t McGill Unive"ity, there has always been a strong emphasis placed on Abasic laboratory research in all aspects of and this has been clearly evident in the new and developing field of microsurgery. Following completion of my and residencies, I was awarded The Birth and Growth a McLaughlin Travelling Fellowship and I had the opportunity of visiting many of the of Microsurgery leading Plastic Surgery Units in England, at McGill Unviersity Europe, and Russia. The year was 1961- 62 and there was clear evidence of the influence of such pioneers as Gillies, Maclndoe, Kilner, and Mowlem in England; Gibson and MacGregor in Scotland; Fogh-Andersen in Denmark; Ragnall and Skoog in Sweden and Limberg in Russia. Numerous innovative techniques in Reconstructive Plastic Surgery were seen in all centers demonstrating a great variety of tube pedicles; single and multi-pedicled flaps; and, a variety of rotation, transposition and cross leg flaps. Everywhere, the circulation of skin flaps was discussed in all of its ramifications although there was no thought at that time of transferring tissue using direct vascular repairs.

EARLY INTEREST IN MICROSURGERY My return to McGill University following the McLaughlin Travelling Fellowship was in 1962 which was one year after the appointment of Dr. H. Rocke Robertson as Surgeon-in-Chief at the Montreal General Hospital and Professor of Surgery at McGill University. All new faculty members at that time were encouraged to participate in basic bench and labora- tory research and I was no exception. A major interest at that time was the circulation and assessment of viability in shifted skin flaps and its alteration following injury such as avulsion or compression. As the Hosmer Research Fellow, my first experiment was the use DEPARTMENT OF SURGERY of fluorescein in evaluation of flap viability following elevation and its changes following NEWSLETTER avulsion from the underlying bed or those following compression. Some years later, fluo- rescein became extremely popular as an aide in assessment of flap survival. ~ McGILL UNIVERSITY

(Please see Microsurgery on page 4) FALL 2007 ...... Letters to the Editor 2 Welcome Aboard 11 = Editor's Note 3 Summer BBQ's 12 -- ...... ~ r:::::L'" Green Light to a Cure 7 Visiting Professors 14 ...... ···································8····· Obituaries tD History of Bariatric Surgery 16 ...... Kudos, Achievements and 10 HistoryofSurgery: .. 18 THE SQUARE z:00: ~ 2 Dear Editor, Here is a picture of our new addition. She was born on July 18, and weighed 61b 15 oz. Baby Jaya is doing well and is a very good baby for the most part. It ? Letters is amazing how our to The Editor lives have already changed so much in just a few weeks. All of a sudden, our new addition has made us feel like residents all over again! Both Dr.M. S. Chughtai with colleagues, 7968. Derek (MacDonald) and I are happy for the change, however. invasive and robotic techniques which Talat S. Chughtai MD, MSc, FRCSC Clinical Associate - hopefully will serve me well in the future. Derek and I are very happy here in Sudbury. Department of Surgery I just wanted to say thank you to all Please give our best to everyone back at Sunnybrook Health Sciences Centre the people at McGill who helped me McGill. throughout my residency. Editor's Note: Both Dr. Talat Chughtai Bindu Bittira, MD Warmest regards, Sudbury Regional Hospital, Sudbury, ON and his father were alumni of McGill Caroline Teng, MD, FRCSC Surgical Residency Programs. Cardiac Surgery Fellow East Carolina University Greenville, N( USA

