Professionalism: An Unanticipated Journey

I
n February of this year, an International Charter on Professionalism was published
simultaneously in The Lancet and The Annals of Internal Medicine. This was the result of
the work of an international committee established by the American Board of Internal
Medicine and its Foundation and
the European Society of Internal
Medicine. Sylvia and I served as
special consultants to the committee, with our task being to ensure that the content of the Charter was consistent with the literature on professionalism.
We also assisted in drafting the final document. The editor of The Square Knot has asked
me that we briefly discuss the Charter and the events in our lives which lead up to our
involvement in the creation of the International Charter.
Professionalism:
An Unanticipated Journey
When Sylvia and I stepped down from our respective administrative jobs in 1995 (when we
were both 65), we embarked upon a sabbatic
year at the Institute for Advanced Study at
Princeton and at Oxford University. Because of
her experiences, Sylvia felt that many of our excellent and well-meaning colleagues did not
fully understand what it meant to be a professional and we consequently decided to study
professionalism in medicine. We discovered an
enormous and rich literature on the subject
which began in the early twentieth century and
Drs.Richard & Sylvia (ruess
continued to the present time. This literature existed almost entirely in the social sciences and in
philosophy, with some contribution from ethics. There was no cross-over literature at the
time and consequently the medical profession itself was largely unaware of its ex~
(please see Professionalism, pg. 4)
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17
~.
Editorial
20
tD
Chairman's
24
Trauma at the MCH
28
23
Welcome Aboard
Div. of Plastic Suroerv-Return
31
of Dr. Chen Lee
Managing
End-Stage Heart Failure Patients
...........................................................................................................
Research Award
32
8
10
NEWSLETTER
McGILL UNIVERSITY
SUMMER 2002
Letters to The Editor
a. News from the JGH
DEPARTMENT OF SURGERY
33
34
Ron I pwil' McGill to Ottawa
35
FR~n Awards
34
THE SQUARE
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Dear Editor,
I have switched jobs. I work for a new
tertiary care center in Saudi Arabia. I am
the Chief of Surgery and the Deputy CMO.
It is a very challenging job to start a new
hospital. I can see a lot of the difficulties
you folks are going through with the
MUHC new center.
Not all our programs are functioning yet, but
they are coming
slowly on line. We
are actively recruiting in every specialty,
and if any are interested, please e-mail
me. Please note my new address and
e-mail, so I remain in touch and receive
The Square Knot.
Letters
to The Editor
?
Sameh Barayan, MD, FRCSC
p.o. Box 473
AI-Khobar, 37952
Saudi Arabia.
[email protected]
Dear Editor,
I am writing to enquire ifThe Square Knot
maintains a list of addresses of former
residents. Specifically, I am trying to locate Lynn Whelchel. Would appreciate it
if you do have his address.
My transition from McGill to Southern Alberta has been an interesting one, and I
am enjoying my practice here. Hope this
finds you well and in good spirits. Kind
regards,
Bernie CosteI/o,M.D.
Editor's Note: Yes,we do keep a list of
Alumni and Dr.Welchel's address was sent
to Dr. Costello.
Dear Editor,
I wanted to write for several reasons. First,
I wanted to tell you how much I enjoy and
look forward to receiving the Sqare Knot
each quarter. It is clearly a labor of love
and serves to keep me constantly reminded of my great years in Montreal. The
second reason is to let you know about a
major life change for me and my family. I
have closed my plastic surgery practice
here in Sacramento to pursue a longstanding dream. We are moving to New
Zealand to start a big new adventure. I
will be a consultant plastic surgeon in
Christchurch and also have extensive
teaching responsibilities in the teaching
and residency program there. My new duties will commence on May 1st.
We are looking forward to our new life
and also the birth of my second child (a
girl!) which will happen in August. If you,
or any of my friends there find yourself
"way down under'; please let us know.
The south island of New Zealand
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(continued on pg.5)
..................................................................................................................
Dear Editor,
I wish to share a recent lighthearted story
with your readers.
Our residents in the research lab have been
doing not too badly collecting various prizes
(attached file). A few days ago, Derek MacDonald, an R3 in our residency program and
spending a lab year with me, was invited to
participate in the "McGill Graduate Biomedical Conference" to present a paper and
compete for a prize with other graduate
students and post-docs from biomedical
departments throughout McGill, from Cell
Biology, Genetics, Pharmacology, Physiology, Medicine, etc. Derek gave his 1a
minute talk, couldn't understand and got
bored of presentations by others, so he
walked out to have a hair cut. When they
announced he was the winner, he wasn't
there. But he sayshe is happy to accept the
$1,000 prize. I was also rather pleased that
a surgical resident from our Department
could beat doctoral students in basic sciences in presenting researchwork.
Ray Chiu,M.D.
NATIONAL/INTER-NATIONAL
WON BY MCGILL CARDIAC
RESEARCH
PRIZES
SURGERY RESIDENTS
YEAR
RESIDENT
PRIZE WON
1997
Julia Dorfman
Walter C Lillehei Residents' Research Prize (US)
American Association for Thoracic Surgery
1997
Marc Pelletier
Thoracic Surgery Directors' Association Prize (US)
Society ofThoracic Surgeons
Terrance Donnelly Prize (Canada)
University of Toronto
1998
Victor Chu
Thoracic Surgery Directors' Association Prize (US)
Society of Thoracic Surgeons
Walter C Lillehei Residents' Research Prize (US)
American Association for Thoracic Surgery
2000
Eddie Chedrawy
Walter C Lillehei Residents' Research Prize (US)
American Association for Thoracic Surgery
Terrance Donnelly Prize (Canada)
University of Toronto
2001
Bindu Bittira
Young Investigator's Award (US)
American Heart Association
Terrance Donnelly Prize (Canada)
University of Toronto
2002
Derek MacDonald
McGill Graduate Biomedical Conference Prize
McGill University
Montreal Children's Hospital Research Institute Prize
McGill University Health Centre
2002
Abdulaziz AI-Khaldi
Terrence Donnelly Prize (Canada)
University of Toronto
2002
Hilal AI-Sabti
Fraser Gurd Surgical Day - 2nd Prize
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THE SQUARE
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Dr. Catherine Milne and "The Patient Care" committee at the
RVHobtained approval so that nurses could be delegated certain medical acts and this led to the qualification of Critical
Care Nurses.
