MUHC PROJECT: AN INlfffTMENT FOR TODAYAND THE NEXT GENERATIONMcGill and the MUHC are committed to the creation of a new medical paradigm

for this city

-Bernard Shapiro, Principal & Vice-Chancellor, McGill University

-David Culver, Chairman, McGill University Health Centre (MUHC)

In working towards the creation of a new McGill UniversityMUHe Project Health Centre facility, the MUHC and McGill share a com-

monality of vision. The goal is a hospital that will deliver thevery best quality of patient healthcare imaginable. The

byproduct is the ability to attract and retain the brightest and most highly-trained medicaltalent to staff the hospital, to teach and to conduct research. ~

(please see MUHC Project, pg.6)

DEPARTMENT OF SURGERY

NEWSLETTER

McGILL UNIVERSITY..............................................................................17

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WINTER 2001

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24Or Rp, A. Brown 25

Dear Editor,We were saddened to hear of the deathof John Gutelius on December 4, 2000.Our sympathies go out to Betty and theirchildren. John was Chief Resident inSurgery when we were junior, middle, orsenior assistant residents in 1960-66. He

was a junior staffmember of theDepartment ofSurgery during thetime we were com-

pleting the various stages of our training.

? Lettersto The Editor

John was a role model for us and manyother surgical trainees of the nineteensixty era at the Vic. He was a superb sur-

geon and gifted teacher. Hehad integrated the bestqualities of his mentorsLuke and McCorriston, hisexperience at Hopkins as asurgical fellow and his inter-pretation of a rapidly ex-panding surgical literature.He was always up to date.In retrospect, it is clear thathe inherently understood

Dr.John Gutelius and practiced "evidencebased surgery" long before

the concept had a name and becamefashionable. We can say the same about"surgical outcome measurements': Earlyin his practice, he reviewed Dr. Luke'speripheral vascular cases to compare re-sults between Dacron and vein grafts, di-abetics and non-diabetics andhypertensives and non-hypertensives.These outcome studies guided his (andDr. Luke's) practice accordingly.

He was very conscious of the teachingobligations of all academic staff. We canrecall humorous stories of how John,while he was still Chief Resident, deliv-ered a message to staff surgeons who"swiped" ward cases. In a polite but firmstrategy, one senior surgeon learnedabout the power of assistants, John andall senior assistant residents who werefree scrubbed in on the case. Junior res-

idents packed the operating room feign-ing interest. The senior surgeon foundhardly any elbow room to do the case.From this time on, staff operated on wardpatients only by invitation.

Perhaps the characteristic of John's thatwe most respected was his life long loy-alty to the colleagues and residents headmired and to the institutions heserved. If you needed counsel, you notonly had the opportunity to turn to John,he expected you to do so. He in turn ex-pected that his academic colleagues whoknew you would also be ready to help. AsChair at another institution, John insisted,despite opposition, that his staff shouldtreat an older colleague with the respecthe deserved from his past performance.John had this type of loyalty ingrained inhis personality. As residents and juniorstaff, we all knew that those deserving ofsupport could count on John Gutelius.

John left McGill to accept prominent po-sitions at two other Canadian MedicalSchools. He continued to contribute andhis work and leadership benefited manymore students, residents and colleagues.Others will write about these years. Wewish to remember the life of JohnGutelius during the early part of his ca-reer and what he meant to us duringthose years - a superb surgeon, a greatteacher and mentor, and a loyal friend.

John Duff, M.D. Peter McLean, M.D.Jim Mackenzie, M.D. EdMonaghan, M.D.Nelson Mitchell, M.D.

(Editor's Note: Please also see Obituary).

Dear Editor,It was with a great deal of sadness andfeeling of personal loss that I learned ofthe passing of John Gutelius.

My relationship with him began in 1962when I was one of a small group that be-gan the first Student Curriculum Com-

THE SQUARE..z!:!2

mittee in the Faculty of Medicine atMcGill. He served as our "Guidance Coun-sellor" and it was he, more than anyoneelse, that led me to choose a career inGeneral Surgery. I remember well in themid '60's, he was one of a group at McGilland RVH which we, as students, referredto as the "Young Turks" which includedDrs. Bernie Cooper and Skip Sheldonamongst others. They believed in a newand, at that time, radical approach toteaching and research based on small in-formal groups and a lot of personal con-tact rather than the traditionalimpersonal class lectures. John was botha mentor and, in later years, a close friend.He had that unique ability to commandrespect and serve as a role model yet atthe same time make you feel that youwere indeed an equal. He was always ona first-name basis with every residentand student and he was always stimulat-ing residents to challenge the traditionalways of doing things.

He had a unique flair and joie de vivreand was always a classy gentleman. I canremember in the residency years the feel-ing of having "arrived" when at the RoyalCollege or American College of SurgeonsAnnual Meeting you would be included inJohn's RVHdinners at the best restaurantstransported by a stretch limo! Thosememories linger on and were typical ofthe acts which led to the close friendshipswhich John seemed to develop withthose around him.

Even after he left McGill to go toSaskatchewan he would never fail to"keep in touch'; inquire on one's careerprogress. He was always in the audienceat the Surgical Forum or College Meetingwhen I presented a paper with his usualunsolicited but always amusing advice onhow to proceed further.

John was a master surgeon both in Generaland Vascularsurgery, a superb program

(continued on pg. 5) ~

NURSE ASSISTANTS IN THEOPERATINGROOM:An Old Possibility Becomes a New Reality

Last December, the Quebec Government passed a resolutionmodifying certain aspects of The Medical Act,thereby allowing nurses to act as First Assis-tants in Operating Rooms. Henceforth, theywill be allowed to do skin sutures, hold retrac-tors, ligate vessels, manipulate laparoscopes

and accomplish any technical or clinical act according to thetype of intervention under the supervision of the Surgeon.

Editorial

There is ample evidence in the surgical literature that thesenurses can become quite proficient. The President of the Que-bec Order of Nurses, Mme. Gyslaine Desrosiers bemoans thefact that it took the government 8 years to adopt this regula-tion. She affirms that, at present, there are 2,217 nurses whowork in peri-operative care in the Province and 50 have ob-tained their certificates in OR assistance from the Universitedu Quebec in Three Rivers. There are currently 40 more intraining in this program, which has been in place since 1996.

There is, however, concern from the Federation of Medical Res-idents of Quebec that this new law will adversely affect theirtraining. Dr.Jean-Fran~ois Cailher, President of the FMRQ,wor-ries that these nurses will essentially, by replacing them, di-lute their operative experience. In other words, perhapsnursing First Assistants should be concentrated in non-Uni-versity Health Centres leaving Residents to do the assisting inUniversity Teaching Hospitals. In addition, Residents do morethan first assist in the OR. They are integral members of theSurgical Team throughout the entire course of the patient inand out of the hospital.

"Not to worry!" affirms Dr.Adrien Dandavino, Director of Med-ical Studies of the Quebec College of Physicians and Surgeons.The College has asked the four Post-Grad Deans to ensure thatResidents have priority in the OR. Even though resident num-bers have decreased markedly in the past decade (there arenow approximately 337 registered in Post-Graduate SurgicalSpecialty Programs) in the four Faculties of Medicine in Que-bec, we must assure that the advent of these OR nurse assis-tants does not diminish the quality of the learning experiencesof our Residents.

To achieve this end, a new committee has been set up atMcGill to plan this co-ordination. The committee consists ofSurgeons and Nurses from all our hospitals.

