On November 8, 1895, German Physics Professor Wilhelm Conrad Roent,gen (1845-1923) worked in his darkened Wurzburg laboratory. His experiments focusedon light phenomenon and other emissions generated by discharging electrical current in

highly-evacuated glass tubes. These tubes, knowngenerically as "crookes tubes'; after the British inves-tigator William Crookes (1832-1919), were widelyavailable. Roentgen was interested in cathode raysand in assessing their range outside of charged

tubes. To Roentgen's surprise, he noted that when his card-board shrouded tube was charged, an object across the roombegan to glow. This proved to be a barium platinocyanide-coded screen too far away to be reacting to the cathode raysas he understood them. We know little about the sequenceof his work over the next few days, except that while hold-ing materials between the tube and screen to test the newrays, he saw the bones of his hand clearly displayed in anoutline of flesh. It is impossible for observers accustomed tomodern imaging to gauge the mixture of wonder and dis-belief Roentgen must have felt that day. ~

(please see Radiology, pg. 5)

Radiology: Past,Present & Future

Frau Roentgen's Hand

..............................................................................-::s Radiology - Past, Present & Future~ .L~tter~ to ih~Editora.,HHHHHHHH.ID Upcoming Events H.

EditorialMUHC Appoints New Chief

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

T5DA Resident Research AwardDivision of Surgical Research

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

Trauma Research at McGillMcGill Hockey Game. .. . ...............•

Surgical EducationWere You There - 1970Neurosurgery & Sports Medicine ClinicTribute to Dr.Mulder................................KudosAchievements Residents & FellowsNew AppointmentsResignation

1 Royal College Grads 15....................... ........

2 A Navy Story 15H2 Rocke Robertson Visiting Professor 163 Sino-Canada International Surgical Conference 184 News from Chairman of Anesthesia 184 Were YouThere?· Nov. 1965 187 Heart-to-Heart in Saudia 197 Scientific Advances 20

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

8 Were YouThere? - Dec. 1965 20. ...........................................•..

10 RVH Research Lab X-mas Party 2111 Molson Medical Informatics Visiting Professor 2112 Were YouThere -1972 21

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

12 SpaceTravel- Part II 22. . ..... . .. . .. . .. ....... . . . . . . . . . .. . .. . .. . .. . .. .13 Meakins Lamb Roast 24

...............................14 In Taking Histories 25H . .......... .............•...

14 Level 1- Trauma Conference 26..................................

15 Obituaries 26......................

DEPARTMENT OF SURGERY

NEWSLETTER

McGILL UNIVERSITY

WINTER 1998

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THE SQUARE..z!a

TE RVII EMERGENCY DEPARTMENTMUST STAY OPEN

Recently, the Clinical Integration Committee (CIC) has made anumber of recommendations regarding it's mission to estab-

lish the McGill University Health Centre(MUHC). We disagree with one of these. Dur-ing the transition period, until we move into

a new single facility in 2004, the plan is that there be a sin-gle merged Emergency Room and that this adult EmergencyRoom and the related Emergency Services be situated at TheMontreal General Hospital. This would mean that the Emer-gency Department of the RVHwould be closed. When theseissues were discussed in the Jeanne Timmins Amphitheatre atthe MNH in November and when again presented by the Chair,Doctor Sarah Prichard, in the RVH JSL Browne Amphitheatreon December 8th, there was much consternation by some ofthe MNH and RVH Staff.

3ion. I do not want to use the term "institution" here as thewhole MUHC is an institution of which we all are a part.

@) It would be a dereliction of our Community and Social Re-sponsibilities to close another Emergency in Montreal atthis time.o There would be an adverse effect on the MNH. It must be

remembered that the Emergency Services of the RVH arealso those of the MNH. Dr. Andre Olivier, Neurosurgeon-in-Chief, affirms that the MNH would become the only Neuro-logical Centre in Canada without an Emergency Room. Hefears the negative implications.o Closure of the RVHEmergency Department during the 7 year

interval would toll the death knell to the RVHDepartment ofSurgery. At the RVH, 90% of admissions to Medicine and30% of those to Surgery are through the ER. In 1997, therewere 1,459 Surgical Admissions. From April 1st to October11th, 896 patients were admitted to Surgery, of which 72went directly from the ER to the MOR.

el) It would be unfair to our benefactors who donated closeto 7 million dollars towards the construction of this newEmergency.

We feel that it is better to have integrated Emergency Servicesduring the planning of the MUHC rather than a unified Emer-gency at the MGH.•

Editorial

There is no doubt that the Emergency Physicians of both theRVH and the MGH desire a single ERsite as soon as pos-sible. They desire a single department and integrated adultemergency services. When we move intothe new "superhospital" in the year 2004,then we will have a unified Emergency De-partment. The debate is whether weshould have unified emergency services inthe interim (which means the closure of anEmergency Department) or whether weshould have integrated emergency servicesuntil then.