(GILL AND CRITICAL CARE
Do you remember as an intern in the 1960's going out on
Emergency calls with Royal or Murray Hill ambulances? Well,
"you have come a long way" since that time. McGill has been
at the forefront in Emergency, Trauma and
Critical Care since then.
Editorial
Just witness the pioneering work of the late Dr. Fraser Gurd
of the MGH on shock or the estqblishment of the first Canadian SICU at the RVH on 8-West Surgery by Dr. Lloyd D.
Maclean with Doctors John Duff and Peter Mclean working therein. Dr. Rea Brown started the ATLScourses at the
MGH and Dr. David Mulder was invited to give the Scudder
Lecture on Trauma for the American College of Surgeons in
1988 after setting up a Levell Trauma Center at the MGH. Previously, Dr. H.F. Moseley had set up an Accident Service at
the RVHand its Surgeons were giving courses to the Montreal
Police who staffed the ambulances.
McGill set up the first Postgraduate Training Program in Emergency Medicine in Canada (second in North America) which
became recognized by the Royal College. The first qualified
physician, Dr. Judy levitan, graduated in 1970. A second
graduate, Dr. Bruce Rowat, went on to head the Emergency
Department at the Toronto General
Hospital. The third year residency
(R-II bis) for extra training in Emergency Care for Family Physicians
was also begun at McGill.
We had a role to play in the founding of The University Association
for Emergency Medical Services and
The Society for Critical Care Medicine, the latter with the Anesthetist, Dr. Peter Safar, inventor
of the Safar tube. Our staff also
paved the way in the paramedical
field. There were developments
such as Intensive Care Modular
Ambulances and we had a role to
play in the establishment of the
Emergency Medical System (911)
in Montreal. The RVH trained Certified Ambulance Attendants in the
1970's and this led to paramedics
(EMTs) in the ambulances.
Recently, following the Bernier Report, the Quebec College of
Physicians, the Office des Professicns and the Ministry of
Health have announced plans to allow doctors more latitude
in delegating duties to nurse practitioners, auxiliary nurses,
pharmacists, ambulance paramedics, nutritionists, physiotherapists, and radiology technicians.
A government bill tabled on May 1st by Justice Minister Paul
Begin (who has jurisdiction over professional orders) and
Health Minister Fran~ois Legault, redefines the roles of
120,000 health workers in 11 professions (this includes doctors). Ambulance technicians, for example, will be able to
administer 5 medications: Salbutamol, Epinephrine,
Glucagon, ASA and Nitroglycerine.
This welcome new
"power" for paramedics is a far cry from when both ambulance attendants just sat up front in hearse-like transport
ambulances, and raced through red lights with siren blaring
on the way to the hospital.
McGill can be proud of its record in the field of Emergency
Primary Care.•
"It's not our policy to disclosedetails of a future operation."
- TheNew Yorker
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left Montreal several years ago as well Dr. Henry Korman
and Dr. Robert Levine have retired. We sadly note the passing of Dr. Bobby Rothstein and Dr.Allan Spanier since our
last report.
ince our last newsy letter in 1996, there have
been many changes in the JGH Department of Surgery. Our
physical teaching offices and clinics remain in the "A" pavilion
and we continually upgrade with up-to-date equipment. Over
the years the surgical staff has
changed considerably. The Division of General Surgery has
expanded with the recruitment of two new general surgeons, Dr. Anna Derossis and Dr. Gabriella Ghitulescu.
Both McGill grads have joined our group augmenting our
thrust in advanced laparascopic surgery, breast surgery and
surgical teaching. We wish them both the best for a long association with our hospital and McGill University. We have established a full-time surgical teaching office with secretariat
and a wonderful Surgical Education Resource room on the
fifth floor for residents and students.
News From The JGH
Dept. of Surgery
Richard Margolese continues to actively supervise the Oncology Service and is involved clinically with the breast cancer clinic that has been established at the JGH. Our part-time
staff includes Ben Mitmaker, Roger Fenster, Jeff Rivilis,
Arthur Freedman, Harry Glick, Issie Weissglas and Issie
Shanfield. Our full-time general surgical group is headed by
Harvey Sigman and includes Jacob Garzon as well as our
two new recruits. Colorectal Surgery has been significantly
strengthened by the recruitment of Julio Faria. Julio is a surgeon/scientist who has great potential to add to the academic lustre of this strong, busy and productive group headed
by Phil Gordon. Barry Stein and Carol Ann Vasilevsky
round out the group at the JGH and both have made significant contributions to the undergraduate and resident teaching programs at McGill. We also note that Dr. Steve Karp has
The Vascular Surgery group includes Daniel Obrand and
Nate Sheiner and we have added a third full-time recruit Dr.
Cherrie Abraham. We are delighted to welcome him to our
institution and McGill University. Our emphasis in Vascular
Surgery continues to be endovascular surgery.
The Plastic Surgery Division is active in head and neck reconstruction and breast reconstruction as well as a busy general
plastic service including a busy emergency room. We are active~y recruiting junior staff to compliment Tassos Dionisopoulos. We note with regret the passing of Dr. Maynard
Shapiro this past year.
Cardiac Surgery has expanded significantly. We have three
full-time cardiac surgeons, including McGill grad Felix Ma and
recent recruit Jean-Francois Morin joining Yves Langlois.
Cardiac Surgery is a priority service in our hospital. We have
recruited Christian Sirois to join Nate Sheiner in our Thoracic Surgical Division in collaboration with the division at the
MGH. This busy McGill service is re-organizing and we look
forward to progress in recruitment.