THE SQUARE1!:l~3

We have certainly seen progress in the evolution of capabili-ties and responsibilities of the nursing profession in the past25 years. Just think of Neonatology, Critical Care,the SICUandthe Recovery Room, Triage in the ER,and in Obstetrics. So thespecialization of nurses as First Assistants in the ORshould bewelcome news as long as there can be proper integration withour residents .•

"I'm sorry. Thedoctor no longer makes phone calls."- The New Yorker

........................................................Upcoming EventsFebruarv.. Zl-22, 2001McGill General Surgery DayDr. Andre Duranceau, Visiting ProfessorThe debate format will be used to discuss controversialsubjects in General Surgery with prizes going to the winners.

March 14-15,2001Cedars Cancer Institute Visiting Professor in Surgical OncologyDr. Stimson Shantz, Head and Neck Service,Memorial Sloan-Kettering Cancer Institute

May 10, 2001Fraser Gurd Day

May 31 - June 1,2001Stikeman Visiting ProfessorshipDr. Peter K. Smith, Professor of Surgery, Duke University

September 6-9, 2001Canadian Surgery Forum,Quebec City• Canadian Association of General Surgeons• Canadian Society of Colon and Rectal Surgeons• Canadian Association of Thoracic Surgeons

Chairman's Message- By Jonathan L.Meakins, M.D.,D.Sc.,F.R.C.S.C.,F.A.C.S.

E NEED THE NEW FACILITY TO ENSUREEXCELLENT TEACHING AND CLINICAL CARETwo of the most compelling reasons for us to embrace theMUHCGlen project are teaching and clinical care. We must en-sure that they remain, not just at their current exceptional stan-dard, but that their levels of excellence continue to expand.

Clinically, of course, we already do verywell. Our medicine is highly sub-special-ized and delivered exceptionally everyday in the face of enormous human, fis-cal, physical and medical resource limita-tions and challenges. Indeed, thesespecializations and restrictions haveforced us to avoid duplication of man-power and services by locating some in-tellectual expertise on one site,equipment on another and client baseonstill another. It gets to be confusing forthe whole medical team - people whoare not ill or incapacitated. Imagine how

disorienting it could be for patients. And imagine how muchmore effective our services will be on one site when doctorscan confer easily together, patients don't have to travel be-tween clinics and assessments and technology is also nearby.

Dr.Jonathan L. Meakins

Let me illustrate this point even more clearly.Recently, the highly-skilled surgical team at theMontreal General Hospital site - after practis-ing the procedure for more than four months -removed a kidney from one patient using themost unusual and non-invasive technique oflaparoscopy (surgery via very small incisions).The organ was then flushed, packed in ice andcarted unceremoniously through Montrealstreets to a waiting patient at the RoyalVictoriaHospital site, where it was inserted most suc-cessfully. The donor and recipient, by the way,are husband and wife. What a success.What atribute to collaboration. What a complex andexhausting exercise that will be immeasurablyreduced when we all are on one site.

I have visitedother medical facilities

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From a teaching point of view also, this move is a must. It isimperative to maintain McGill's superior standing as a med-ical school. Our graduating residents are in high demand ex-actly because we have designed their education to integrateclinical excellence and to develop doctors who can truly lookafter patients. We are in the enviable - and fun - position ofhaving other institutions chasing our "product" precisely be-cause we know what makes a first-rate physician. Equallyimportant is our need to recruit, and retain our own stu-dents. The idea of a first-rate facility, modern equipment,large operating rooms, wide corridors, top quality researchlabs and fertile professional stimulation are all tremendousdrawing cards when the graduates are choosing where tosettle. I have complete confidence that we have the re-sources within the next generation of MUHC practitioners tosustain a new plant. I just want to make sure they are en-ticed enough to stay.

We are already in the transition phase of merging a varietyof units. It has required, and will continue to require the good-will and intellectual energy of all concerned to harness mul-tiple medical cultures, skillsets, visions and protocols. But ifthis difficult period has taught us nothing else, it has rein-forced how important it is to design a final facility from theground up. Renovation is no good. Trying to reshape an oldspace is an exercise in frustration; just ask the MGH peoplewho are living through the ICU 'upgrade' and the nightmareof structural incompatibilities. The positive side, of course, isthat once we are finished this difficult period we will have animproved area and that having made these changes, we knowexactly what we want in the new building. And we will beeven less willing to continue under compromised conditionsin the future. As part of the planning task forces, I have vis-

ited other medical facilities that have gonethrough - or are going through - similar archi-tectural experiences and the consensus is unan-imous: don't renovate .....build afresh. No matterwhich prism you examine it from - patient flow,infection control, cost, anticipated clinical needs,medical standards, technology, education, hu-man ambience .....the answer is always: "designfrom square one':

that have gone through -

or are going through -

similar architectural

experiences and

the consensus

is unanimous:

don't renovate ..... build

afresh.

It would be a lot easier to stay put. Although Ihave supported the idea of this reorganizationfor more than fifteen years now, I am a creatureof habit just like most people and I certainly un-derstand the resistance to the merger. I wouldhave been more comfortable staying only at theRoyal Victoria among the people and systemswhere I was known. But it has been ~

4

~ important to split my time between the two sites ofthe RVHand the Montreal General in order to assessthe sur-gical management issues and to expedite some of the moredifficult transition details. And now I would be happy to avoidanother move in a few years.Of course it's easier to do nothing.But to relocate on the Glen site is definitely the right thing todo. So I'll do it. It sounds dramatic but I think it's simple; ifwe stay put we're going to die. We must always strive not just

THE SQUARE""z~

to maintain the status quo but to pursue the very highest lev-els excellence in delivering patient care, teaching and re-search. The planning projections describe the new and ultramodern facility as a place where we can do that. The rest willbe up to the next generation; but let's leave them in goodshape for the future .•

H:\MUHCF\COMMUNICATlONS\The Gazette\Meakins.dec.doc

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MUHCSurgical ServicesManagement Committee

This is a new Committee which Dr.Meakins has set up to dealwith surgical issues across sites. It will not replace the currentcommittees established on each site: The Pavilion Manage-ment Committee at the RVHand the Surgical Advisory Com-mittee at the MGH. These will continue to deal with

site-specific issues,but will meet quarterly instead of monthly.

Committee members include:

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

Dr. J.L. Meakins, Chair Dr. M. Elhilali Dr. J.-E. Morin

Dr. S. Backman Dr. G. Fried Dr. D. Mulder

Dr. H. Brown Dr. E. Harvey Dr. D. Roy

Dr. M. Burnier/Dr. F. Cod ere Dr. A. Katsarkas Dr. 1. Tulandi

Dr. F. Carli Ms. S. Lanctot, R.N. Dr. M. Tanzer

Dr. N. Christou Dr. R. Lewis Dr. B. Williams

Ms. C. Doray, R.N. Dr. P. Metrakos

(continued from pg.2)

director, guidance counsellor, andgood friend.

My sincere condolences to Betty and hismany offspring. May they gain somecomfort in knowing what a profound in-fluence he had on those of us who werefortunate to train under and with him.

Marvin J. Wexler, M.D., FRCS(C)....................................

Dear Editor,Here's a voice from your dim dark distantpast! It's been 26 years since I finished myorthopaedic residency at RVH.

I enjoy reading the Square Knot althoughthe familiar names get fewer and fewer.On a whim, I looked up your missing or-thopaedic alumni in the directory of theAmerican Academy of Orthopaedic sur-geons and found Dr. Irwin Enker.

Dr. Colin F. Moseley,LosAngeles, CA....................................

Letter received from Dr. Humberto

Sangiovanni of Santo Domingo in theDominican Republic. Humberto was achief resident in General Surgery in 1963-1964 along with Drs. Rube Zemel, Vince

Piccone, R. Baird and Henry Shibata.

The SKthanks him for his generous gift of$100.00 .•

5

~ The relationship between the hospital and McGill'sFaculty of Education is so close as to be symbiotic; one needsthe other to succeed and each other's strengths are celebratedin unison.