It is our opinion that there should be seri-ous reconsideration concerning the closureof the RVH Emergency Services for the fol-lowing reasons:

o The Emergency Rooms of the RVH arenew and are "State of the Ar( as regardsAmbulance Entrance, Receiving Rooms,Triage, lObed observation area, exami-nation facilities and treatment rooms. Itis situated in a new Centennial Buildingwhich also houses other Critical Care Ar-eas.e It is a fallacy to consider that a Tertiary Care Hospital does

not need a Portal of Entry into its Health System. There is al-ways a need for Primary Care or Continuing Care to patientswho have been treated in that building or facility or pavil-

"The doctor is in court on Tuesdays and Wednesdays"- The New Yorker

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~ He plunged into seven weeks of meticulouslyplanned and executed experiments to determine the natureof the rays. He worked in isolation, telling a friend simply, "Ihave discovered something interesting, but I do not knowwhether or not my observations are correct': In fact, one won-

ders if Roentgen's experiments were asmuch to convince himself of the reality ofhis observations as to enhance the scien-tific data supporting the phenomenon.

Radiology(continued from pg.1J

On December 28, 1895, Roentgen gave his preliminary report,accompanied by experimental radiographs and by the now fa-mous image of his wife's hand. By New Year's Day, he had sentthe printed report to physicist friends across Europe. Januarysaw the world gripped by "x-ray mania'; and Roentgen ac-claimed as the discoverer of a medical miracle. Roentgen, whowon the first Nobel Prize in Physics in 1901, declined to seekpatents or proprietary claims on the x-rays, even eschewingautonomous descriptions of his discovery and its applications.

Milestones in Radiology1896: Within months following Roentgen's discovery, the first

clinical radiographs in Canada were performed in theRutherford Lab at McGill.

1913: First Plastic X-ray Film1925-1930: Angiography & The First Usable Contrast Medium1935: Canadian Association of Radiologists Formed1949: First Image Intensifier1952: First Clinical Ultrasound of Soft Tissue1964: Shoe-fitting Fluoroscopes Abandoned1969: The World's First Dedicated Chest Radiograph Machine

Installed at the Royal Victoria Hospital1970: Hounsfield & Cormack Developed Computed Tomography1973: First Canadian CT Scanner at MNI1985: First Canadian High-Field MRI at MNI

McGill - Past & PresentDoctor J. Scott Dunbar, Chairman1969-1972, an icon in PediatricRadiology, founding member ofthe Society of Pediatric Radiology.This was the first subspecialty so-ciety in Diagnostic Radiology. Dr.Dunbar and associate Dr.

7896,First X-Ray (Shoulder) Bernadette Nogrady well knowninternationally for their work in

genitourinary radiology and his now famous "crescent sign':

Dr. Robert G. Fraser, Chairman 1972-1976, consummate teacher,very active in many radiology organizations and is the founder ofthe Fleischner Society, an international and interdisciplinary groupdedicated to the study of diseases of the chest. His most signifi-

THE SQUARE...zS5

cant contribution to this field is the multi volume work Diagnosisof Diseases of the Chest, first published in 1970. This work has be-come the standard reference text in the field of pulmonary radiol-ogy and has been translated into approximately 20 languages.

Dr.Max J. Palayew, Chairman 1978-1987, a student of Dr. Ben-jamin Felson, only McGill Faculty of Medicine DepartmentChairman to be based at the Jewish General Hospital, pastPresident of the Canadian Association of Radiologists, prolificteacher of chest radiology.

Dr. Romeo Ethier, Chairman 1987-1992, stereoscopist par ex-cellence. Instrumental in obtaining Canada's first CT scanner(EMI, Electrical Musical Industries, UK).

Dr.Ross Hill 1960 -1994, Musculoskeletal Radiologist, teacher, pro-lific team-player who always represented McGill in the most hon-orable fashion possible. Past President of the Canadian Associationof Radiologists and Member of the McGill Board of Governors.

Dr. Patrice M. Bret, Chairman 1992-1997, expert in Hepato-Bil-iary and Pancreatic Imaging, recruited a team of abdominalradiologists to create a division of international repute.

Technological ExplosionThere has been, in the past threedecades, a rapid growth in the ca-pacity of physicians to "image" dis-ease. This "medical-scientificphase" of radiology began withHounsfield and Cormack's inven-tion of CT. Thus also began thetransition from analogue to digitalimaging. The modern tomographic

MRCP methods all provide sectional im-ages in one or more planes, avoid-

ing the superimposition of structures that still characterize achest radiograph. Some techniques also use computer imageprocessing but do not yield sectional data (e.g. digital subtrac-tion angiography and magnetic resonance angiography). It isimportant, nevertheless, to note that the chest radiograph isstill the most common radiological procedure.