Ms. Judy Pollack remains as the executive assistant to the
Chief of Surgery. She looks after the departmental affairs with
good humour and wise counsel. The current departmental
Chief, Martin Black has fulfilled his mandate and at this time
there is a search for a Chief of Surgery at the JGH.
The Department remains committed to excellent teaching, the
best clinical care and a serious commitment to engage in ongoing clinical research.•
...............................................................................................................................
~
is one of the most beautiful places in the
Letters
Albert Guerraty. I also remember a bright, energetic, skinny kid
(cont'd from pg.2)
world and the people are lovely. With best wishes and
warmest regards
Howard Klein, MD
Scarborough, Christchurch, New Zealand
Dear Editor,
Thanks for continuing to send The Square Knot. My year as the
first postgraduate Vascular Fellow from 1987-88 at the RoyalVic
stands out as one of the most rewarding experiences and professionally advancing periods of my life. I especially remember
Drs.Jim Symes,Alan Graham, Normand Poirier,Nick Christou and
named Oren Steinmetz, M.D. who was my intern. Congratulations Oren!
I enjoyed private practice in Santa Monica, California after
leaving naval duty in 1991. I was recalled last year and was
proud to have been Battle Group Surgeon for USS Enterprise
in October in the Arabian Sea when Operation Enduring Freedom began. I am Chief of Vascular Surgery here at Naval Medical Center San Diego. I miss you all as well as the beautiful
city of Montreal. •
Capt. Stephen F. McCartney, MC, USN
San Diego, California
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THE SQUARE
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7
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has acquired a Masters in Epidemiology, and in December,Steven Paraskevas will complete and receive his PhD.
It appears at the Surgical Forum that research productivity is
declining. In fact, it is increasing as subspecialties in Surgery
create their own societies and our scientific productivity is
spread to many different Journals and presented at a wide variety of meetings. New knowledge and its creation is the
lifeblood of a Department. We are cooking with gas.•
...............................................................................................................................
·
·· Welcome
THERE HAS BEEN a significant re-organization of trauma care
Dr. Suneel Khetarpal joins
·
at the Montreal Children's Hospital under the leadership of Dr.
the General Surgery staff at
· Aboard
the MUHC (MGH site) as of
Kenneth S. Shaw, Medical Co-ordinator and Ms. Debbie
·
July 1,2002. He will round out
Friedman, Program Head. This resulted in the development
··
the present complement of
of one coordinated, patient and family focused interdiscipli·
general surgeons at the MGH
nary program which meets
·
·
dedicated to trauma and critineeds of all pediatric and
Trauma at the MCH the
·
cal care. A Canadian-trained
adolescent trauma.
·
general surgeon (Calgary,
· 1996), Dr. Khetarpal has completed
fellowships in Trauma
The MUHCTrauma/Neurotrauma Program achieved Accreditation from the Canadian Council on Health Services Accreditaand Critical Care in Minnesota. He returns to Canada
· Surgery
after having worked three years at the Fairview-University
tion (CCHSA) and was commended for its commitment to
· Medical Center in Minneapolis and the Regions Hospital in St.
providing quality care and service in the community. The
·· Paul, a Level 1 Trauma centre.
MCH-MUHC Pediatric and Adolescent Trauma Program re·
ceived the maximum 5 years designation as a pediatric and
· Dr. Cherrie Z. Abraham joins the Division of Vascular Surgery
adolescent trauma center. Its achievements and dedication to
·· at the JGH (with a cross-appointment at the MUHC) effective
trauma care were acknowledged by the Groupe-conseil min· July 1,2002. Dr.Abraham is a graduate of the Dalhousie Medisteriel en traumatologie. As well, the MCH was designated as
· ical School in Halifax where he also did his General Surgery
a Pediatric Neurotrauma Center of expertise for the province.
· training (1994-99). He then completed a Vascular Surgery Fel· lowship at the University of Western Ontario and an EndovasLast December the MCH opened a newly renovated trauma
· cular Fellowship in San Francisco and New York (Albert Einstein
resuscitation room. The new changes to the Crash Room fur· College of Medicine). It is expected that Dr. Abraham will in
ther enhance the MCWs availability and expertise as a
due course spend some time in Australia becoming familiar
trauma center .•
· with
and visceral aortic endovascular procedures that
·· he willcarotid
bring back to Montreal. •
·
Madeleine Beaulne
·
·
...............................................................................................................................
Division of
Plastic Surgery
~
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DR. CHEN LEE returns to McGill University as the new Chairman of the Division
of Plastic Surgery
Following completion of his medical degree at the University of Toronto, Dr. Lee completed his Residency in General
Surgery and In Plastic Surgery at McGill University (1992).
He went on to do a Clinical Fellowship in Adult Craniofacial
Surgery and also in Paediatric Craniofacial Surgery at the
University of Toronto. He is certified in Plastic Surgery
through the Royal College of Physicians and Surgeons,
Canada, and the American Board of Plastic Surgery. Following his Fellowships, he was on staff at the University of California, San Francisco as an Associate Professor in the
Department of Surgery. While at the
University of California, he was involved in research projects on Endoscopic Repair of Complex Zygomatic
Fractures; Endoscopic Repair of Condylar Neck Fractures; Construction and
Evaluation of a Totally Autologous Vascular Conduit.
Dr.ChenLee
A warm welcome is extended to Dr.Lee
and we look forward to his continued
contributions to the Division of Plastic
and Reconstructive Surgery at McGill
University .•
....
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the patient's current clinical situation to the available therapy. Once the therapy is delivered, close follow-up
by a trained heart failure team helps assure favourable outcomes. The effective care of these complex patients requires
total commitment by many dedicated individuals.