Of course, no one ever thought the taskbefore us would be easy. How could itbe? We are talking about a major pro-ject that covers a plot of land morethan forty-three acres large, that has

integrated four distinct establishments and that will only takeon a new physical shape in a few years to come. But, simplystated, it needs to be done and we know that together we aregoing to make this happen.

MUHC project(continued from pg.l)

Indeed, the very scope of the project is one of its strongestpoints. In the process of blending these individual sites, cul-tures and personnel, a more vital entity is being created; onethat is extremely rich in talent, brainpower and diversity, all ofwhich are focussed on enriching patient care.

For a city as cosmopolitan, as sophisticated and as unique asMontreal, we are unusually passive when it comes to de-manding high standards in medical facilities. Perhaps that isbecause the services, in spite of outrageous limitations and di-minishing resources, have still been distinguished. The struc-tures' however, even to the untrained eye, are substandard.And an ageing plant cannot sustain the new model of cutting-edge, high-technology medicine, which is what our healthproviders are committed to delivering.

Given this extraordinary effort by Montreal's medical person-nel, it makes sense that people don't want to let their old in-stitutions go; they are tremendously loyal.

Actually, much of our confidence in the future is based on ourrich and successful historical past; Montreal has always beena leader in healthcare and we still have the largest talent poolin Canada. McGill University's Faculty of Medicine alone isamong the finest in North America, and its achievements flowthrough to support many of the University's accomplishmentsin other fields.

Certainly, the list of innovations and innovators at both McGilland all its teaching hospitals, has always been impressive. Fur-thermore, our excellence has always attracted excellence.

However, successes built on over-extended human resourceswill not be available indefinitely. To produce superior researchone needs to attract superior researchers.Toattract superior re-searchers and top-flight clinicians one needs to offer libraries,

THE SQUARE,..z~6

labs, equipment and spaces that support their activities.

So it's fine to mourn for the passing of those older organiza-tions; but then to recognize the benefits of a new reality. It isequally important, as well, to remember the very real flawsthat our familiar and comforting institutions have.

McGill and the MUHC are committed to the creation of a newmedical paradigm for this city. Some would refer to this asthe establishment of a superhospital. This term can been inpositive or negative lights. It is certainly understandable thatsome people are afraid that such an ambitious project will re-sult in a greater feeling of alienation. But super doesn't haveto mean mega, it can just mean great; as in great staff, greatequipment, great medical care. People, though, are concernedthat the money going into this undertaking is well spent andthey want to be reassured that all aspects of healthcare in ourcity -homecare as well as ambulatory services - are strength-ened in any reorganization. The MUHC agrees; it is part of ourongoing dialogue with the government.

Most people are impatient to see the new hospital built, toenjoy the benefits of a freshly-designed state-of-the-art med-ical facility. For some, that impatience translates itself into apessimism; will it ever really happen?

It will and it must. Many of us who are working hard on theorganization and transition of the MUHC won't even still beworking in the system when the doors open around 2005, butthat doesn't dampen our enthusiasm for, or commitment tothe vision. Like planting an orchard, this endeavor is an in-vestment in the future of generations to come. It is our re-sponsibility, whether we personally are here to reap therewards or not. Our children and granchildren will be. •

This column is made available by the McGill University HealthCentre (MUHC) Foundation. Please visit us at:

www.muhcfoundation.comWe are located at

2155 Guy Street, Suite 900Montreal, Quebec H3H 2R9

Tel: (514) 931-5656 Fax: (514) 931-5696

oDecember 21",2000, a team of surgen"s,anesthetists, nurses and other specialists and techniciansachieved a first in Quebec. At 18 weeks gestation, a fetus wasdiscovered to have a large neck mass. After referral to the

McGill Fetal Diagnosis andTreatment Program, fur-ther detailed ultrasoundexaminations and othertests showed this mass to

be a teratoma. There were no other malformations. After sev-eral meetings with pediatric surgeons (Drs. Flageole andLaberge), the obstetrician (Dr. Samir Khalife) and the ge-netic counsellor (Ms. Lola Cartier, also coordinator of the Fe-tal Program), the mother decided to carryon with thepregnancy. The teratoma was partly solid, partly cystic, andwas so large (more than 3 times the size of the head) as toprevent fetal swallowing, leading to severe polyhydramnios.Because of maternal discomfort and the risk of premature la-bor, six amnioreductions were required during the course ofthe pregnancy (from 500 cc up to 3,000 cc each time). Thelarger cysts in the teratoma were also aspirated six times, foramounts varying between 300 and 800 cc.With such a largemass causing neck distortion, there would have been a highrisk of respiratory distress at birth with inability to intubatethe baby. Therefore, the team planned for an "EXIT" procedure,or EX-utero Intrapartum Treatment. This consists of a cesareandelivery under deep maternal anesthesia to afford completeuterine relaxation and maintenance of the placenta-fetal cir-culation while the airway is secured. Meetings were held be-tween all obstetrical specialists (surgeons, anesthesiologists,nurses) and their pediatric counterparts. It became obviousearly on that delivering the baby at the RVHwould be risky,even in the presence of the pediatric team; bleeding withinthe teratoma could occur at the time of delivery, necessitatingemergency resection; even if the newborn was stable, the air-way would be precarious, making transport to the MCH dan-gerous. The decision was unanimous. The EXIT procedurewould occur at the MCH, with RVH obstetricians (Drs. Khal-

ife, Gregory and Jean), anesthesiologists (Drs. Hemmings

and Kaufman) and nurses (Julie Goudreau for coordination,Francine Asswad, scrubnurse, and Jane Heaton, circulatingnurse and postpartum care). We obtained the necessary per-missions for privileges at the MCH,for which Dr. Dupont (As-sociate-DPS) and Mrs. Borisov (MCH Director of Nursing)were most helpful.

The "EXIT" Procedure

The date was set for Thursday, Dec. 21". Even though the fe-

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tus would only be 32 4/7 weeks gestation, we felt that the se-vere polyhydramnios, combined with the short cervix, waslikely to result in premature delivery; the massive size of theteratoma could also result in cardiac failure with hydropsfoetalis, necessitating an urgent delivery with a fetus in worsecondition. We were proven correct: the mother had to be ad-mitted to the RVH because of decreased fetal movements onDec. 19. She was kept under constant monitoring until trans-fer to the MCH on the morning of Dec.21st. Maternal steroidshad been given and pulmonary maturity established.

In early December there were more meetings between all in-volved to discuss planning and coordination. One of these wasattended by Dr. Sarah Bouchard (McGill graduate in GeneralSurgery, U. of M. in Pediatric Surgery), who is currently doinga Research Fellowship at the Fetal Center in Philadelphia. Shesummarized the Children's of Philadelphia experience withEXITprocedures, but would not be present for our case sinceshe delivered her own first baby in mid-December (congratu-lations Sarah and Felix!). Special uterine staplers had to be or-dered from USSC.This instrument, shaped like a TA-55, places2 double rows of resorbable staples (metal staples could actas an IUD) and cuts in-between, like a GIA does. This is es-sential to prevent bleeding from the uterine edges. Since thisinstrument is not stocked in Canada, it had to come from theU.s.; it finally arrived on Dec. 20!

Another component that arrived Dec.20 was the software thatwould allow the ultrasound machine used for fetal echocardio-graphy at the MCH to also provide obstetrical ultrasound at thebeginning of the procedure (see below). The rest of the equip-ment was all available at the MCH and RVH; it was just amatter of getting it ready. The position of each piece of equip-ment and each person in the O.R.was determined, and a list ofall those who would be allowed access inside the room wasmade.