Advanced three-dimensional imaging and new catheter tech-niques have led to the interventional radiological develop-ment. Led by Dr.Joachim Burhenne who described extractionof retained biliary stones through the t-tube tract, interven-tional radiology has matured into an important subspecialtywhich touches upon and often alters the management ofmany serious medical and surgical problems. As with surgery,the success of an interventional procedure often de- ~

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B'ginning in April 1997, th' Division of Su~i"lResearch embarked on a wide-ranging exercise to completelyrestructure the graduate program in Experimental Surgerywith a view to making it a more relevant and meaningful ex-

perience for bothnon-MD graduatestudents and oursurgical residents.

News from the Divisionof Surgical Research

Three complementary directions are being pursued. First, ex-isting courses were reviewed and are in the process of beingextensively revised or dropped completely. Second, a newlyconstituted Course Curriculum and Program Committee, underthe direction of Dr. Anie Philip, is preparing to send proposalsfor several entirely new courses, including Signal Transductionand Experimental Design and Biostatistics for Basic SurgicalScientists, to the Faculties of Medicine and Research & Grad-uate Studies for their approval. The keystone Bench-to-Bed-side course, coordinated by Dr.Pnina Brodt, has completed theinitial phase of a two-year overhaul, and will reflect a morefocused approach to presenting fundamental problems in sur-gical research, as well as an expanded section dealing withscientific writing, including the preparation of grant applica-tions. Finally, an entirely new program in Surgical Epidemiol-ogy, under the direction of Dr.John Sampalis, is being readiedfor introduction in the next academic year .

THE SQUARE

""z:5l7

Surgical Epidemiology in the Division of Surgical Research willbe a three tiered program. At the most basic level, Dr. Sam-palis has designed the course Experimental Design and Bio-statistics, alluded to earlier. This course is targeted to studentsin the graduate program pursuing basic science research, andrepresents the minimum knowledge of statistics required fora degree (MSc or PhD) in Experimental Surgery. Next, and per-haps most exciting, is a six-month diploma program in Surgi-cal Epidemiology (30 credits}, with an orientation ontechnology assessment and outcomes analysis. This programwill be offered initially only to surgical residents, especiallythose in General Surgery, who are required to complete 4 1/2clinical years of training to fulfil the requirements to sit theexamination of the American Board of Surgery. Finally, a Mas-ter's/PhD program in Surgical Epidemiology is also being read-ied to be sent for university approval next year.

The changes that are outlined above represent only a soupfonof what is to come. The transformation of the graduate pro-gram in Experimental Surgery will probably require anothertwo to three years to be completed.

Anyone who is interested in obtaining additional informationabout any of the courses or programs discussed in thisoverview is encouraged to contact myself, Dr. Anie Philip orDr. John Sampalis .•

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

Undor th, direction of Or. John Sampalis,trauma research in the Department has flourished and has

evolved into one of the topranking and successful in-jury research programs inthe world. With over twomillion dollars in research

funds and over 20 publications in high ranking journals in-cluding the Journal of Trauma, the McGill Trauma ResearchProgram could certainly be considered among the successesof our Department.

Trauma Researchat McGill

The Quebec Trauma Registry which was created, centralizedand coordinated at The Montreal General Hospital has become

the envy of all Registries. With over 15,000 patients and 85%of the 99 hospitals participating, the Trauma Registry has be-come a source of data that is being used to direct the evolu-tion of the Quebec Trauma Care System. The results of thesestudies are also having important impact on trauma care sys-tems in the rest of Canada and the world.

Funding for research is extremely sparse these days. However,despite these difficult times, the Trauma Registry has receivedcontinued funding. In addition, a study will be conducted thatwill compare pre-hospital trauma care in Montreal, QuebecCity, and Toronto. This will be the most important study ontrauma care ever conducted in Canada since it will compareall possible systems. The results of this study will provide thenecessary data to give a final answer to the ongoing debatesurrounding pre-hospital trauma care. The study will befunded by the NHRDP.•

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

~ experiences during the first six months of our pro-gram. Others will be encouraged to develop their computerskills and use cutting edge educational methodology toteach the Principles of Surgery.

RESEARCH IN SURGICAL EDUCATIONThe search committee has completed its interview with PhDcandidates. Once the Division Director is named, he or she willhelp choose the person to head the research arm of the newdivision. This person will be identified in the next issue of theKnot along with the areas of research McGill's team will pursue.