THE MCGILL UNIVERSITY MECHANICAL
CARDIAC ASSIST PROGRAM
At the MUHC,we currently offer four distinct types of pulsatile
cardiac assist devices, capable of supporting patients for extended periods of time. The Novacor LVASand the HeartMate
LVADare totally implantable, and powered via a percutaneous
driveline. The Thoratec VADis paracorporeal, with the blood
pump positioned externally on the abdominal wall, and the
inflow and outflow cannulas entering the mediastinum percutaneously. The Berlin Heart VAD,recently acquired in order
to bridge a 2-year old child at the Montreal Children's Hospital site, is implanted in a similar fashion. Both these latter
blood pumps can be adapted for uni- or bi-ventricular support. In addition, we are the first and currently the only Canadian program to enrol patients in the INTrEPID destination
LVADclinical trial, having successfully implanted two Novacor
systems for long-term use, as alternatives to transplant. We
have also developed a VADtechnical training program based
on a swine model, through which several Canadian centers
have been recently trained. In an effort to offer this technology to non-transplant cardiac centers, our future plans include the development of a hub-and-spoke network, whereby
patients in peripheral hospitals in need of mechanical cardiac
assist could be stabilized locally with the use of devices specifically designed for short-term use, then transferred to our institution for weaning, or bridging to transplant. We also have
commitments to participate in several upcoming clinical trials
to test innovative new blood pumps.
THE ROAD AHEAD
Mechanical cardiac assist technology will continue to evolve
towards permanent cardiac replacement. Improvements in
biocompatibility and in device-to-patient matching will lead
to more widespread application of this form of therapy and in
tandem with more conventional treatment plans, will form
the basis for a broader armamentarium in the management
of end-stage heart failure .•
...............................................................................................................................
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D'S'ON
OFVASCULAR
SURGERY
The Department of Surgery and Division of Vascular Surgery
saysfarewell to Dr. Ronald Lewis as he moves on to the University of Ottawa this summer. Ron has had a long history at
McGill University in the Department of Surgery. Ron originally
came from the West Indies to
Montreal back in 1960's where he
started his surgical residency training in 1968 at the Montreal General Hospital. After completing his surgical training in 1972 and a short stay back at
home, he returned to Montreal in 1974 and came on staff at
the Queen Elizabeth Hospital Department of Surgery, and 1987 he
became Surgeon-in-Chief at the
Queen Elizabeth Hospital.
Ron Lewis:
McGill to Ottawa
geons and vascular lab technicians from
three separate hospitals were integrated
at one site (Royal Victoria Hospital) and
molded into a cohesive group working
within the MUHC. He strengthened the
ties between the vascular surgeons at
the MUHC and the Jewish General Hospital and we now work closely together
with respect to clinical activities, the
Dr.Ron Lewis
vascular fellowship, and academic endeavors. Within the division, we will all
miss his steady leadership and depth of
experience. After his move, he will be particularly missed by
the large population of patients to who he is unfailingly dedicated. We wish him all the best in his future endeavors and
we will be keeping in touch .•
After the closure of the Queen
Elizabeth Hospital, he came over
to the MUHC - Royal Victoria
Hospital Site as the first chief of
the newly formed Division of Vascular Surgery. Ron has guided us
through our first five years as a
Division of the Department of
Surgery at McGill. Under his competent leadership, vascular sur-
Thanks to
Our Contributors
As a result of the Letter of Request for
Donations to the McGill Surgical Alumni
and Friends in the last issue of The
Square Knot, we are encouraged by the
response. We would like to extend our
thanks to all those who have sent us
funds and particularly the following
who have generously contributed
$100.00 or more.
fOM
Dr. Carlos Alvarez
Dr. Bernard J.F. Perey
Dr. Edwin Lafontaine
Dr. C. Barba
Dr. Susan E. Skanes
Dr. Ramesh lokanathan
Dr. S. Burwell
Dr. Emil Skamene
Dr. Lloyd D. Maclean
Dr. Richard Cruess
Dr. Judith Trudel
Dr. David S. Mulder
Dr. Robert A. Forse
Dr. Patrick E.Wherry
Dr. Jonah N.K. Odim
Dr. Jacob Garzon
Dr. Ian M.F. Arnold
Dr. Jorge Schwarz
Dr. Giles S. Hedderich
Dr. N. Belliveau
Dr. Roger Schwarz
Dr. Ahmed Jamjoom
Dr. David Andrew Cherry
Dr. Roger Short
Dr. David latter
Dr. Peter M. Feldman
Dr. Joseph Stratford
Dr. Guy Lemire
Dr. Fivos Gahhos
Dr. A. Turnbull
Dr. James R. Mackenzie
Dr. Robert B. Gledhill
Dr. Ihor A. Zakaluzny
Dr. Douglas J. Mirsky
Dr. John D. Hsu
Dr. Richard O'Connor
Dr. A.R. Ismail
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~ SAMPALlS, John, S.
FRSQ Chercheur-boursier "Senior; Clinique et Epidemiologie
TITLE: Evaluation of Trauma Care Services in Canada
DATE: July 7, 2002 - June 30, 2006
DESCRIPTION: The research that I will be pursuing during the
next five years will be a natural continuation and an expansion of the work that I have completed and initiated during
the last five to ten years. This work focuses on the evaluation
of trauma care services with a secondary focus on Surgical
Epidemiology.
During the next five years, my research will advance in the following directions: First, from a geographical scope the research will now evaluate trauma care services in Canada as a
whole and will establish the basis for international projects.
The following studies are included in this: 1. Evaluation of
the association between the degree of trauma care regionalization/integration and mortality and morbidity in patients
with major trauma. 2. Evaluation of the impact of trauma
hospital designation and characteristics on the mortality and
morbidity of patients with major trauma. 3. Evaluation of the
association between trauma patient triage and transport policies on mortality and morbidity of patients with major
trauma. 4. Evaluation of the association between the type of
pre-hospital trauma care and mortality and morbidity.