Here was the plan:

o Bring mom to the MCH by car, then up to the ACM* bywheelchair to change, fit antiembolic stockings and gatherthe charts for both mother and her unborn child. If she hadto be admitted to the RVH ahead of time, then she wouldbe accompanied during transport to the MCH by the ob-stetric head nurse, Marie-France Noel.

(*ACM: Alternative CareModule = a place on the in-patientsurgical ward where we can treat out-patients to avoidovernight admissions).

f) Go into the O.R.at 7:45 a.m., start I-V, then, under I-V se-dation, place arterial and central venous lines, perform ul-trasound to check fetal position and insert a ~

~ 22ga needle to drain as much fluid from the cysticparts of the teratoma as possible to facilitate delivery.

@) Under deep general anesthesia with isoflurane in lithotomyposition, perform a long transverse laparotomy to expose thewhole uterus. This would be done by the obstetrician andhis resident (Drs. Khalife and Jean). The two pediatric sur-geons would also assist (Drs. Flageole and Laberge).o Map the edges of the placenta (which was anterior, mak-

ing things more difficult), in order to keep the hysterotomyincision several cm away from its margin.o Take two large full-thickness uterine bites with a 0

monofilament suture under ultrasound guidance; incise theuterus with the cautery between those "lifting" sutures justenough to insert the uterine stapler and the surgeon's fin-ger (to ensure that the cord or a fetal part is not caught inthe stapler.o Fire the stapler repeatedly along the predetermined line

until the uterine opening was large enough to allow deliv-ery of the head, neck and upper chest with both arms, whileavoiding any trauma to the teratoma that could cause rup-ture or bleeding. The lower half of the body, including theumbilical cord, were to stay inside the uterine cavity. A con-tinuous perfusion of warm saline through a catheter placedinside the uterus would keep the fetus warm and moist. Atthis point two pediatric anesthetists would be scrubbed in(Drs. Brown and Goujard) with their anesthesia techni-cian (Miss N. Medeiros). The obstetricians would staysterile but take a step back.o Although the fetus would be anesthetized through the pla-

centa, fentanyl and pancuronium would also be given I-Min the fetal arms to ensure a complete anesthesia. An O2saturation monitor would be placed on one hand after dry-ing it while an I-V would be started on the other hand. Oneof the pediatric surgeons would hold the teratoma whilethe other would assist the pediatric anesthesiologist withintubation, especially if rigid bronchoscopy or tracheal ex-posure became necessary. Meanwhile, the pediatric cardi-ologist would also be scrubbed in to perform a continuousfetal echocardiogram. If simple intubation failed, the nextstep was to intubate over a flexible bronchoscope, then togo to a specially-curved rigid fetoscope and leaving aguidewire over which to intubate. Had that failed, wewould have surgically exposed the trachea at the sternalnotch and tried to pass a guidewire in a retrograde fashionto try and intubate oro- or nasotracheally, before finally re-sorting to a tracheostomy. By keeping the uterus relaxedand the placental circulation maintained, the fetus can bewell oxygenated for 60 and even up to 90 minutes duringthe EXITprocedure.o After successful intubation, the tube would be secured, and

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when everyone was ready, the obstetrical anesthesiologist(Dr. G. Hemmings) would stop the isoflurane and give I-V syntocinon, the cord would be clamped, the baby placedon a radiant warmer and brought to the adjacent operat-ing room. A cross-match and blood gas would be sent fromthe cord blood.o The obstetric team (Drs. Khalife, Gregory and Jean)

would finish this most unusual C-section, while next doorthe team of neonatologists (Drs. Louis Beaumier andGenevieve Piuze) pediatric anesthesiologists and pedi-atric surgeons would stabilize the newborn baby and es-tablish umbilical venous and arterial lines. The plan was towait one to two hours and have cross-matched blood avail-able before starting resection of the teratoma, unless he-morrhage occurred from the tumor. Going down one floorto the NICU for stabilization was dismissed because of theprecarious airway.

@ Post-operatively, the mother would be kept overnight inthe PACUat the MCH,attended by postpartum nurses fromthe RVH (Jane Heaton initially, then Carmen Holness).

Becauseof our chronic lack of beds at the MCH,mom wouldbe returned by ambulance to the RVH the next day, ac-companied by Louisa Ciafoni, RVHclinician nurse special-ist. (We can't wait until the MUHC is on a single site!!!).

So was the plan, and it functioned as smoothly as can be, de-spite having more than 20 people inside the operating the-ater. Four staplers were required to ensure an atraumaticdelivery. This resulted in a 20+ cm hysterotomy (and an evenbigger hole in the MCHO.R.budget!). After the fetus was ex-posed and monitored, the mouth was suctioned and Dr. Gou-jard intubated nasotracheally without problems. However,flexible bronchoscopy through the tube demonstrated no tra-cheal lumen at the end of the tube, likely because of the tra-cheal compression and deviation by the teratoma. Therefore,the tube was advanced just above the carina under guidancewith the flexible scope, which was hooked to the Storz videocamera so that everyone could see on the monitor. At thislevel the tracheal lumen was adequate. We could then takeour time to suction the baby and suture the tube to the up-per lip while she was still being oxygenated by the placenta.

Thirty-seven minutes after the head was out of the uterus, thematernal anesthesia was modified to allow uterine contrac-tion. Two minutes later, the cord was clamped and dividedand the baby was born! The baby was hand-bagged andtransferred on the radiant warmer and out into the adjacentO.R.without problems. There was no difficulty with placentalextraction and uterine closure. On the baby's side, the masswas just as huge as expected. It had to be lifted off her chestto allow adequate ventilation. The neonatology ~

8

~ team then took over. Drs. Beaumier and Piuze,

assisted by nurses Patricia Leroux and Danielle Lecavalier,

stabilized the baby and inserted umbilical arterial and venouslines. The father was even dressed up in O.R.clothes to visithis daughter, and mother was informed that the EXITproce-dure had been the success.

About three hours after birth, we started the excision undergeneral anesthesia given by Dr. Reyes. The 2 pediatricsurgery fellows (Drs. Emil and Kay) helped resecting this raretumor. It involved the whole left side of the neck, distortingthe normal anatomy (see picture). It was intimately adherentto the left side of the larynx and pharynx, where we ended upwith two small mucosal tears. While teratomas are usually be-nign at birth, complete excision is essential because they maycontain malignant elements, and benign ones can recur anddegenerate into a malignant yolk sac tumor. The left carotidand jugular entered into the tumor and were totally absentcephalad to the mass. We never saw a left vagus nerve andobviously even less of a recurrent nerve on that side. The leftlobe of the thyroid gland was widely exposed and the leftparathyroids potentially damaged (or resected with the mass),but the tumor did not extend to the right side of the trachea.When we were finished, there were no strap muscles left, theflimsy ends of the left sternomastoid were re-approximated,but the scalene muscles and the left phrenic nerve appearedintact. The tumor had been adjacent to or displacing the leftear, parotid and mandible, but these structures were also in-tact at the end of resection.

The tumor weighed l,085g in pathology. Adding 300 cc offluid that was removed under ultrasound guidance at the be-ginning of the EXITprocedure, it gives us a 1.4 kg tumor in a1.6 Kg baby. The heart was really pumping for two!