THE SQUARE

""zS11

H. ROCKE ROBERTSON VISITING PROFESSOR IN TRAUMASURGERYCongratulations to all the residents who presented cases dur-ing the 3rd Annual H. Rocke Robertson Day on Jan 22, 1998,Canada's only Trauma Visiting Professor Day.The quality of thetalks was excellent and talks were given by residents from allsurgical specialties .•

Core Surgery: Principles of Surgery Learning ProgramMCGILL UNIVERSITY, DEPARTMENT OF SURGERY

SUMMERBREAK

3wks 6wks 4wks

SURGICAL SKILLS

SUMMERBREAK

Good .Quick .Cheap ..

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

·

····

The three best attributes of a projectis that it be a good project, quicklydone and cheap. But there is adilemma:

Were You

There? 1970Official Opening

of MammographyClinic - RVH

Good and QuickGood and CheapQuick and Cheap

Not CheapNot QuickNot Good

EDM

{..(It. to rt.) Dr.Frank Grainger looks on as Dr.Rolla Wilson points out

an interesting finding in an X-ray film to Dr.Henry Shibata.

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D.Jeffrey Bark." hasbeen named a Member of the Conseil d'e-valuation des technologies de la sante duQuebec on the recommendation of the

Ministre de la Sante etKUDOS!! des Services sociaux.

Dr. Ray Chiu hasbeen elected to the Canadian Institute ofAcademic Medicine, and appointed tothe Editorial Board of the Journal ofTho-racic and Cardiovascular Surgery. He wasan invited speaker at a symposium on"What's New and Innovative in Cardio-thoracic Surgery" in Minneapolis, USA onOctober 25th, 1997; an invited lecturerat the International Symposium on theManagement of Patients with End-stageHeart Failure at King Fahad Hospital,Riyadh, Saudi Arabia on December 3rdand 4th, 1997; and a guest lecturer atthe Asian Pacific Congress of the Inter-national College of Surgeons in Taipei,Taiwan on December 14th, 1997. At thattime, he also served as a Visiting Profes-sor at Chang Gung Memorial MedicalCenter in Kaoshiung, Taiwan, assistingthem in setting up the Master of ScienceProgram for Surgical Research headed byone of his previous research fellows,Dr. George Chuang.

Dr. Nicolas V. Christou and his wifeKatina visited Vancouver and Whistlerfrom November 25th to 30th. The reasonfor this trip is that Nick was the Royal Col-lege Visiting Professor at the UBCDepart-ment of Surgery 13th Annual SurgicalUpdate on Sepsis in Surgery. Their visitwas hosted by Drs. Richard Finley andNis Schmidt. He gave three addresses:1) The Delayed Type Hypersensitivity Re-sponse in Surgery: What Have We Learnedin 25 Years?; 2) How Sepsis Affects HostDefense; and 3) Host Defense Mechanismsin Surgical Patients: Friend or Foe?

Drs. Helele Flageole and Jean-MartinLaberge in collaboration with Dr. BrunoPiedboeuf from Quebec City were suc-cessful in obtaining a three year MRCGrant for their research on Temporary Fe-tal Tracheal Occlusion to Treat Diaphrag-matic Hernia.

Dr. Peter Goldberg, Associate Physicianat the RVH and Associate Professor ofMedicine at McGill, has been appointedDirector of the Intensive Care Service atthe RVHeffective November 1, 1997.

Dr. Jean-Martin Laberge presented apaper at the Canadian Association of Pe-diatric Surgeons meeting entitled Prena-tal Diagnosis of Congenital CysticAdenomatoid Lung Malformations: TheCanadian Experience. He was also a Visit-ing Professor to the Schneider Children'sHospital, Long Island Jewish Medical Cen-ter to Dr. Pena's course on "The SurgicalTreatment of Anorectal Malformations"from Movember 17-19, 1997. The title ofhis lecture was The Anterior Sagittal Ap-proach for Imperforate Anus Repair.

Dr. Jonathan Meakins was the 1998Jonathan E. Rhoads Lecturer. The title ofhis lecture was Host Defense, Infection &

THE SQUARE...z

~

13

Nutrition: Yesterday, Today & Tomorrow.

Dr. John Sampalis has received a fiveyear salary support Medical ScientistAward from the Medical Research Councilof Canada. He was also awarded anNHRDPScholar's Grant which he declinedin favour of the MRC. Also under his su-pervision, Dr.Toni Ferrario and Dr.AndreasNikolis presented papers at recent meet-ings of the American Association for theSurgery ofTrauma and the Trauma Asso-ciation of Canada at the annual Royal Col-lege meeting.