Second, from a content point of view, my research will evolve
with respect to outcomes assessed by studies that will evaluate the impact of trauma care on functional status, and quality of life. In addition, a series of studies will develop models
for health economic evaluation of trauma care.The population
studied will expand from the general urban population to specific sub populations including rural, geriatric and pediatric
patients. These are groups that have unique trauma Epidemiology and specific needs for trauma care. In collaboration with
surgical residents who are also my graduate students, I will
pursue the following studies that will address specific clinical
issues: 1. Evaluation of risk factors for hospital acquired pneumonia in trauma patients. 2. Assessment of risk profile for
thrombo-embolic events in trauma patients, and 3. Evaluation
of diagnostic assessment of the spine in trauma patients.
From a trauma care point of view, my research will expand in
the development of trauma patient triage algorithms and a
more focused comparison of paramedics, physicians and
emergency medical technicians in the pre-hospital management of trauma patients.
Third, from an implementation and dissemination point of
view, my research will evolve by introducing a National Canadian Internet Network for the exchange of information and
the implementation of trauma care evaluation that will be
based on common standards and methodologies. In addition,
through two program grants, I will participate in the development of a critical mass of trauma researchers in Canada as
well as in the training of new clinical and health service researchers.
In Surgical Epidemiology, my research will focus on advancing
my previous work on surgical waiting times. In addition, I will
continue my work on the evaluation of diagnostic methods
for breast cancer and outcome assessment for plastic and reconstructive surgery.
Funding for my research over the next 2-4 years has been received from the Canadian Health Services Research Foundation, one program grant and two operating grants from the
Fonds de la recherche en sante du Quebec (FRSQ).Applications
for funding of ongoing and related projects will be submitted
to the same agencies over the next 3-5 years.
SHUM-TIM, Dominique
FRSQ Chercheur-boursier
C/inicien Junior 7, Fondamental
TITLE: Contr61e de 10 circulation extracorporelle et de 10
protection cerebrale lars d'une chirurgie cardiaque chez Ie
nourrisson
DATE: July 7, 2002 - June 30, 2006
DESCRIPTION: My current research activity focuses on two
main areas. The first one is the Management of Cardiopulmonary Bypass and Cerebral Protection during Pediatric Cardiac Surgery. This research project basically brings our bedside
cardiopulmonary bypass protocols and studies them in a controlled bench-side experimental condition. As the outcome of
complex cardiac surgery is improving in the pediatric population, the neurological morbidity has become a prominent issue. This research is aimed at improving the quality of life and
social dependence of many of our patients following repair of
cardiac malformations. We have received our first peerreviewed Award, the Jonathan Bailon Award, from the Heart
and Stroke Foundation of Quebec in 2000. With this Award,
we have been able to continue our work which I have started
since I was in Boston and thus far, we have presented our work
at the Society of Thoracic Surgeons, the American College of
Surgeons and the American Heart Association. As a busy clinical surgeon, the Award from the FRSQundoubtedly provides
me with some protective time to continue my interest as an
academic surgeon. Hopefully, it will continue to help my lab
to achieve our goals.
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changes and microstructure implications to clinical
fracture healing. The general goal is to provide a more complete understanding of the bone at the fracture and nonunion
site. Microtopography and surface chemistry of the fracture
site both contribute to the physiological processes of fracture
healing. The relative contribution of these and other parameters is poorly understood. Clarification of these parameters
could have a huge effect on orthopaedic trauma care through
modification of treatment, implant design, implant type and
adjuvant therapy. Fracture modeling will be carried out to better understand fracture mechanics, fixation modalities and delineate treatment options at a fracture site (ultrasound
stimulation, distraction osteogenesis, synthetic graft and others) by developing a long bone model capable of reproducing
assorted fracture patterns. With the use of the fracture model,
the microtopographical structure of different fracture types
will be determined. This knowledge with cell culture data is
to determine which fracture types need more aggressive therapy such as operative treatment.
We should be able to determine which fractures need adjuvant therapy such as bone grafting or immobilization. We will
then examine coated and textured surfaces currently in common usage to supply some of the information needed to fine
tune management of fracture surfaces. Expense of bio-engineered morphogenic proteins and ingrowth lattices increases
the overall cost of grafts. Optimal dosage of microtopography
and surface chemistry has yet to be determined and the relative contribution at the level of the nonunion has not been
delineated. If this was evident the initial treatment of fractures can be changed to decrease the incidence of nonunions.
Cell culture studies will be carried out to evaluate the effects
of different surface topographies and materials on bone formation in vitro.
This project will have a direct impact on orthopedic trauma
care and could reduce the overall costs (hospital stay, reduced
surgery, and reduced loss of productive years) to the medical
system. Through cooperation with industry (surface analysis,
donated implants) there is an opportunity for direct technology transfer (manufacture of implants, design of implants).
This information could have a huge effect on orthopaedic
trauma care through modification of treatment, implant design, implant type and adjuvant therapy.
METRAKOS, Peter
FRSQ Chercheur-boursier
15
cliniden Junior 1, Fondamental
TITLE: Un modele in vitro de xenotransplantation
Ie role des eel/ules endotheliales
d'ilot:
DATE: July 1,2007 - June 30, 2004
DESCRIPTION: Xeno-transplantation
is seen as a solution to
the growing disparity between the lengthening waiting lists
for transplants
and the availability of donor organs.
Xenogenic islet transplantation may have two advantages
over the problems that have been encountered with whole organ xenotransplantation.
(1) Primarily vascularized
xenografts, including whole pancreas, are destroyed first by
hyperacute rejection (HAR), which is not yet preventable by
treatments sustainable in clinical use. HAR is a vascular phenomenon resulting from the fixation of complement by
xenoreactive natural antibodies (XNAs) that bind to carbohydrate determinants on cells of the graft; particularly its vascular endothelial cells (ECs). Cellular xenografts, such as
pancreatic islets, are vascularized by the ingrowth of host vessels and are therefore not susceptible to XNA-mediated endothelial damage.