The initial post-operative course was uncomplicated, given thistype of surgery in a premature baby. On POD6, we extubatedher in the O.R.under flexible bronchoscopy. There was no tra-cheomalacia. Extubation was successful, but over the courseof the following week there were episodes of desaturation andaspirations, especially after nasogastric feedings were begun.Direct laryngoscopy showed a left vocal cord paralysis, as wellas poor sensation and motricity of the pharynx. This is com-plicated by the presence of gastroesophageal reflux. Othercurrent problems/sequelae include a paresis of the mandibu-lar branch of the left facial nerve and a depressed scar at theangle of the mandible, with an excessof skin further laterally.In summary, there was loss or damage to part of the Vll'hnerve, likely the IXthand Xlth,and surely the Xth,including therecurrent laryngeal. She currently tolerates nasojejunal feed-ings and her lung function is adequate despite aspiration of

THE SQUARE..z:!a9

saliva. Her right cord should compensate for the left palsy, butwe do not know when she will be able to feed by mouth. Neckmovements are already quite good and physiotherapy is fol-lowing her for passive exercises. Despite the large scar, herlooks are much improved! (see picture)

The parents were remarkable during the whole process. Themother was especially courageous to submit herself to multi-ple uterine punctures during the course of the pregnancy, bedrest for the last 2 months and a very large laparotomy for theC-section. She did recover very well and is now hoping thatthe current problems will improve with time.

This experience also brought closer all the members of the Fe-tal Diagnosis and Treatment Program, including physicians,nurses and other personnel from the RVH and MCH. It wasdefinitely a first in Quebec. Even though the EXIT procedurehas been used a few times in Toronto and in several centersin the U.S., this may be the baby with the largest cervical ter-atoma in relation to body weight to be delivered successfully.Our thanks to all those who contributed to this success. Weare appending the names of the ones who were directly in-volved on the day of delivery, but many others contributed,ranging from blood bank specialists to head nurses, whohelped coordinate things between the RVHand MCHsites, andincluding Mr. Riopel from Material Installations, who wasable to bring up the temperature of both operating theatersto a comfortable 260 Celsius. We now feel ready more thanever to handle other fetal malformations that may require anoperation before birth .•

List of personnel inside the Operating Theater at

one time or another during the EXIT procedure:

(alphabetically):

Asswad, Francine (RVH nurse)Beaumier, Dr. Louis (Neonatologist)

Bellerore, Gaby (Anesth. Tech)Brown, Dr. Karen (Ped. Anesth.)*

Clogg, Donald (Anesth. Technical Assistant)Flageole, Dr. Helene (Ped. Surgeon)*

Goudreau, Julie (RVH nurse)Goujard, Dr. Etienne (Ped. Anesth.)*Gregory, Dr. Diane (Obstetrician)*

Heaton, Jane (RVH nurse)Hemmings, Dr. Gisele (RVH Anesth.)

Heon, Daniel (Audio-Visual)Jean, Dr.Catherine (Obst. Resident)*Jutras, Dr. Luc (Ped. Cardiologist)

Kaufman, Dr. Ian (Anesth. Resident)Khalife, Dr. Samir (Obstetrician)*

Laberge, Dr. Jean-Martin (Ped. Surgeon)*Lambert, Marisol (nurse)

Lecavalier, Danielle (Neonatal nurse)Leroux, Patricia (Neonatal nurse)

Lestage, Martine (nurse)Medeiros, Natalina (Anesth. Tech.)*

At birth - 1

Immediate Post-Op - 1

At 3.5 Weeks - 1

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Payne, Dr. Jim (PCA)Piuze, Genevieve (Neonatal fellow)

Sand, Linda (nurse)Soulieres, Diane (Anesth. Tech.)

Technician in U/STetreault, Maryse (Anesth. Tech.)

* indicates scrubbed personnel

At birth - 2

Immediate Post-Op - 2

At 3.5 Weeks - 2

10

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

; ItemsCII - By E.D.Monaghan, M.D.z:

OR. PAUL BELLIVEAU GOES TO QUEENSAs of January 7th, 2001, Dr. Paul Belliveau has left the MUHCto take a position in colorectal surgery in the Department ofSurgery at Queens University in Kingston, Ontario.

Paul graduated from McGill in 1974 and was a member of theMcGill Postgraduate Training Program in General Surgery. Hewasa chief resident with Dr.Dominique Cheung in 1978-79. Subse-quently, he did Fellowships in colorectal surgery in Minnesota aswell as at the london Hospital with the late Sir Alan Parks. Dr.Lloyd D.Maclean took him on staff at the RVH in 1981.

Paul is a very well respected and capable clinical surgeon .. Hehas developed a special interest in inflammatory bowel dis-ease where his services are much in demand.

He has also become a renowned Educator and his C.V. is re-peat with awards and responsibilities in this area.

The McGill University Health Centre is very sorry to lose himand we wish him well in his new and challenging career.

JACK WHITE RETIRESAs of November 2000, Jack White and his wife Andy havemoved to Tantallon in Nova Scotia at the head of St. Margaret'sBay. At this location, Jack and Andy are very close to the homeof Betty lou and Dr. Bernard Perey. Andy is originally aMaritimer and they have two grown children. They are aboutto become grandparents for the first time.

Jack graduated from McGill in 1957, trained in General Surgeryat the RVH and was a chief resident in 1964-1965 along withDrs. Jim Mackenzie, Peter McLean, and the late Dr. EdCharette. After a Fellowship at Johns Hopkins University in Pe-diatric Surgery, he went to settle in Albany, New York where hewas Professor of Pediatric Surgery for eleven years. Then hewent to loma Linda in California in the same capacity until1993. He moved to long Island, NY in private practice, afterwhich time he went to Mercer University in Macon, Georgia.

Jack goes in to teach once or twice a week at the IWK Chil-dren's Hospital in Dalhousie University, Halifax.

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ANTOINE LOUTFlIS BACKEveryone was delighted to welcome the return of Dr. Antoineloutfi in January after a Sick leave since last July.

He will resume all his duties including Co-Director of theBreast Centre (RVH site) along with Dr. David Fleiszer. Also,he has been appointed as Head of the General Surgery Ser-vice at the RVH.

.............................JOE MEAKINS TAKES A L.O.A.In December, the Chairman announced that he is taking amini-sabbatical from June 1st until labour Day, 2001. He isgoing to Oxford University to work in the Nuffield Depart-ments of Medicine and Surgery to gain expertise in Technol-ogy Assessment, which is one of the priorities of theDepartment and to improve his understanding of thisapproach to Evidenced Based Medicine. The opportunity tostudy at the Welcome Institute for the History of Medicine hasbeen established. Dr. Mostafa Elhilali will be Acting Chairduring this time and the Associate Clinical Heads of Surgery,Dr. Gerald Fried, at the MGH site with Dr. Jean-E. Morin atthe RVH site will also handle the administrative workload. Wewish him well during this "sabbatical leave':

HOCKEYStaff/Residents Hockey Match to win the coveted ReaBrown Cupwas held February 19th at 10:15 P.M.at the McGill arena.•

"Thisis a serious hole. Youmight want to try a different hat."- TheHumanitarian

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Update From The McGill Divisionof Surgical Reseach- By Lawrence Rosenberg, M.D., Ph.D.

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

···

··

THE DIVISION WEBSITE is now fully functional and has at-tracted graduate studies applications from around the world.Faculty members of the Division were provided last Fall with alogon Ld. and password. These were sent individually bye-mail.You are all highly encouraged to upload your research projectsto this site as soon as possible. If you need to re-obtain yourlogon Ld. and password, please contact me at:

lawrence.rosenberg@mcgill.caThis site was designed not only as a showcase of research tal-ent to attract graduate students, but also as a means of col-lecting and collating research-related information that can thenbe used to generate an accurate and up-to-date annual reportof research activities. For this to work, faculty members mustsupply the required information. I thank you all in advance foryour co-operation and support. •

TDivision heldits lrd AnnualGraduateStudieslee"ture and reception on December 4, 2000. Our featured keynotespeaker this year was Dr.Marsha Moses, Associate Professor ofSurgery, Harvard Medical School, who spoke on The Regulationof Angiogenesis by Metalloproteinases: Therapeutic and Diag-nostic Implications. Dr. Moses is an independent investigatorin the Angiogenesis Programme directed by Dr.Judah Folkman.This highly successful night was co-ordinated by Dr.Eunice Leeand was hosted at the Shriners Hospital For Children. Dr. Leedeserves our congratulations for organizing an excellent eventthat was attended by our students, faculty and guests .•

B

Lt. to Rt.: Dr.John 5. Mort, Dr.Marsha Moses (guest speaker) and Dr. Euni(e R.Lee

12

.•...........................•......•...................•..••...............•..................................................