Dr. Adi Yoskovitch presented a paperentitled Cystic Thyroid Lesions in Childrenat the Canadian Association of PediatricSurgeons meeting in Banff in October1997 with Dr. Jean-Martin Laberge asthe senior author. The paper was ac-cepted for publication in the Journal ofPediatric Surgery .•

MGH RESEARCH INSTITUTE 1997 AWARDSThe MGH Research Institute, one of the largest in Canada, presented its awards for 1997

at the Saint-James Club as follows:

Arsenault, Denise Urology The MGH 175th Anniversary FellowshipChevrette, Mario Urology Simone and Morris Fast Award in OncologyEvans, David C. Surgery Alan G. Thompson Fellowship in SurgeryFried, Gerald Surgery The Florenz Steinberg Bernstein

& David Bernstein AwardGuy, Pierre Ortho Surgery The MGH 175th Anniversary FellowshipHarvey, Edward Ortho Surgery Simone and Morris Fast Award in OncologyJohnston, Karen Neurosurgery The MGH 175th Anniversary FellowshipLi, Maria Neurosurgery Frank McGill Travel FellowshipNguyen, Dao Surgery Hartland Molson Fellowship

& Herbert S. Lang AwardTanguay, Simon Urology Simone and Morris Fast Award in OncologyRosenberg, Lawrence Surgery Nesbitt-McMaster Award for Excellence

in Medicine and Surgery

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RESIGNATION OFDR.PIERREDUPUISAS PRIJ.

GRAM DIREaOR AND APPOINTMENT OF NEW PROGRAM

DIREaOR

Dr. Pierre Dupuis stepped down as Program Director, Divisionof Orthopaedic Surgery, McGillUniversity at the end of the year1997.Resignation of

Dr. Pierre DupuisI would like to take the opportu-

nity to personally thank Dr. Dupuis on behalf of the Divisionfor his great commitment, his enthusiasm for the teaching andthe changes which he brought into the program for the well

This is the transcript of an ACTUAL radioconversation of a US naval ship with Cana-dian authorities off the coast of New-

foundland in October 1995. Radio conversation released bythe Chief of Naval Operations 10-10-95.

A Navy Storyo

\Ii

!I

Americans: Please divert your course 15 degrees to theNorth to avoid a collision.

Canadians: Recommend you divert YOUR course 15 degreesto the South to avoid a collision.

Americans: This is the Captain of a US Navy ship. I sayagain, divert YOUR course.

Canadians: No. I say again, you divert YOUR course.Americans: THIS IS THE AIRCRAFT CARRIER USS LINCOLN,

THE SECOND LARGEST SHIP IN THE UNITEDSTATESATLANTIC FLEET.WE ARE ACCOMPANIEDBY THREE DESTROYERS,THREE CRUISERS ANDNUMEROUS SUPPORTVESSELS. I DEMAND THATYOU CHANGEYOURCOURSE15 DEGREESNORTH,THAT'S ONE FIVE DEGREESNORTH,OR COUNTER-MEASURES WILL BE UNDERTAKEN TO ENSURETHE SAFETY OF THIS SHIP.

Canadians: This is a Light House.EDM

THE SQUARE..z~15

being of the residents and the Division. We know that he con-tinues to consider resident teaching as one of the most nobleduties of an academic surgeon.

Effective January 1, 1998, the new Program Director will be Dr.Michael Tanzer, Associate Professor in the Division of Or-thopaedic Surgery at McGill and Deputy Chief, Department ofOrthopaedics at The Montreal General Hospital. He can be as-sured of all the necessary support he will need for this de-manding task .•

Dr.Max Aebi,

Professor & Chairman,

McGill Division of Orthopaedic Surgery.

CONGRATULATIONS

The following passed the qualifying examsof the Royal College of Physicians and Surgeonsof Canada in 1997 for the following Surgical Specialties

GENERAL SURGERYDr. Mohammed A.H. AI-Zahrani, Dr. Sarah Bouchard,

Dr. Stephanie Elizabeth Helmer, Dr. Brian Douglas Mott,Dr. Zafer Mohammed Rasim, Dr. Sadeesh Kumar Srinathan,

Dr. Sameer A. Softa

CARDIOTHORACIC SURGERYDr. Renzo Cecere, Dr. Gary Chris Salasidis

NEUROSURGERYDr. Laura Susan Pare

ORTHOPEDIC SURGERYDr. Salem Awwad T. AI-Shammari, Dr. John Antoniou,Dr. Ram Prasad Aribindi, Dr. Mark Lewis Burman,

Dr. Paramjeet Singh Gill, Dr. Jonathan Daniel Glassman,Dr. Delphine France Glorieux, Dr. Khalid Farouk Jamjoom