Dear Editor, As always, I greatly enjoyed reading The Dear Editor, Square Knot. I was particularly interested I received the summer issue of The and pleased to read the excellent account Square Knot and found it interesting and of transplantation at McGill by Steven informative. I read with great interest the Paraskevas. It's a long and complicated history of transplantation at McGill and story and I would like to offer a couple of it brought back great memories. There is, Editor's Note: Bindu Bittira and Derek corrections. however, a significant error that should be MacDonald met while they were both corrected. The claim is made that Maclean undertaking cardiac surgery residency The heart transplant done by Dr.Dobell in and Dobell did the first heart transplant training at McGill. 1968 was the first at McGill not the first in Canada in 1968. The first one was done in Canada. Drs DD Munro and Jack White in Toronto at St. Michael's Hospital. The did the first lung transplant in Canada Montreal Heart Institute did, I believe, and Jean-Guy Beaudoin did the first liver seven heart transplants before Dobell and Dear Editor, transplant at McGill. Maclean did the first one at the Royal I enjoyed the last issue of the Square Knot. Sincerely yours, Victoria Hospital on November 3, 1969. With respect to the Transplant article, you L.D. Maclean, MD, PhD I gave the anesthetic to the recipient mentioned that the first heart transplant while Dr. Germaine Houle looked after performed by Dr. Dobell and team. I am the donor .1 remember the date because attaching a picture showing Dr.Dobell, my it was my Mother's birthday and I had Father (Dr. MS Chughtai) 1st assisting, Dr. Dear Editor, to call her to say I would not be home Mclean (2nd assisting), and Dr. Vineberg Just a short update from North Carolina. for her party. The transplant team had (watching from behind the anesthesia I am having a great time operating with been looking for a donor for quite a few drapes). Perhaps you could include this Dr. Chitwood. He is an excellent teacher weeks. On Saturday, November 2, 1969, picture in a future issue. and more than generous when it comes I was giving an anesthetic for a kidney Thanks very much. to letting us operate. It is an excellent transplant and was told another potential opportunity to learn some minimally (Please see Letters on page 75) ~ THE SQUARE ~ ~ 3 internationally. Dr. N.V. Christou, the first president of the Canadian Association of Bariatric Physicians and Surgeons, also provided a superb description of McGill bariatric surgery in this issue. We feel such stories can bolster our pride and identity, excellent lead artieie in the last issue of The and encourage the younger generations to carryon with our TeSquare Knot (Summer 2007), on the history of Multi-Organ tradition of excellence. Many of you had contributed, or are Transplant Program at McGill by Dr. Steven Paraskevas, doing so at present, to the legacy of surgery at McGill. Thus we was very well received, as can be seen like to invite you to participate in this endeavour by submitting in the "Letters to the Editor" section in articles, documenting the development in the art and science Editor's Note this issue. We are particularly pleased to of surgery at McGill, in the specific area of your own interest. receive feed-backs from the pioneers who Your vision for the future will also be welcome. personally contributed to the memorable g:, '< achievements described in that artilce. Some of the corrections In fact, we wish to encourage even broader feed-back from our ::00 offered in these letters confirmed my suspicion that unless readers. Do you have any suggestions to improve The Square '<'" ~ such historical events are documented properly in time, some Knot? How can we make The Square Knot more relevant, fun, 1"'\ ~:::r. of the valuable information may be lost or distorted for the and useful in promote our collegeality, the raison detre for this s: future generations. publication? • ? ~ In the lead article of this issue, Dr. Bruce Williams tells us !;::I about the history of microsurgery at McGill. He has been not only a pioneer, but also a nurturer in this field, both locally and ......