McGill Transplant Patient WinsGold Medal at First CanadianTransplant Games

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Were You There?Cedar Cancer ResearchFund -1972Dr. Paul Farrer (left) Director of Nuclear Medicine,

RVH shows the total body scanner to DannyThomas, and Joseph Chamandy, Chairman Cedars

Cancer Research Fund. Dr. Edward Tabah (extreme

right), Director of the Tumour Registry, RVH,shows his

delight at the gift from the Fund.•

Elizabeth Ingram who received a combined kidney/pancreas transplant

by Dr. Peter Metrakos won a gold medal at the First Canadian Transplant

Games held in Sherbrooke, Quebec last August. •

13

Team QuebecFront row Lt. to Rt.: Jean-Marie Tremblay (heart recipient), Daniel Boudreau (heart recipient), Carmen Boudreau (kidney recipient), Gordon Denison (kidney recipient),Laureen Bureau (kidney recipient). Back row Lt. to Rt.: Jan-O Brosseau (lung recipient), Elizabeth Ingram (kidney-pancreas recipient), Caroline Dube (heart-lungs recipi-ent), Pierre Lazard (heart recipient). Missing from photo: Diane Hebert (heart-lung recipient), Nadine Ogonowski (kidney recipient), Mathieu Plourde-Turcotte (kidney

recipient), Danny Labonte and Jacques Forest (kidney recipient).

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Dr. Rea A. Brown DayThursday November 9, 2000The Montreal General Hospital

Osler AmphitheatreoNovember 9th.2000, the Division of GeneralSurgery celebrated Rea Brown Day to mark Rea's retirementafter 31 years of service to the Department of Surgery. InvitedVisiting Professor, Dr. C. William Schwab, Chief of the Divi-sion of Traumatology at the University of Pennsylvania spokeat Grand Rounds of the impact of Trauma Systems. For the re-mainder of the day,we were treated to a series of scientific pre-sentations from Rea's colleagues and former residents.

Presenters came to pay homage toRea from as far afield as Kentucky andCalifornia. After a long, at times, emo-tional day, a reception and dinner washeld in honour of Rea and KathyBrown at the Hotel Omni Mont-Royal.

Rea received some moving and some humorous testimonialsfrom friends, colleagues, former residents and his family. All inall, ReaBrown Day proved to be a huge successand a fitting wayto pay tribute to a man who has given so much of himself toMcGill and the Department of Surgery.•

Roger Tabah, M.D.

14

Moderator: 09:30 10:45 14:00Dr.Dr.Liane Feldman Dr. Helene Flageole Dr. Lawrence Rosenberg Dr. David Fleiszer

Introduction: Evolution of the Detachable Balloon in From Cigarettes to Insulin Innovations in the Management of Breastthe Feotal Treatment of Congenital Disease

Dr.Tarek Razek Diaphragmatic Hernia 11:00

Dr. Salim Ratnani14:15

07:45 09:45Surgical Grand Rounds

Trauma: Two Interesting Cases Dr. Ray ('-J. Chiu

Dr. Danny Marelli and the LabDr. (, William Schwab Donor Hearts Preserved with University of 11 :15Chief, Division ofTraumatology Wisconsin Solution

Dr. Robert M. Ford14:30

University of Pennsylvania Medical CenterTrauma Systems Praise of Older Surgeons Dr. James Sullivan

10:00 Aging Knee:What you Kneed to Know09:00 Coffee Break 11:30

Dr. Tarek RazekLunch - Board Room (E6-112) 14:45

10:15Dr. Andrew HillMentors in Medicine

Donna Stanbridge, R.N. 13:30 Submucosal Small Intestine VascularMinimally Invasive Suite Bypass Grafts I -09:15 Dr. Vinay Badhwar

Dr. Kashif Irshad 10:30Failure Surgery - An Emerging Sub-

15:00Operative Management of Hockey Groin SpecialtySyndrome: 12 Yearsof Experience in Dr. David Sloan Dr. Doug Kinnear

National Hockey League Players Improving Surgical Education: Cloning 13:45 Most Famous CaseReaBrown and Other Strategies

Diane Borisov, R.N.

Many Sides of Dr.ReaBrown"

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15

9l:;:z..3lflfnOS3Hl

DPnina Brodt was pro-moted to FullProfessorasof January1st, 2001.

The first pediatric retroperitoneal laparo-scopic nephrectomy in Canada was per-formed November 28th, 2000 at the

Montreal Children'sHospital. The team of

IlilDO( !! Drs. J.P. Capolicchio

~ and Maurice Anid-

jar of the Division ofUrology performed

the surgery as part of the pre-transplantpreparation of a patient with high outputrenal failure and a solitary hydronephrotickidney. The retroperitoneal approach, al-though limited by the amount of expo-sure, obviates violation of the peritoneumand the attendant risk of adhesions. Fur-thermore, maintenance of peritoneal in-tegrity allows for continued peritonealdialysis, an important advantage in theend stage renal disease patient.

Mario Chevrette, Ph.D., Urology Re-search, has been elected President of theMedical Board of the Canadian ResearchSociety.

McGill University hascompiled a list of its topten research stories of2000. The top spot forthe researcher who at-tracted the most inkoverall goes to Dr. Ray

c.-J. Chiu, Professor inthe Division of Cardio-thoracic Surgery, whomade 56 appearances indifferent media. Dr.Chiu

and his colleagues studied the possibleuse of immature bone marrow tissuecalled marrow stromal cells as an ap-proach for tending to damaged hearts.These cells are unique in that, once in-jected into different parts of the body,

Dr.Ray C. -J. Chiu

they transform themselves into new tis-sue that's appropriate to their new sur-roundings. The reason why that'simportant is that damaged hearts can'tcreate new tissue to replace what's beenlost as a result of a heart attack or heartdisease. The New York Times, the Los An-geles Times and CBCRadio's "As It Hap-pens" all covered the story. Dr. Chiu toldthe McGill Reporter that he is anxious tosee the new therapy, done successfully inmice, tried on human subjects. "I believeit will take at least two years for this pro-cedure to come into clinical practice. Butif patients exert pressure to speed up theprocess, that could speed things up. Iknow that lots of patients with nothingto lose will volunteer for the trials':

Dr. Claude Gagnon, Director of the Urol-ogy Research Laboratory at the RVH,gavea plenary lecture at the British AndrologyMeeting in Bristol, UK last October. Thetitle was The Role of Reactive OxygenSpecies (ROS) in the Capacitation of Hu-man Spermatozoa. Last September, healso gave a lecture in Berlin at a Work-shop on The Beneficial Effect of ROS onSperm Function.

Dr. Philip H. Gordon continues to bringhonors to his Colon and Rectal SurgeryService at the JGH. He recently receivedfour appointments: first of all, he was ap-pointed to the Executive Committee ofthe Division of General Surgery of theMUHC. He also was ap-pointed reviewer to theBritish Journal ofSurgery as well as tothe Surgical La-paroscopy, Endoscopyand Percutaneous Tech-niques group. Finally,he was appointedmember of the Scien-tific Advisory Board ofthe McGill Inflamma-tory Bowel DiseaseGroup. In November,Philip accumulated

THE SQUARE..zC>...17

some air miles. He was invited to be Vis-iting Professor at the Cleveland ClinicFoundation from November 9th to 11'h

where he discussed Perianal and AnalCanal Neoplasms in one seminar and To-tal Mesorectal Excision -Is It Necessary forCarcinoma of the Rectum? in another. Healso gave a paper entitled Awareness,Prevention, and Early Detection ofColorectal Neoplasia. At the end of No-vember, he travelled to Marbella inMalaga, Spain where he was an InvitedGuest at the Congreso Iberolationoamer-icano de Coloproctologia. Here he gavefour papers. On December 1st, he was anInvited Guest at a seminar entitled "NewPerspective in Colorectal and PancreaticCancers" at the Ottawa Regional CancerCentre. His address was entitled Colorec-tal Cancer Prevention: Its'Simple. Why isNo One Listening?