The principle target for HAR is the
Gala(1-3)Gal epitope whose expression is diminished on islet
cells and, therefore, appear not to generate as severe an HAR.
(2) Islets offer the opportunity for in vitro pretransplant modification. Islet endocrine cells have a low inherent immunogenicity; therefore careful choice of isolation techniques can
exclude those cells that are important for the initiation of a
rejection response such as macrophages, dendritic cells and
endothelial cells. In vitro culture of islets also offers the opportunity for transfection of genes that can modify the rejection process.
PHILIp, Anie
FRSQ Chercheur-boursier
"Senior; Volet fondamental
TITLE: Caracterisation de /'action du facteur de croissance
transformat-fJ (TGF-fJ) dans les eel/ules de la peau
humaine
DATE: July 7,2007 - June 30, 2004
DESCRIPTION: Impaired healing and hypertrophic scarring are
major medical problems with no satisfactory treatments. The
efficacy of topically administered transforming growth factor-b
(TGF-b) to promote wound healing is well documented in animal models. However, clinical results in humans have been
discouraging, possibly due to the inappropriate timing of administration or the unavailability of the delivered factor. An
alternative would be to manipulate the action of endogenous
TGF-b locally using regulatory molecules. Thus, my
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Dr. Jacques (orcos, Chief of the Department of Urology at the JGH,had the honor
of being invited to a number
of speaking engagements: /.
In November, he gave a talk
at the Asian Surgical Association Meeting on the Pelvic
Floor. In Shenzen, China, he was a
member of a workshop in Urodynamics and in Xian and Beijing, he spoke
about Minimally Invasive Surgery to Treat
SUI. Last March in Montreal, he spoke to
approximately 100 participants in the
McGill Geriatric Medical Course for Practitioners on TheAging Urinary Tract. In April,
he addressed a group on the following
subject La Readaptation: L'integration de
connaissances pour une clientele camplexe.
In May in gave two talks, one in Quebec
City as the invited guest speaker entitled
Mise a jour sur Ie traitement dessymptomes
de /'appareil urinaire inferieur and in Vancouver he spoke to the American Spinal
Cord Injury Association Meeting on Intrathecal Clonidine.
also been appointed an External Reviewer for the Alberta \
Heritage Foundation for Medical Research. His two recent
publications are as follows:
Yuan ZQ, Gottlieb B, Beitel
LK,Wong N, Gordon PH, Wang Q, Puisseux A, Foulkes WD, Trifiro M. Polymorphisms and HNPCC:PMS2 - MLHI.
Protein Interactions Diminished by Single
Nucleotide Polymorphisms. Hum Mutat
2002;19:108-113. Andermann A, Thiffault I. Wong N, Gordon PH, MacNamara E, (hong G, Foulkes WD,
Percesepe A, Ponz de Leon M, Peltomaki P. Multimodality molecular screeing is required to improve the sensitivity of
MLHI and MSH2 Mutation Analysis. J Clin
OncoI2002;20:1705-1707.
Dr. Jean-Martin Laberge participated
in several conferences and presentations
early this year. February 18-21 in Nice,
France he attended the International
Congress on Pediatric Pulmonology
(ClPP-V) and was asked
to chair a Symposium on
"Congenital Pulmonary Anomalies': He gave a presentation on
The Management of Asymptomatic Congenital Lung Lesions.
Dr. Laberge was invited as Visiting Professor at British Columbia Children's Hospital,
""--.)
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17
Vancouver from April 11-12. He presented at Surgical Grand Rounds The
Effects of Fetal Tracheal Occlusion and Release on Lung Growth and Function in the
Ovine Congenital Diaphragmatic Hernia
Model. This year the Children's Oncology
Group Meeting (COG) was held from
April 23-27 in Jacksonville, Florida. He
was part of the Surgical Discipline Committee and presented Nephroblastomatosis: A Concept Study. This will form
the basis for a prospective study. Also,
Dr. Laberge has been appointed as a
member of the Comite de la remuneration of the Quebec Association of General Surgeons.
Dr. Antoine Loutfi of the MUHC (RVH
site) was the moderator of a seminar on
Cancer of the Breast at the meeting in
Hull of the Quebec Association of General
Surgeons during the week-end of the 25th
of May. Antoine has also been named to
the Board of Directors of the Canadian
Network for International Surgery.
Drs. Peter McLean and Tarek Razek
represented the C.N.l.S. as observers at a
course on Essential Surgical Skills for
Graduating Doctors from May 3'dto 14that
the Goudar Medical School in Ethiopia.
There are three medical schools in
Ethiopia - the other two are in Addis
Ababa and the Jimma Insti~
We congratulate Dr. Helene Flageole
who has been appointed as Associate Professor of Surgery, McGill University.
i r
Dr. Philip H. Gordon of the JGHwas presented with the Dr. Carl Arthur Goresky
Memorial Award in recognition of
his dedication and outstanding
contributions
to Inflammatory
Bowel Disease. This was with the
McGill Inflammatory Bowel Disease
Research Group last April. Philip has
1
Dr.TarekRazekwith Surgery students in Ethiopia.
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Dr. Nancy Morin will be going
to the Cleveland Clinic for a Fellowship in
Colorectal Surgery.
Surgery Research Council
held in Boston, Massachussetts in April, Dr.
Parker won the Clifford
Synder Prize in Plastic
Surgery. Her presentation
was entitled Endoglin is Expressed on Human Chondrocytes and
Forms a Heteromeric Complex with 8etaglycan in a Ligand and Signaling Receptor Dependent and Independent
Manner. This work was done with Dr.
Anie Philip in her laboratory at the MGH.