Announcements Dr. Helene Flageole joined the Pediatric General Surgery Service in 1995 and remained a valued colleague and surgeon until her departure in August 2007. For family reasons she has To him who devotes relocated to Ontario and is now Professor of Surgery at McMaster Chidlren's Hospital. We wish her much successand his life to science, happiness. nothing can give more happiness

As of September 2007, Dr. Irwin Kuzmarov has been than increasing the number \ J" ~~ , " ~~Jf~j.!' appointed Director of Professional and Hospital Services at of discoveries, ~\\"Ii~~ the Santa Cabrini Hospital in Montreal. Dr. Kuzmarov has but his cup of joy is full spent the last 30 years as Urologist at the Lakshore General Hospital. when the results of his studies immediately find Dr. Lawrence Rosenberg, Professor of Surgery at McGill University, has been practical applications. appointed as the Chief of Surgical Services - Louis Pasteur (7822-1895) at the Jewish General Hospital in Montreal, In "Free Lance of Science': a major teaching hospital affiliated with the McGill University Faculty of Medicine. He is also the Director of the Division of Surgical Research at McGill. •

Dr. Lawrence Rosenberg THE SQUARE z::0: !a 4 ~ RABBIT TRANSPLANTS USING AN OXYGEN- VISIT OF MAINLAND CHINESE SURGICAL DELEGATION ATOR During this research year, interest was directed TO MCGILL UNIVERSITY (1973) toward the microcirculation and blood vessel flow was studied At the same time of our laboratory development, we had both in small arterioles and venules of the mesentery and the the pleasure of hosting a large delegation of Microsurgeons rabbit ear. It was known that small composite grafts would from Mainland China. This visit was initiated by Dr. Martin survive by inhibition for a few days but larger grafts would Entin, an active participant in the Plastic Surgery Program be lost. With this knowledge, it was thought then to trans- at McGill University, and was partly due to the important plant rabbit and to maintain their microcirculation using relationship of Dr. Norman Bethune to Chinese medicine a miniature artificial respirator with in the '30s and '40s. infused oxygenated glucose so that the Microsurgery amputated part could be preserved until Among the visitors were Professor Chen Chung-Wei from continued from page 7 it developed its own circulation from the the 6th Municipal Hospital, Shanghai, and Dr. Cheng Hsu-hsi recipient bed. Dr. Ellen Gordon, a Bio- from The Chi Shui Tan Hospital, Beijing. The Chinese surgeons chemistry Researcher at the McGill University Medical Clinic, related their experience on digital replantations listing their was involved in perfusion of liver tissue using a miniature early failures but as their technique improved, a number of oxygenator. Using this apparatus, I was able to preserve rabbit remarkable successesresulted which led to the development of ear transplants for several days while infusing them oxygen the microsurgical field in their country. Soon after the Chinese passed through a physiological solution. However, most of the visit, we were successful at McGill in the transplantation and ears would eventually necrose, probably related to an infective replantation of several amputated digits as well as larger process at the site of fluid infusion. Needless to say,it became segments in the upper and lower extremities. A second Chinese evident that permanent survival would result only with direct medical delegation visited McGill University in January, 1981. vessel repair. CIRCULATION OF THE SKIN AND FREE FLAP TRANSFERS SMALL VESSEL ANASTOMOSES As our experience in microsurgery continued, the major Several stapling devices had been developed in the early emphasis of our research laboratory was directed toward '60s for repair of small blood vessels. The Nakayama stapler the development of these techniques. Dr. Rollin K. Daniel from Japan was used widely in clinical cases for transplant- participated with me in microsurgical research with a study of ing jejunal segments in head and neck surgery. About the free flap transfers by direct suture of the feeding and same time, the Vogelfanger stapler was under development using microsurgical techniques. Both the microscopes in the National Research Council, Department of Health and themselves and the instrumentation and sutures were rapidly Welfare, Ottawa, Canada. I visited their laboratory and was improving and in this experiment, free flaps were transferred able to obtain one of their staplers for repair of vessels in in the pig model, both on the abdomen and flanks and from the range of 1.5 - 2 mm. in diameter. The Nakayama stapler the trunk to the lower extremities. It was remarkable to see was also quite successful in repairing vessels of this size the survival of full thickness flaps following restoration of but smaller vessels had lower patency rates. Using a bench their circulation and there was always excitement when the microscope, I was able to compare the repair of small vessels flap returned to its normal colour following release of the using this stapling apparatus and by direct suture of the microsurgical flaps. This experimental work was awarded vessels using magnification. Despite the rather crude in- the James Barrett Brown Prize in Plastic Surgery for the most strumentation and