Dr. Jean-Martin Laberge accompaniedhis wife, Dr. Louise Caouette-Laberge

(Head of Plastic Surgery at Ste-Justine),on a mission to Cuenca, Ecuador withOperation Smile. He served as a surgicaleducator, giving lectures and conferencesin Pediatric Surgery, while his wife wasoperating on children with cleft lip andpalate and various other problems.Dr. Laberge has been awarded the Teach-ing Award for Surgery.

Dr. Peter McKinney of Chicago is a Di-rector and Historian of the ~

Weneed more whellchairs down at the clinic.

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General Surgery

Academic Half Day

Thisyear'sacademichalf-daywill alter-nate betweenthe RoyalVictoriaHospi-tal and the MontrealGeneralHospital,commencingat theMGHonJanuary10.

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Royal Victoria Hospital (beginning January 77)

1:00 - 2:00 p.m. SRPRounds

2:00 - 3:00 p.m. GeneralSurgeryLecture*(ArchibaldAmphitheater 6th Floor)

3:00 - 4:00 p.m. Morbidity and Mortality Rounds

Montreal General Hospital (beginning January 70)

1:00 - 2:00 p.m. GIRounds(D14)

2:00 - 3:00 p.m. GeneralSurgeryLecture(OslerAmphitheater 6th Floor)

3:00 - 4:00 p.m. Morbidity and Mortality Rounds

January 17* Hepatic Infection & Acute Hepatic Failure Dr. A. Sherker

January 24 Anorectal disorder Dr. J. Trudel

January 31* Hepatic Neoplasms Dr. P.Metrakos

February 7 Calculous Biliary Disease I Dr. G. Fried

February 14* Melanoma Dr. S. Meterissian

February 21 Colonic Polyps/Polyposis Syndromes Dr. B. Stein

February 28* Biliary Neoplasms Dr. J. Barkun

March 7 Spring Break

March 14 Colorectal Cancer Dr. P.Gordon

March 21* SESAP Dr. S. Meterissian

March 28 Diverticular Disease Dr. D. Owen

April 4* I Anal Cancer I Dr. S. Meterissian

April 11 Breast Cancer - In situ Dr. D. Fleiszer

April 18* Breast Cancer - Invasive Dr. A. Loutfi

April 25 Ulcerative Colitis Dr. C. Vasilevsky

May 2* Thyroid Cancer I Dr. M. Wexler

May 9 Parathyroid Diseases Dr. R. Tabah

May 16* Soft Tissue Sarcomas Dr. S. Meterissian

May 23 Spleen Dr. R. SalasidisMay 30* Acute Upper GI Bleeding Dr. T. Razek

June 6 Acute Lower GI Bleeding Dr. D. Evans

* = Royal Victoria Hospital

T.",Annual H. Rocke Robertson Visiting Profe~or-

ship took place on February W, 2001 with Dr. David B.Hoyt as this year's Visiting Professor. Dr.Hoyt is presently the

Monroe E. Trout Profes-

sor of Surgery at UCSan

Diego School of Medi-

cine, California, where he

serves as Vice Chairman

in the Department of

Surgery and Chief of the

~ Division of Trauma, Burn and Surgical Critical Care. His talk

3' during Surgical Grand Rounds at the MGH was entitled

~ Trauma Systems: Evidence and Ongoing Assessment. Later

E that day, he also gave the Residents' Lecture which was enti-

tled Vascular Exposure of Penetrating Injuries.

H. Rocke Robertson

Visiting Professor

in Trauma

Ineffably diligent and productive, Dr. Hoyt has become a

respected leader in trauma care throughout the world.' He

is currently one of an elite group of

accomplished academic surgical

traumatologists whose opinions

mould our delivery of clinical

trauma care and impact cogently on

the future development of trauma

systems. It was an honour to wel-

come him to McGill University as the

6th annual H. Rocke Robertson Visit-

ing Professor in Trauma .•

·

···

·

······................................•.....................................

··

Dr.David B.Hoyt

"He is the best physician

who is the most ingenious

inspirer of hope"

-Samuel Taylor

Coleridge

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~

20

Were You There? -1982

The Royal Victoria Hospital made medical history when

Dr.Tomas Salerno of Cardiovascular Thoracic Surgery admin-

istered the first transfusion of artificial blood to a patient in

Canada.•

McGill Alumni Prominent in (AGS

Dr. John MacFarlane President (Vancouver)

Dr. Jeff Barkun Member of ResearchCommittee

Dr. Gerald Fried Member of Committee on Endoscopicand Laparoscopic Surgery & Member ofthe Computer Committee

Dr. Antoine LoutfiDr. Peter McLean

Members of the Liaison Committeefor the Advancement of SurgicalServices in the Developing World

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Dr. Peter Metrakos Member of the TransplantationCommittee

Dr. Roger Tabah Chair of the Head and NeckCommittee

Dr. Carol Ann Vasilevsky Chair of the Committee onColorectalf Surgery

...............................................................................................................................Welcome Aboard Dr. Maurice Anidjar

joined the Division of Urology inJuly 2000 and is based at theMUHC. He did his medical trainingat the Universite de Paris (France)and has a Ph.D. in Surgical Sciences.In addition, he trained in laparo-

scopic surgery in Strasbourg. He continues to be involved inresearch at McGill in the area of gene therapy to treat benignurologic strictures (ureter, urethra). He is presently involvedclinically in endourology and stone disease and in laparoscopicsurgery for upper and lower urinary tracts.

Dr. Brian Buchlerjoined the Division of General Surgery at St. Mary's Hospital inSeptember 2000. Dr. Buchler is a graduate of Laval (M.D.1988) and did his residency at the University ofToronto. Be-fore coming to St. Mary's, he was on staff at the Centre Hos-pitalier des Vallees de l'Outaouais in Gatineau.

Dr. Mark Burmanjoined the Division of Orthopaedic Surgery at the MontrealGeneral Hospital in July 2000. After graduating from theMcGill program, Dr. Burman stayed on for a one-year fellow-ship in Orthopaedic Sports Medicine and Arthroscopy. Thiswas followed by two further years of training in Sports Med-icine, first at the University of Oklahoma, then at the Univer-sity of Toronto under Dr. Anthony Maniaci.

Dr. Liane Feldmanjoined the Division of General Surgery MUHC,Montreal Generalsite in July 2000. After graduating from the McGill program, Dr.Feldman stayed on at McGill to complete a two-year fellowship

in Laparoscopic Surgery under Dr.Gerald Fried. She is involvedin developing minimally invasive surgery at McGill, and is en-rolled in the M.5c. Program in Epidemiology and Biostatistics.

Dr. Tarek Razekjoined the Division of General Surgery MUHC, Montreal Gen-eral site, in July 2000. A graduate of the McGill program(1998), Dr.Razek did a two-year fellowship in trauma and sur-gical critical care at the University of Pennsylvania. He ispresently active in the trauma program and critical care at theMUHC.

