultant anaesthetist forthe past twelve years. Preceding that, Dr.Covert did a two-yearfellowship in Critical Care at Sir George Washington Universityafter completing her anaesthesia residency at McGill.

So,as one can see, Dr.Covert has been a resident, a fellow and isnow a consultant and an educator. Her personal experience andacademic background make Dr.Covert an excellent choice to headMcGill's anaesthesia training program into the next century.

Good luck, Ruth .•

Dr.Ruth (overt

THE SQUARE...:z5:

Royal College of Physicians and Surgeons of CanadaACCREDITED CLINICIAN INVESTIGATOR PROGRAMS

(May 12, 1998)__ .__ u_

UBC Toronto Queen's McGill Laval Dalhousie #CIP Residents

Anesthesia 2 2Cardiac Surgery 3 3Community Medicine 2 2General Surgery 20 6 1 27Internal Medicine 1 1Neurology (Adult) 1 1 2Neurosurgery 9 1 10Obstetrics & Gynecology 1 1Ophthalmology 1 1Orthopedic Surgery 5 5

Otolaryngology 1 1Plastic Surgery 3 1 4Psychiatry 4 1 5

Radiation Oncology 1 1Urology 3 3Endocrinology & Metabolism (Pediatric) 1 1Gastroenterology (Adult) 1 1Gastroenterology (Pediatric) 1 1Hematology (Pediatric) 2 2Nephrology (Adult) 1 1Critical Care Medicine (Pediatric) 1 1

Totals 2 61 NEW 11 NEW 1 7S

Were You There? 1965

When Mrs. Muriel Lennon retired in July, from herpost as Supervisor of Admissions, many people at-tended the reception given in her honour. Here area few of them photographed with Mrs. Lennon.

Lt. to Rt.:Mr. Jean Bachand, Miss Audrey Fraser, Mr. John Lup-ton, Mrs. Kay Forrester, Mr. Gordon MacKay, Dr. JohnDrummond, Dr. Mason Couper, Mrs. Lennon, Dr.Wai-ter Scriver, Dr. Edmond Monaghan.

22

INCOME LEVEL OF QUEBEC POPULATION IS 100 LOW

TO PAY FOR PRIVATE INSURANCE

Our health-care system is under a microscope. As governmentwithdraws, many fear - while others look forward to - theemergence of a two-tier system in Quebec.

Two-Tier Health-Care

System Won't Work

='<,...iiiI:a.III=o3::s

The current system wasbegun with public hospi-talization insurance in1961,and a health insur-

ance plan in 1970. It is widely accessible and covers almostall medically necessary care.

Quebec health costs climbed from 8.3 per cent of provincialGDP in 1975 to 9.2 per cent in 1990, and 10.1 per cent in1994, before dropping back to 9.8 per cent in 1996. Since1994 there have been a series of government spending cutsand an optimization of resources, with an accent on ambula-tory care and less costly ways of providing services.

As a yardstick, Quebec health costs as a percentage of GDPwere higher than the Canadian averages of 9.7 per cent and9.5 percent in 1994 and 1996, and the French average of 9.7per cent in both years. However, they were lower thanAmerican averages of 13.5 per cent and 14 per cent for thesame two years.

These increases have caused even more concern given thatQuebec's population is relatively young. Citizens age 65 andover account for 12.4 per cent of the population, whereas theymake up 15.7 per cent in Great Britain and 17.4 per cent inSweden, according to 1996 statistics. It is anticipated thatnearly 18 per cent of Quebec's population will be 65 and overwithin 20 years.

Compounding the effects of an aging population are increasesin costs related to expensive new medical technologies and arise in the number of cancers, heart problems, respiratory dis-eases and chronic illnesses common to industrialized coun-tries. Quebec has had no choice but to either rationalize orabandon certain services.

One of the main avenues chosen was to develop ambulatorycare and reduce the length of hospital stays, an option madepossible by new technologies for such procedures as tonsil-lectomy, cosmetic ear surgery, hernia treatment, rhinoplastywith bone graft and so on. Day surgeries in Quebec increased

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from 154,013 in 1987 to 210,185 in 1994 and 239,335 in1997, and now represent nearly 50 percent of all operationsperformed in the province. The average short-term hospitalstay decreased from 10.3 days in 1987 to 9.7 in 1994, and8.7 in 1997.

At the same time, the Quebec government has rationalizedhospital spending by closing short-term-care beds, reducingthe ratio from 4.1 per thousand inhabitants in 1991 to 2.8per thousand in 1997, with a goal of two beds per thousandby 2000. In comparison, Ontario had a ratio of 2.5 beds perthousand in 1994.