Dr. Andreas Nikolis has two papers
which were presented in May at the World
Health Organization's 6th World Conference
on Injury Prevention and Control. These
were entitled as follows: Nikolis A, Zerey
M, Liberman M, Mulder OS, Brown R,
Sampalis JSAssessment of Risk Factors in
the Development ofThromboembolism in a
Trauma Population. The second paper by
Nikolis A, Zerey M, Salasidis R, Gursahaney A, Chaudhury P, Mulder OS, Flesizer 0, Sampalis JS was entitled
Evaluation of Peripherally Inserted Central
Catheter Placement in a Critically InjU~~d
Population.
Dr. Wendy Parker, Plastic Surgery
6:
resident working on her Ph.D. with Dr.
Anie Philip, was the recipient of this year's
Benjamin Shore Prize in Plastic Surgery.
At the recent meeting of the Plastic
of his two year Fellowship on July 1st,
2002. This past year, he has been doing
his research year in Transplantation and Hepatobiliary Surgery and received
the Canadian Society of
Transplantation Trainee Award
for 2002. He completed 3 manuscripts
along with 9 abstracts accepted and gave
3 oral presentations .•
Congratulations to Dr. Jose Pascual of
General Surgery and to his wife Do~ minique on the birth of their
~
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Jf) first born son Mateo Paul Pas'h cual born May 18th and
~r
weighing 7 pounds, 5 ounces.
Dr. George Tzimas of our Transplant Program is the recipient of the Dolgin and
Cohen Fund for Transplant and Hepatobiliary Surgery. He begins the clinical year
Mateo Paul Pascual
...............................................................................................................................
"You'll feel better when you see the doctor. "
- TheNew Yorker
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Nina (Ordas) Davies obtained a Bachelor of Science with
honors in Biology (1994) from the
University of Western Ontario. She
received her MD from the University
of Ottawa in 1998. She joined the
General Surgery Program in 1998
with an interest in Trauma and Critical Care. Congratulations to Nina and John Davies who got
married in Dec 2001.
Nairn Otaky is originally from Dubai. He is a graduate of McGill. He obtained his B.Se.in Psychology
with first class honors in 1994. He received his MD
in 1998. He joined the General Surgery Program in
1998 and is planning a career as a Community General Surgeon.
Michael Tan is a Graduate of
McGill. He obtained his B.Se.in Microbiology and Immunology in
1992 with great distinction and a
university scholarship. He received
his MD in 1996. He joined the General Surgery Program in 1996 with
a special interest in Transplantation.
He completed his M.Se. Degree in Transplantation.
ORTHOPEDIC SURGERY
Program Director: Or. Michael Tanzer
Kevin Draxinger, our former Olympic swimmer
who has not seen a pool in the past 5 years, is the
pride of Kelowna, B.C. Kevin arrived at McGill as a
whirlwind, but the storm has been calmed by something even more powerful, Hurricane Sarah. Next
year, he will be pursuing a Spine Fellowship at John
Hopkins. We wish him all the best dodging bullets in
Baltimore.
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Farhad Moola, born of Indian and
Irish parents and separated at birth
from Milan, Farhad was banished to
Prince Albert, Saskatchewan. After
an unfortunate stint in Family Medicine, he was reunited with his long
lost brother in the wonderful world
of Orthopaedics. Farhad heads off to
Vancouver next year to pursue a Fellowship in Sports Medicine,
where he will be reunited with another old friend, Peter Guy.
Dr. Mohammed
Nahhas is a
native of Saudi Arabia, where he
completed his medical school training. Dr. Nahhas received his medical
degree from the King Abdulaziz
University in Jeddah and then went
on to complete a one year internship at the King Fahad Hospital, also
in Jeddah. He had begun residency
training in General Surgery at the King Khalid Hospital in Jeddah before joining the Orthopedic Surgery Residency Program
here at McGill in 1998. Dr. Nahhas is married and the proud
father to a beautiful baby girl.
Andy Pickle born on the Rock and raised
in a potato barn, this rambunctious redhead enjoys Screech, codfish, and minigolf. He has recently discovered the world
of the internet and is learning now to finger type. After completing his seven year
residency at McGill, Andy will be pursuing
a research fellowship in the sports in Ottawa with his true love, CH.
Milan Sen, born of Indian and
Irish parents, "Luc" came to Montreal on the boat from England in
1975. He is our international man
of mystery who prides himself on
supporting the local fashionistas.
Future career paths take Milan to
Louisville, Kentucky to pursue a
Hand Fellowship and hopefully be a competitor in the championship tractor pull.
Monika Volesky, the Czech chick from
Montreal, affectionately known as "Monster'; is the only narcoleptic to successfully
complete an Orthopaedic residency program. Indeed, she has proven that she can
operate with her "eyes wide shut': Monika
will pursue a Sports Fellowship in Ottawa
where she will learn how to treat her many
Volleyball and Hockey injuries.
PEDIATRIC SURGERY
Program Director: Or. Jean-Martin Laberge
Dr. loana Bratu was born in Romania and immigrated to
Canada with her parents at 10 years of age. She completed
undergraduate studies and medical school in Edmonton, graduating first in her class and accumulating many
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Looking back .... The Current Site of
The Montreal General Hospital
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Top 10 Caddy
Comments
o
Golfer: "Please stop checking your watch all the time.
It's too much of a distraction':
Caddy: "It's not a watch - it's a compass':
o
Golfer: "How do you like my game?"
Caddy: "Very good sir, but personally, I prefer golf':
~ Golfer: "Think I'm going to drown myself in the lake':
Caddy: "Think you can keep your head down that long?"
o
o
Golfer: "I'd move heaven and earth to break 100 on this
course':
Caddy: "Try heaven, you've already moved most of the
earth':
@) Golfer: "Do you think it's a sin to play on Sunday!"
Caddy: "The way you play, sir, it's a sin on any day':
Golfer: "Do you think my game is improving?"
Caddy: "Yes sir, you miss the ball much closer now':
f} Golfer: "This is the worst course I've ever played on':
Caddy: "This isn't the golf course. We left that an hour ago':
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Golfer: "Do you think I can get there with a 5 iron?"