PLASTIC SURGERYDr. Ezat Hashim, Dr. Stephen Costas Nicolaidis,

Dr. Mitchell Andrew Stotland

UROLOGYDr. Gianpaolo Capolicchio, Dr. Joseph Jonah Itovitch,

Dr. Duc Sieu Ngo, Dr. Richard Sioufi

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THE SQUARE...:z5l

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LIII

ooking down from the podium, I suddenly saw a fa-

miliar face. I was not expecting to find someone I know since

I was giving an invited lecture on Surgical Therapy for Heart

Failure at the King Fahad National Guard Hospital in Riyadh,

Saudi Arabia. I

looked at him

again and rec-

ognized that he

was Ghassan Baslaim, our recent graduate of the McGill Car-

diothoracic Surgical Residency Program. Ghassan just re-

turned to Saudi a few months ago following seven and a half

years of residency training at McGill, both in General Surgery

and Cardiothoracic Surgery. He was universally liked and ap-

preciated as a gentleman and a competent resident. He was

pleased to see me again and told me that he came

to Riyadh looking for a staff position in Cardiac

Surgery. He was undergoing a trial period at the

King Faisal Specialist Hospital and Research Centre

in Riyadh, one of the major cardiac centers in the

Kingdom of Saudi Arabia. It turned out that the

Chief of Cardiac Surgery in this hospital, Dr. Zohair

AI-Halees, and I had met before at another meeting

in Nice, France as we share interest in an experi-

mental procedure known as "Dynamic Cardiomy-

oplasty for Heart Failure" Dr. AI-Halees is a leading

congenital heart surgeon in that region, performing

more than 500 congenital heart operations yearly.

I had the opportunity to tell him how we felt about

Ghassan at McGill and that he could become a valu-

able member of his team. I was therefore very

pleased that after a few weeks following my return

to Montreal, I received a letter from Dr. AI-Halees

stating that Ghassan had been officially appointed

to the staff of that institution.

Heart-to-Heart in Saudia

While in Riyadh, I was also able to introduce Ghassan

to Dr.Alex Bayes, the Head of the Cardiac Surgery Ser-

vice at the King Fahad Hospital. Alex is another true

gentleman who finished training in Cardiovascular

and Thoracic Surgery at McGill University in 1985. I

was happy to see these two McGill graduates suc-

cessful and contributing to the care of cardiac surgery

patients in Saudi Arabia.

Talking about Alex, he told me an interesting story af-

ter his chief, Dr. Rod Landymore, who was the Chief

of Cardiac Surgery at the University of Nova Scotia,

THE SQUARE...:z

~

19

took me on a tour to the Bedouin camp in the outskirts of

Riyadh. It was spectacular to see thousands of camels and the

tents of the nomads scattered among them over many square

miles of desert land. Alex said last year he took his youngest

daughter, who was visiting from Calgary, to see these camels.

He was asked whether his attractive 17 year old daughter was

married, and when he replied that she was single, he was of-

fered two camels for her. He said he was very disappointed this

year when he brought his two older daughters there and got

no offers. Alex and his wife would not answer my question

whether he ever accepted the previous offer.

These delightful and capable graduates are our ambassadors

to the world, and represent the deep international commit-

ments of McGill University, and an important heritage of our

Department. •

Ray c.-J. Chiu, M.D., Ph.D.Chairman, Division of Cardiothoraci( Surgery

I

Dr. Chiu and Dr. Bas/aim

Dr.Bas/aim with one of his patients.

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~~~~"'\CTO.,

" ..."~...0Ji~il. "JJ!:"jJ

,i\j~'c..'r,v·\Royal Victoria Hospital Research Laboratories

Christmas Party, December 5th, 1997

Bottom row Lt. to Rt.: Dr. Peter Metrakos, Ziba Aalamanian, Dr.Jeff Barkun, Dr. Nick Christou, Louise Chartrand,Dr.Jean Tchervenkov,Dr.Nancy Morin.

Toprow Lt. to Rt.: Myriam Fernandez, Diane Cunningham, Dr.Andrew Seely,Dr.Jose Pires,Dr.Jonathan Fridell,Marie Monaghan, Betty Giannias, Dr.Shuqing Liu, Mary Bouldadakis, Dr.Xuwu Chen

Were You There? 1972 Practical Surgery

of the Hand September 11-15, 1972

About one hundred Surgeons from many states and

Canada took part in a 5-Day Course on Practical Surgery

of the Hand with the object of updating their knowledge

in this important field. The Chairman of the Course was

Dr. Martin A. Entin, Surgeon-in-Charge, Plastic Surgery,

RVH. A distinguished faculty of international authorities

on Surgery of the Hand presented latest developments in

the treatment of injuries of tendons and nerves, recon-

struction of deformities due to arthritis, Dupuytren's Con-

tracture, etc. A program was arranged for the wives of

the doctors attending this course to show them places of

interest in Montreal and the Laurentians.