the limited magnification, our early series significant publication in the Plastic Surgery literature in 1973. showed an improved patency rate in both small and Following his laboratory experience, Dr. Daniel travelled to using direct suture techniques when compared with Australia and while working with Mr. Ian Taylor, performed the stapling devices. This was particularly true for vessels the first free flap transfer from the groin to the lower limb in with a diameter of 1 mm. or less. a young patient with complex fractures and soft tissue loss using the knowledge gained from the experimental labora- Nerve repairs under the microscope were also practised in the tory. The background preparation for this landmark case was laboratory and Dr. Michael Orgel participated as a research developed within the research laboratory at the Montreal fellow and studied the return of sensation in free skin grafts using General Hospital. a direct counting technique of the regenerating nerve fibers. MICROSURGICAL NERVE RESEARCH Earlier interest in the reinnervation of skin grafts prompted further investigation into nerve injury and repair. ~ THE SQUARE :00:::z ~ 5 ~ Dr. Julia K. Terzis joined the laboratory and partici- Dr. Jeffrey Khoury has been a significant contributor to the pated over a two year period and was successful in obtaining teaching of residents particularly in microvascular techniques her Ph.D. in Experimental Surgery. Dr. Terzis developed an and in the management of patients following trauma. He elegant electrophysiological technique and was able to pro- participated as a Fellow in the Experimental Laboratory duce a mapping procedure by direct stimulation of the nerve's and obtained his M.Sc. in Experimental Surgery with some components and the contributions of each segment with their excellent work on the vascularization of free bone grafts using distribution. Functional recovery of free muscle transplants microsurgical techniques. was also carefully investigated using microsurgical techniques and the importance of tension was clearly elucidated. The Visitors from other countries have made several contributions to research protocol was also directed toward functional recovery our laboratory and to microsurgery in general. These include in free muscle transplants using microsurgical anastomoses Drs. Marlise and Luis Bueno from Brazil; Dr. Edie Gaetano from with the assessment of factors such as muscle length follow- Brazil; Dr.Koichi Nemoto and Dr.Masatoshi Amako from Japan. ing transfer, tension, muscle force measurements and cellular recovery. Dr.Terzis was awarded the Medal in Surgery by the FURTHER CONTRIBUTIONS BY MEMBERS OF PLASTIC Royal College of Physicians and Surgeons, Canada, for her SURGERY ATTENDING STAFF work in the laboratory and she has continued to be a major Dr. Lucie Lessard completed her training in Otolaryngology contributor to the microsurgical field. at McGill University and obtained her FRCS(C)in that specialty. Dr. Lessard finished her two year Residency in Plastic Surgery INTERNATIONAL SYMPOSIUM ON SUTURES at the Peter Bent Brigham and Children's Unit in Boston. She IN WOUND REPAIR has brought back a skilled expertise in the management of In 1972, I was invited to participate in an International Sym- craniomaxillofacial abnormalities and in reconstructive surgery posium on Sutures in Surgery and I had the unique oppor- of the facial and skull area. Dr.Lessard also has a major interest tunity of participating in this interrelationship between the in basic laboratory research and continues in her investigation various surgical specialties. My portion of the program was of steroid effects in wound healing, leech therapy and distrac- directed toward the newly developing field of microsurgery. tion osteogenesis for treatment of severe facial deformation. My presentation was entitled "The Shifting of Experimental On the clinical side, Dr.Lessard continues to provide her surgical Skin Flaps on Microvascular Pedicles" and at that time, it skills to the management of skull base tumours, as well as the received a great deal of interest from all of the participants entire field of microsurgical reconstruction. She is a member in this Symposium. The question that was raised during my of the combined McGill-University of Montreal Provincial Re- presentation was as follows: "Would it be possible to utilize plantation Program. All patients in the province with digital such excellent pedicles or similar tissue based on a known or other are referred to this Center. blood supply and transfer them to other areas of the body by direct microvascular anastomoses to vessels at the recipient Dr. Ronald G. Zeit is a graduate of the McGill Program and site?" This question was to be quickly answered and the ex- he spent an additional year in a fellowship with Mr. Ian Taylor plosion of microsurgical techniques with free tissue transfers at the Royal Melbourne Hospital in Australia. Dr. Zeit's main of skin, nerve, muscle, bone, and composite tissue was soon interest is in surgical education which followed a one year evident throughout the world. fellowship at the University of Southern California where he obtained his Master of Education Degree in that area of interest. THE YEARS THAT FOLLOWED Dr. Zeit has become an important contributor to curriculum