Dr. Rudolf Reindljoined the Orthopaedic Surgery staff at the Montreal Generalin January 2001 where he rounds out the Orthopaedic TraumaGroup. After completing his Orthopaedic residency at McGillin June 1998, Dr. Reindl did a fellowship in OrthopaedicTrauma at Der Humboldt University, Berlin, which is one of thethree largest trauma centers in Europe, followed by anotheryear at Sunnybrook in Toronto.

Dr. Francine Tremblayjoined the Division of General Surgery (Oncology) at the Jew-ish General Hospital in July 2000. Her area of particular in-terest is breast cancer. Dr.Tremblay completed her residencyin general surgery at the Universite de Montreal in 1989, thenpracticed in Sept-lies and Joliette. From July 1998 to June2000, she was a fellow in Surgical Oncology at McGill underthe supervision of Dr. Sarkis Meterissian .•

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22

MCGillUniversity Department of SurgeryChristmas Party

Dr.Marvin and Randy Wexler

Dr. Peter and Amalia Metrakos

Dr. Kashid Irshad and Dr. Kristina Zakhary

Dr. Nick and Katina Christou

Dr. Patrick Charlebois and guest

Dr.Shannon Fraser and Dr.Jose Pascual

Dr.Madeleine Poirier and Dr.Marc Zerey

.Maria Monaghan, Mary Bouldadakis, Line Dessureault

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Mary Bouldadakis, Lorenzo Ferri, Betty Giannis, Andrew Seely,Prosanto Chaudhury, Jose Pascual

MGH SICUnurses

Lorenzo Ferri and spouse

Janice Hazarian, Lynn Milburn, Rita Piccioni, Ennia Mulfati, Line Dessureault, Ita Symth, Mary Bouldadakis, Diane Cunningham.

23

O.R. Allocation RVH SiteJanuary to March 2001

XXX Holiday URGENT XXXJanuary 7,2001 MCLEAN METERESSIAN I Clinic/AHD I PURPLE CHRISTOU

XXX Wexler Milne XXXJanuary 14,2001 CHRISTOU METERESSIAN Clinic/AHD PURPLE WEXLER

XXX LRD/Urgent Purple Milne XXXJanuary 21,2001 CHRISTOU METERESSIAN Clinic/AHD I PURPLE WEXLER

XXX Meakins Milne XXXJanuary 28,2001 CHRISTOU METERESSIAN Clinic/AHD PURPLE WEXLER

XXX LRD/Urgent Purple Milne XXXFebruary 4, 2001

IMCLEAN

I METERESSIAN Clinic/AHD I PURPLE CHRISTOU

XXX Meakins Milne XXXFebrua ry 11, 200 1 CHRISTOU METERESSIAN Clinic/AHD PURPLE WEXLER

XXX LRD/Urgent Purple Milne XXX

February 18,2001 I CHRISTOU I METERESSIAN Clinic/AHD I PURPLE WEXLER

XXX Meakins Milne XXXFebruary 25,2001 Holiday METERESSIAN Clinic/AHD PURPLE CHRISTOU

XXX LRD/Urgent Purple Milne XXXMarch 4, 2001 CHRISTOU METERESSIAN Clinic/AHD PURPLE CHRISTOU

XXX Meakins Milne XXXMarch 11,2001 CHRISTOU METERESSIAN Clinic/AHD PURPLE WEXLER

XXX LRD/Urgent Purple Milne XXXMarch 18,2001 MCLEAN METERESSIAN Clinic/AHD PURPLE WEXLER

XXX Meakins Milne XXXMarch 25,2001 LOUTFI METERESSIAN Clinic/AHD PURPLE WEXLER

XXX LRD/Urgent Purple Milne XXX

CAPITAL LETTER = Room to 6 pm Lower Case Letter = Room to 3:30 pm N.v. Christou (Division Head) December 1,2000

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Were YouThere? 1989 - 1990

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25

UNIVERSITY SURGICAL CLINIC RESEARCH DIRECTORS AND FELLOWS

L to R (top row): Audrius libaitis, E. John Hinchey, Gustavo Bounous, H. Bruce Williams, Ray C. -1. Chiu, Christo I. Tchervenkov, David S.Mulder, David M. Fleiszer,A. Hope McArdle, Lawrence Rosenberg, Gerald M. Fried, Dao Nguyen. L to R (bottom row): Dong Dai, Chris Ouong, Carlos Li, Carlos Barba, Salim Ratnani, Johah Odim,Frank Campanile, Dan Thomas. In absentia: Peter Metrakos, Dan Tanguay, Gary Schmidt, Teanoosh Hosseinzadeh, Scott Wilcher, ReaA. Brown, Hani Shennib,

William A. Mersereau, Denis Bobyn .

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

Own an

"Alyson Champ"

Untitled oil painting on masonite

panel by Alyson Champ for sale

by the artist.

12" x 16" image size, tastefully

framed. $400 negotiable.

Tel.: 450-825-2247 or e-mail:

alysonchamp@hotmail.com

Gutelius, Dr. John Robert peacefully

at Kingston General Hospital on Decem-

ber 4th, 2000. Beloved husband of Betty

(Timmins - a graduate nurse from the

RVH School of Nursing), brother of Bill

and Kitty, dear father, father-in-law and

grandfather of a very large family.

After graduating from Loyola College in

1949, John went to McGill Medical

School from which he graduated in

1955. He trained in General Surgery at

the RVH and went on a McLaughlin

Scholarship to Johns Hopkins University

from 1959 to 1960. He was the chief

resident in the Department of Surgery

with Dr.Art Freedman in 1961. He was appointed to the Sur-

gical Staff at the RVHand was soon involved in Surgical Teach-

ing. He became the Program Director in the General Surgery

Residency Training Program and was a Markle Scholar from

1963 to 1968.

Dr.John Gutelius

He left McGill in 1969 to become the Head of Surgery at the

University of Saskatchewan and was Dean of that Faculty of

Medicine from 1970 to 1973. In 1973, he moved to Queens

where he was Head of the Department of Surgery until 1983 .

John was qualified in General Surgery, Thoracic Surgery and

Vascular Surgery. In latter years, he was mainly involved in

Vascular Surgery.

However, his main interest throughout his entire career was

that of TEACHING. He has many publications under this topic

and will be remembered fondly by his many residents and stu-

dents. At the time of his death, he was Emeritus Professor of

Surgery at Queens. He will be missed.

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Charles W MCDougall

MCDougall, Charles W. on November 30th, 2000 surrounded

by his family in his home in Edmonton, Alberta after a coura-

geous year-long battle with cancer. The Royal Victoria Hospi-

tal and MUHC employees will fondly remember Charles for his

fifteen years of loyal and dedicated service. He leaves to mourn

his wife Sandy and three children. The Charles W. M'Dougall

Memorial Fund has been created in his memory. •

26

fOM

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E.D. Monaghan, M.D .• Editor· THE SQUAREKNOT· The Royal Victoria Hospital687 Pine Ave. w., Room: 510.26, Montreal (Quebec) Canada H3A 1A1

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M: ETHICON ENDO-SURGERY~ a ~m-ett~company .:. MERCK FROSST USSTca

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E.D. Monaghan, M.D.Editor

Emma LisiAssistant Editor

Marie M. CimonCopy Editor

The Audio VisualDepartment ofThe MontrealGeneral HospitalDesign & Layout

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All photographscourtesy of TheMcGillSurgery Department

McGILL SURGERYALUMNI& FRIENDSContributions of $50.00 are appreciatedin ensuring the continued publicationof "The Square Knot" and supporting McGillSurgery Alumni activities. Pleasemakecheque payable to the McGill Departmentof Surgery and forward to Maria Bikas,McGill Surgery Alumni & Friends,TheMontreal General Hospital,1650 CedarAvenue, Room: 06-136,Montreal (Quebec) CanadaH3G1A4Telephone: (514) 937-6011,ext.:2028Fax: (514) 934-8418.

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