THE SQUARE

"":z~

21

The First

Molson Medical

Informatics

Visiting Professor

DAVID M. KAUFMAN, Ed.D.,DALHOUSIE UNIVERSITYNovember 27-28, 1997Hosted by Dr. David M. Fleiszer, Dr.Kaufman presented two lectures in the

Meakins Amphitheatre. The first was enti-

tled Overcoming Obstacles in Medical Edu-cation: The Role of Medical Informatics. The

second address was entitled Virtual Realityin Higher Education .•

David M. Kaufman

(It. to rt.) Drs. Raoul Tubiana, Paris, France; Harold Kleinert, Louisville, Kentucky;Martin Entin, Erik Moberg, Giitenborg, Sweden; Alfred Swanson, Grand Rapids,Michigan. Not present for this photograph was Paul Brand of Carville, Louisiana.

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~ either in the pockets of one of the medical kits, sim-ilar to those of a paramedic, or with special straps of eitherVelcro or elastic. Sterile instruments are usually left in steril-ized kits until needed and can be tucked back into the sterilekit when not in use. Preparation of a sterile field may be per-formed with self-adhesive drapes and topical betadine.

As in terrestrial surgery, adequate pain control, visualizationand hemostasis are critical determinants of success in themanagement of a surgical emergency. Local anesthetics andregional blocks are performed whenever possible for pain con-trol during a procedure. In the shuttle program there is no ca-pability for the administration of a general anesthetic, anysituation requiring this capability would result in an immedi-ate return to earth. Intraperitoneal or intramuscularly admin-istered general anesthetics have been used successfully foranimal surgery in space with no apparent need to alter thedose administered to produce anesthesia.

Hemostasis may be achieved with direct pressure quite eas-ily. In microgravity, capillary and venous bleeding forms acollection of blood adherent to the skin/tissue surface byvirtue of the surface tension of a liquid, prior to formation ofa clot. Arterial bleeding may result in droplets of blood de-parting the wound site which may travel significant dis-tances until they impact upon a firm surface. As in terrestrialsurgery, hemostasis in space may be problematic. Indeed,epistaxis can present significant problems both with the con-trol of bleeding as well as contamination of the spacecraft ifthe patient and CMO are not careful.

Wound repair may be undertaken with the use of tissue ad-hesives such as Histoacryl or conventional repair with suturesor staples. On STS-90, we will be using a tissue adhesive forwound closure in the first survival surgery done on animalsin space. The primary advantage is ease and rapidity of use,compared to the time required to suture or staple the woundin microgravity.

Instrument control, particularly the management of "sharps"is critical in preventing injuries when working inside a closedglovebox or surgical isolation chamber with another operator.Unrestrained sharps present a potential hazard and it is im-portant for both operators to maintain situational awarenessthroughout a procedure. I have had the opportunity to per-form a number of surgical procedures on animals in micro-gravity aboard the KC-13S, the most complex of which was alaminectomy in rats, and have found that the feel of the in-struments and tissues is the same as in terrestrial surgery. Itwill be interesting to see if this changes in space as there issome evidence to suggest alterations in proprioception and

THE SQUARE

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23

other sensory/motor changes that take place in astronautsduring space flight.

Performing a surgical procedure inside the general purposeworkstation (GPWS), the glovebox we will be using aboardSTS-90, makes tissue visualization more difficult and has atendency to make the operator feel remote as the procedureis often accomplished at an arms length. We use magnifyinglou pes to enhance visualization of the operative field whenperforming detailed dissections and have been successful inperforming complex procedures with minimal difficulty.

There are many exciting developments that will take place inmedical and surgical practice to support the human explo-ration of space. Novel non-invasive diagnostic techniques willplay an important role as will diagnostic and therapeutictelemedicine. Surgical simulators and remote teleroboticsurgery offer tremendous promise in both terrestrial and spacemedicine. Canada is uniquely positioned to offer a number ofinnovative technologic solutions to some of these problems insupport of the space station program and further human ex-ploration of this remaining frontier.

During a space flight, members of the crew are given the op-portunity to bring a small number of items with them. I willbe bringing items from the Montreal Neurological Instituteand the McGill Faculty of Medicine. I am looking forward toreturning them to McGill and sharing the excitement of themission with the McGill community after the mission. Withoutthe excellent training that I received at McGill as an under-graduate, graduate and medical student, I would not have hadthe fortunate opportunity to participate in such a mission.

Editor's Note:The Square Knot wishes him well in this intrepid space adven-ture. We are looking forward to further reports from him .•

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T following quotes were taken from a«ual med-ical records as dictated by physicians:

Taking Histories ...

~ By the time he was admitted, his rapid heart had stopped,and he was feeling better.