Numerous other participants in our laboratory and in our development and in assessment techniques in the Department Residency Training Program have contributed to the micro- of Surgery and he has a major interest in both undergraduate surgical field. Dr. Donald Lalonde should be mentioned for and graduate learning experiences. Dr. Zeit has also added his work in the free transplantation of bone and the study of a major contribution to the microsurgical reconstruction of the circulation of free transplants with a comparison to the extensive defects following trauma and tumour excision. The microvascularized grafts. This work was further refined by rapid increase in microsurgical free fiap procedures has been Dr. William Papanastasiou and by Dr. Akihiro Fukui of clearly evident since his return to the University. Nara, Japan. Drs. Dan Durand, Dan Thomas, and Stephen Nicolaidis also contributed to microsurgical research in the Following completion of his residency at McGill University, Dr. laboratory at McGill University while obtaining their Master Teanoosh Zadeh completed a Fellowship in at of Science in Experimental Surgery. the University of Milwaukee and a further six months in Tissue Engineering at Harvard University. Dr.Zadeh's main ~ THE SQUARE z:00: ~ 6 ~ interests are in hand surgery, microsurgery, and free SUMMARY flap tissue transfers. His interspecialty collaborative efforts in Each of the problems in microsurgery has been carefully reconstruction of soft tissue and bony defects with Orthopaedics investigated in many laboratories and the solutions obtained has been a great advance in the care of malignancies and have been directly applied to the management of clinical traumatic defects. problems. This clearly outlines that the true success of basic research is the direct application of these positive laboratory Dr. Daniel Durand, who is also a graduate of the McGill findings to improvements in patient care and this is particularly Program, has had extensive training in brachial plexus true in the field of microsurgery. reconstruction during a fellowship year at the University of Southern California. A Multidisciplinary Clinic at The Montreal The Plastic Surgery Division at McGill University with its three Children's Hospital under the direction of Dr. Zadeh and Dr. component parts at The Royal Victoria, The Montreal General, Durand's has been established. This Clinic, which includes and The Montreal Children's Hospitals remains strong with Neurologists, Neurosurgeons, Physiotherapists, Occupational a dynamic influence on the specialty both in Canada and Therapists, and Imaging Services, will continue to expand other countries. The clinical component is broad based and and improve treatment modalities in this difficult area of the strength of research within the Division contributes to management. its overall stature. The teaching of Plastic Surgery, both at the undergraduate and graduate levels, also continues to be RESEARCH SUPPORT strengthened and the quality of our graduating residents is a Members of the Plastic Surgery Division at McGill University clear indication of success in this portion of the Program .• have been very successful in obtaining research grant support for many important laboratory investigations. This support has come from the Medical Research Council, the Educational Dr. H. Bruce Williams is Professor of Surgery, Director Emeritus Foundation, the Cedars Fund, Industrial organizations, and of the Division of Plastic Surgery at McGill, and until recently the from the Quebec Hydro Corporation. Despite this past success Surgeon-in-Chief at the Montreal Children's Hospital, MUHC. and related to increasing difficulties in obtaining grant sup- port, we were extremely pleased with the establishment of the Neville G. Poy Endowment Fund in Plastic Surgery for the support of research and education. Dr. Poy is a graduate from the McGill Plastic Surgery Program and he spent a Fellowship 'Tis the Chyrurgions praise, year in the experimental laboratories with pioneering work in and height of Art skin flap survival. Not to cut off, INTERNATIONAL RELATIONSHIPS but cure the viscious part. Publications of the first limb replant by Dr. Ronald Malt in 1962; of the first replant by Dr. Susumu Tamai from - Robert Herrick (7597-7674) Nara University; the first toe to thumb transfer by Dr. John lesperides,"Lenitie" Cobbett at East Grinstead; the Chinese experience; the work from Australia by Mr. Bernard O'Brien, Ian Taylor, and others; and, the numerous contributions from Japan, the United States, and Canada, has had a lasting and important effect on this developing field. Others such as Edgar Biemer in Germany, L earning without thinking Marco Godina in Yugoslavia, and Robert Pho from Singapore have contributed Significantly to the field. is useless, Thinking without learning The 13th Scientific Congress of the International Microsurgery is dangerous Society with representation from 40 countries was held in - Confucious Montreal in June, 1996, under my Presidency. I am also a Past President of the American Society for Reconstructive Microsurgery. THE SQUARE z:0:: !:l 7 The evening was a continuous flow of touching tributes, including a beautiful video honouring Professor Elhilali and a dramatic painting created onsite by artist Jeremy Bortz.