Caddy: "Eventually':
Golfer: "You've got to be the worst caddy in the world':
Caddy: "1 don't think so sir. That would be too much of
a coincidence':
AND the
#1
best caddy comment:
Golfer: "That can't be my ball, it's too old':
Caddy: "It's been a long time since we teed off, sir':
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We are well aware that as a surgical specialty we cannot work in a void. Our clinical success relies heavily on every
link in the managing chain of our patients. We require a specialized and dedicated medical team, nursing team and auxiliary team to manage our challenging cases. That chain starts
from our secretaries that manage our time and mans the
phones trying to sort out which patients need to be seen urgently or not and our long waiting list; to the nurses in our outpatient department educating our patients for their up-coming
surgery; to the internist, cardiologist and anesthesiologist that
ensure that our patients are medically fit to undergo major
surgery; to the orderlies that help us position our patients in often challenging positioning on the operating room; to our dedicated ORstaff that need to be knowledgeable on the ever more
complex spinal instrumentation; to our intensivist and to our
nurses on the ward who care for our patients post-operatively;
and finally to our physical therapist that rehabilitates our patients to normal activity.
Each of the MUHC facilities has
been upgraded and renovated and continue to be modified - so
that we can provide the best care
we can under the circumstances.
None of our original buildings, renovated spaces or additions
were designed to accommodate this immense volume of traffic.
When the Vic opened its doors in 1893, its total floor space
was 180,000 square feet, and there were 14 medical staff to
treat the 1,500 in-patients and 4,800 out-patients, who came
there that year. Today, the MUHCfacilities take up 3.4 million
square feet; we have 11,000 people on staff and our patients
open the doors of our facilities nearly 1 million times every
year. More than 900,000 of these patients walk in and out
again the same day.
And none of them were built to support the large and heavy
equipment that's needed for surgery and diagnosis and
treatment.
Let me put this in perspective - we've gone from a 1 to 3 ratio of in-patients to out-patients to a 1 to 30 ratio. Three thousand people, many of them needing high-tech specialized
treatment, come into our hospitals and go home the same day.
Every day - 365 days a year.
Editor's Note:
Philip O'Brien, board member of the McGill University Health
The MUHC Move:
A Perspective
Without their help, our group would not exist.
Well in brief, that is what the McGill Orthopedic Spine Group
is all about. We are striving toward providing cutting edge
spinal surgery to patients in the greater Montreal area and
across North America. Our next project is to expand our field
and to include artificial disc replacements. Two members of
our group are soon going to Europe to acquire expertise on
this technique .•
None of them were designed to manage the patient flow
needs of our hospital today.
In any other working environment what we are asking our
people and facilities to do is unacceptable. And the question
is not whether we can afford to build this new hospital, but
whether we can afford not to.
-
Philip O'Brien
Centre Development Corporation and Chairman and CEOof Devencore, speaking to a room full of people at a breakfast organized by the Board of Trade of Metropolitan Montreal
entitled Healthy Opportunities for Montreal .•
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Visiting Professors
Stikeman
Visiting Professor
MAY 2 - 3, 2002
DI.mando
Ortiz-Monas
••riowas theVisit-
ing Professor to the Plastic Surgery Division at McGill University, April 24-25,2002. Dr. Ortiz-Monasterio is the Emeritus
Professor, Universidad Nacional Autonomas de Mexico. During his visit, he gave two presentations on The Problem
Rhinoplasty and Modern Management of Complex Craniomaxillofacial Deformities in Children and Adults.
..........................•...............•...............•......
Flanders
Visiting Professor
OR. WILLIAM SASSER
APRIL 78,2002
CHARLES MARTIN AMPHITHEATRE - MCINTYRE BUILDING
This year, Kappy Flanders instigated an awareness program
for lung cancer patients to coincide with the Flanders Visiting
Professor. The Visiting Professor was Dr. William Sasser who
is currently Chief ofThoracic Surgery at St. John's Mercy Medical Center in St. Louis, Missouri. He discussed The Current Application of PETScanning in the Management of Lung Cancer.
The program, Community Forum: Treating Lung Cancer
in the 21" Century [Up in Smoke: Exploding the Myths of
Lung Cancer], for the education or increased awareness in
lung cancer for the community at large was sponsored by
Bristol-Myers Squibb and Aventis. Speakers included Dr.
D. Mulder (Chief, Cardiothoracic Surgery MUHC), Dr. J. Gruber (Pulmonary Oncologist MUHC), Dr. L. Ofiara (Medical
Oncology), Dr. L. Souhami (Radiation Oncology), and Dr. W.
Sasser (Visiting Professor) who gave the medical perspective. Mrs. Doreen Jones (Living with Lung Cancer) and Mrs.
Kappy Flanders (Affected by Lung Cancer) gave the patient
perspective.
The goal of this Community Forum was to highlight the many
options for treating lung cancer and by so doing, dispel some
of the many myths surrounding lung cancer.
EKL
Dr. Alain Carpentier, Professor of Cardiovascular Surgery
from the University of Paris, was this year's Stikeman Visiting
Professor for the Division of Cardiovascular and Thoracic
Surgery at McGill University.
At Surgical Grand Rounds at the MGH on Thursday morning,
Dr.Carpentier gave a very well received talk entitled What Remains To Be Discovered. Following Rounds, laboratory and
clinical presentations were given by residents, staff and
alumni. During the luncheon, Dr.Carpentier had the opportunity to meet with residents and staff .
A banquet was held Thursday evening in honour of the Visiting Professor and the graduating resident, Dr. Stephen
Korkola, at the University Club.
On Friday morning, clinical presentations by alumni, faculty
and residents took place at the RVH followed by a luncheon.
It was a pleasure to welcome Dr.Carpentier, a world renowned
cardiac surgeon and teacher, as the 35th Stikeman Visiting Professor along with many of our Quebec French colleagues who
attended the two-day events .•
EKL
.........................................................
It
is
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but it is
more important
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