Administrative services and medical consultations and treat-ments have also been affected and insured services, particu-larly outside Canada, have been reduced.

Generally, the private sector has stepped in to fill the gap leftby the decline in public spending.

Public spending, which accounted for 78.8 per cent of Que-bec's health-care spending in 1975, dropped to an estimated67.8 per cent of the total in 1997. Total Quebec health-carespending, both public and private, increased from $14.2 bil-lion in 1990 to $17.6 billion in 1996. This increase camelargely from private sources, private and group insuranceplans, and direct individual spending.

To date, along with prescription drugs, the private sector hasbeen called upon to finance health services not consideredmedically necessary, such as cosmetic surgery, as well as othercomplementary services such as dental, chiropractic, opto-metric and psychological care. The drug insurance plan rep-resents a new, private-sector partnership approach designedto provide coverage to all Quebecers. Reduced coverage forchildhood dental care and the decision to no longer insure eyeexaminations for 18-65 year-olds are part of the transfer ofresponsibility from the public to the private realm.

This movement has largely run its course. The forthcomingend to cutbacks will stabilize the percentage of public and pri-vate responsibility in the years ahead. In consequence, theemergence of a two-tier health-care system in both Quebecand Canada is highly unlikely.

During the National Forum on Health in 1997, Quebecers andother Canadians expressed their opposition to a system thatwould allow the wealthy to obtain privileged access to med-ically necessary services. The Canada Health Act prohibitsfees (user fees, direct payment for diagnostic services, andso on) on any of these services under penalty of ~

reduced transfer payments.

In addition, the Quebec population does not enjoy the level ofincome required to support a private health-care system.High-income earners are not legion; only 7.2 per cent, or ap-proximately 150,000 families, earn more than $100,000 and10.1 per cent of individuals, or 545,000 people, earn more than$50.000 per year, according to statistics for 1996. Available in-come is stagnating.

With hospitalization costs of $500 to $800 a day in Quebec andaround $3,000 in the United States (and up to $10,000 for spe-cialized services) the limits of a second tier are easy to see.

As a result, the biggest developments in the private sector willoccur in the area of non curative care as well as home care forthe chronically ill and the elderly, who have lost autonomy orare living alone. This extension of services should provide im-

FROM THE GENERAL SURGERY RESIDENTSAT QUEEN'S UNIVERSITY

Dr. Simon Francis George WrenMay 13, 1937 - September 10, 1998The surgery residents at Queen's University have lost a greatfriend. Dr. Simon Wren was born in London, England, in 1937and immigrated to Montreal in 1955. A graduate of McGill's

B.Se. Program in 1958 andmedical school in 1963, Dr.Wren completed his intern-ship in Vancouver before re-turning to McGill to train asa general surgeon. After aresearch fellowship at Har-vard, Dr.Wren came on staff

at Queen's in 1974, where he continued his research pursuitsin immunocyte metabolism and surgical nutrition.

Though Dr.Wren was quite proud of his McGill roots, we atQueen's are quick to claim him as our own. We were fiercelyloyal to Dr.Wren as he was unfailing in his sincere supportand encouragement towards us. He was a quiet man with asparkling, mischievous sense of humour and joy for life. Hewas an outstanding clinician and teacher and friend whosepresence was calming and always in demand. Our love forhim is deep. Our respect for him is without condition.

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mediate, personalized assistance and greater peace of mind.

New forms of assistance ranging from simple telephone-in-formation lines to intervention co-ordination in emergencysituations will emerge. Private companies will continue to of-fer alternatives to government withdrawal in certain special-ized areas, without undermining the current system .•

Claude Boivin is President and c.E.0. of Blue Cross.

Dr. Simon F.G.Wren

At some point in each ofour careers, we would beoperating with Dr. Wren,only to look up and findhim leaving the room. Thiswas his nod that you wereready to go it on your own.Simon's death on Septem-ber 10 was true to form ashe again left us quietlyand unexpectedly. How-ever, none of us were pre-pared for his exit.

Dr.Wren is survived by hiswife, Josephine, his daughter, Melissa, and a generation of sur-geons and residents from Queen's who will carry the memoryof this gentle, charming and generous man close to ourhearts. We miss him terribly .•

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Residents at Work

Courtesy Mr. Pierre Dubois - Biomedical Photographer

Audio Visual Services, MUHC - RVHPavilion.

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