GREEN LIGHT TO A ruRE GALA IN The beautiful painting was later presented to Prof. Elhilali by TEHONOUR OF DR. MOSTAFA ELHILALI the Weizmann Institute's Prof. Avigdor Scherz, co-inventor of On June 19th 2007, the Windsor Ballroom in Montreal was Tookad. (Tookad is a light activated drug designed to eradicate exquisitely transformed to reflect the theme of Green Light deadly tumours with minimal side effects and which Prof. to a Cure.The Gala was a joint venture between The Montreal Elhilali has been conducting clinical trials in Montreal). Chapter of Weizmann Science Canada and The Montreal General Hospital Both organizations were thankful to have Dr. Arthur T. "Green Light Foundation. Honouree of the evening Porter, CEOof the McGill University Health Centre, as MC for to a Cure" Gala was Professor Mostafa Elhilali, Chief the evening. Some of the dignitaries in attendance included the of Surgery for the MUHC. Israeli Ambassador to Canada Alan Baker with his wife Dalia, Consul General of Eqypt in Montreal Mrs. Wafaa Elhadidi and A large crowd, including many leaders of the Montreal business Consul of Israel in Montreal Ms. Michele Seguev. and professional community were in attendance as the organizations proudly announced that they raised over $2.25 We were proud to have with us our wonderful new dean million for research in prostate cancer and related diseases. of medicine at McGill, Dr. Richard Levin and his wife, NY attorney and committee member Jane. Both organizations are grateful to Gala Chairman David J. Azrieli and his wife Stephanie and Honorary Chairman Michal "We are thankful to all those who have supported this campaign Hornstein and his wife Renata, for their support and wish and helped to make it such a wonderful success" said Susan to extend a very warm thanks to all who contributed to this Stern, Executive Director, Eastern Region, Weizmann Science worthy cause and in honouring such a well-deserving and Canada. "The successof this event illustrates that science knows dedicated man. no borders ... International collaborations benefit humanity"!. Courtesy of: Veronica Redgrave, Society Editor, YU Magazine and Permission from Ms. Susan Stern

Dr. Elhilai with Prof Avigodor Scherz,co-inventor ofTooad, a light activated drug designed to eradicate deadly tumours.

A view of the Gala.

Dr.Arthur T. Porter, CEOof the McGill University Health Centre,as MC for the evening THE SQUARE ~ ~ 8 History of Bariatric (Weight-Loss in 1989 which showed the superiority of gastric bypass,vertical banded gastroplasty Surgery) at McGill 1963-2007 was replaced by the Roux-en-Y gastric bypass as the main weight loss surgical procedure.