~ Patient has chest pain if she lies on her left side for over a year.

~ On the second day the knee was better and on the thirdday it had completely disappeared.

~ She has had no rigors or shaking chills, but her husbandstates she was very hot in bed last night.

~ The patient has been depressed ever since she began see-ing me in 1983.

~ Patient was released to outpatient department withoutdressing.

~ I have suggested that he loosen his pants before standing,and then, when he stands with the help of his wife, theyshould fall to the floor.

~ The patient is tearful and crying constantly. She also ap-pears to be depressed.

~ Discharge status: Alive but without permission.

~ The patient will need disposition, and therefore we will getDr. Blank to dispose of him.

~ Healthy appearing decrepit 69 year old male, mentallyalert but forgetful.

THE SQUARE..z!:l

25~ The patient refused an autopsy.

~ The patient has no past history of suicides.

~ The patient expired on the floor uneventfully.

~ Patient has left his white blood cells at another hospital.

~ The patient's past medical history has been remarkably in-significant with only a 40 pound weight gain in the pastthree days.

~ She slipped on the ice and apparently her legs went in sep-arate directions in early December.

~ The patient experienced sudden onset of severe shortnessof breath with a picture of acute pulmonary edema athome while having sex which gradually deteriorated in theemergency room.

~ The patient had waffles for breakfast and anorexia for lunch.

~ Between you and me, we ought to be able to get this ladypregnant.

~ The patient was in his usual state of good health until hisairplane ran out of gas and crashed.

~ Since she can't get pregnant with her husband, I thoughtyou would like to work her up.

~ She is numb from her toes down.

~ While in the ER,she was examined, X-rated and sent home.

~ The skin was moist and dry.

~ Occasional, constant, infrequent headaches.

~ Coming from Detroit, this man has no children.

~ Patient was alert and unresponsive.

~ When she fainted, her eyes rolled around the room.

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

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Tie one onfor McGill!

THE SQUARE

""z:5l

TheMcGill Department of Surgery invites you to tie one on for the old school!TheMcGill blue silk tie and scarf with CREST,SQUAREKNOTand FLEAMare available for purchase from the Alumni Office as follows:

McGill Dept. of Surgery Alumni, Montreal General Hospital

1650 Cedar Avenue, Room C9 126, Montreal (Quebec) H3G 1A4

Telephone: (514) 937-6011, ext. 2028

Fax: (514) 937-5522

Please send me the McGill Department of Surgery Tie or Scarf.

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Costs:

Tie $50.00

Taxes ore includedQty:

Scarf $95.00

Taxes are includedQty:

Address .

Postage and Handling add $200 per item

City Province .

Country Postal Code .

Telephone: ( ) .

Method of payment (Please check one)

o Cheque 0 Money order

Total

Total

Total .

L ~

We can't do itwithout you !

THE SQUARE::II:::zo.....~

E.D. Monaghan, M.D.Editor

Emma LisiAssistant Editor

Marie M. CimonCopy Editor

The Audio VisualDepartment ofThe MontrealGeneral HospitalDesign & Layout

Les Servicesgraphiques, P.R.Printing

All photographscourtesy of The McGillSurgery Department

McGILL SURGERYALUMNI& FRIENDSContributions of $40.00 are appreciatedin ensuring the continued publicationof "The Square Knot" and supporting McGillSurgery Alumni activities. Pleasemakecheque payable to the McGill Departmentof Surgery and forward to Maria Bikas,McGill Surgery Alumni & Friends,TheMontreal General Hospital,1650 CedarAvenue, Room: C9169,Montreal (Quebec)CanadaH3G1A4Telephone: (514) 937-6011,ext.:2028Fax: (514) 937-5522.

Write to us ! Send us your news !We want to hear from our readers!

If you have any information you want published inTHE SQUARE KNOT, comments about our newsletter

or suggestions, we want to hear from you!Send submissions to:

E.D. Monaghan, M.D.. Editor' THE SQUAREKNOT' The Royal Victoria Hospital687 Pine Ave.W, Room: S10.26· Montreal, Quebec' Canada' H3A 1A1

CALLUS at: (514) 843-1600 FAXUS at: (514) 843-1503E-MAIL USatmbikas@is.mgh.mcgill.ca

VISIT OURWEB SITE: http://www.mcgill.ca/surgery

MOVING?If you change your address,or if you knowsomeone who would like to receive thisnewsletter, please drop us a line.

Sponsors of the McGill Department of Surgery

1I11..~11J·Auto Suture Company, CanadaA Subsidiary of United States Surgical Corporation

a ETHICON ENDO-SURGERY~ a ~crn.¥'\..14'Ielt company

., MERCK FROSST SHERWOODDAVIS&GECK