, THE 1990'S Dr. Rae Brown Because McGill bariatric surgeons learned ...T.EARLY YEARS that separation of the staple line with Jejunocolic Bypass: The first weight loss surgery at McGill vertical gastroplasty led to (Royal Victoria Hospital) was performed 44 years ago in 1963. fewer gastro-gastric fistulas This was a jejunocolic bypass by Dr. H. Shibata and Dr. R. C. they created a small gastric Long. The outcome of this surgical approach pouch vertically along the was reported at the American College of lesser curve of the stomach Surgeons Surgical Forum session in 1966: (the less distensible part), and separated this new Henry R.Shibata, James R.Mackenzie, Richard "stomach" completely from C. Long: "Metabolic Effects of jejunocolic the main stomach. With bypass: Surg Forum XVII, 29- 32, 1966. this operation they started to achieve better long-term Dr. H.R.Shibata Jejuno-ileal bypass: In 1967 bariatric results when the following surgeons at McGill's Royal Victoria' Hospital principals were maintained. (H.R. Shibata, JR Mackenzie, l D. Maclean) • Small pouch «15 ml) started performing the Jejunoileal bypass. This procedure was offered until 1980 when Isolated Gastric Bypass Procedure as • Totally separated pouch the then chair, Dr. Lloyd. D. McLean reported Practiced at the MUHC • Not dependent on staples significant complications on 45 cases with • No stasis 8 year follow-up, including malnutrition, • No foreign material liver failure, severe diarrhea, and electrolyte imbalance. • Anastomosis permits ingestion of solid food MacLean LD, Rochon G, Munro M, Watson KE, Shizgal HM : Since 1989 bariatric surgeons at the McGill Intestinal bypass for morbid obesity: a consecutive personal (Dr. R. Brown at the MGH site and Drs. lD series. Can J Surg 23:54, 1980. Maclean, RA Forse, CN Nohr, APH Mclean Dr. C. Nohr and NV Christou at the RVH site) offered THE 1980'S the open Gastric bypass (Roux-en- Y at the Vertical Banded Gastroplasty: Bariatric surgeons at the RVH, loop gastrojejunostomy at the MGH) McGill's Royal Victoria Hospital (lD Maclean, AR Forse and to prospective clients. Dr.AR Forse relocated APH McLean) switched to vertical banded to the US in 1988. Dr. CN Nohr relocated to gastroplasty without separation of the staple Alberta in 1995. Dr.lD Maclean retired from line in the early 1980's. After several failures surgery in 1994. due to gastro-gastric fistula across this staple line these surgeons started separating the Dr. N. Christou In 1995 Drs. NV Christou and APH Mclean staple line. Despite this they saw (and we continued to offer open Isolated RY bypass continue to see up to 20+ years later) fail- to clients at the MUHC.With the retirement ures due to stenosis at the outlet and pouch of Dr. APH Mclean in 2000, Dr. NV Christou Dr. A.R. Force enlargement. At McGill's Montreal General was left to handle the entire surgical work Hospital, Dr. Rae Brown started offering the load (he had to limit his practice exclusively Mason type gastric bypass in the early 1970's with good early to weight loss surgery) until 2005. results. He continued to follow his patients until his retire- ment. Following a randomized study reported by lD Maclean The most frequent and persistent Dr. A.P.H.McLean THE SQUARE z::0: ~ 9 ~ complication of this open approach to gastric bypass • 3 conversion to open Roux-en-Y Gastric bypass has been wound infection in 20% of cases. We reported • No port site infections our findings on wound infections to the American Society • 28 dilatations (at about 4-6 weeks) of Bariatric Meeting in Boston June 2003. Almost all wound • Length of stay 2.0 days (vs. 4.7 open) infections were followed by an incisional hernia that required • 3 deaths (0.38%, 1 due to PE on day of discharge, 2 due to sepsis from leaks) 1-3 surgical interventions to correct. The current Director of Bariatric Surgery, Dr. Christou, and his Christou NV,Jarand J, Sylvestre JL, et al. Analysis of the incidence colleagues recently published 2 relevant articles on the value and risk factors for wound infections in open bariatric surgery. of bariatric surgery, both in saving lives as well as health care Obes Surg 2004; 74: 76-22. costs.

7. Christou NV, Sampalis J., Liberman M, Look D, Auger S, Mclean THE MINIMALLY INVASIVE SURGERY ERA APH, Maclean LD. Surgery Decreases Long-term Mortality, One way to prevent the development of a wound infection Morbidity, and Health Care Use in Morbidly Obese Patients. is not to make a large incision. This could be accomplished Ann. Surg. 240(3): 476-24,2004. by a laparoscopic approach to the RY gastric bypass.We felt that the ability to hand-sew the 2. Sampalis JS, Liberman M, Auger S, Christou NV : The Impact gastrojejunostomy (in order to create the very of Weight Reduction Surgery on Health-Care Costs in Morbidly small pouch that we have shown is needed to Obese Patients. Obes Surg 74(7): 939-947, 2004. achieve excellent results after gastric bypass The findings have been confirmed by several other centers surgery) was an essential component to our and are used by decision makers in health care to institute switching to a laparoscopic approach. After policies designed to increase accessto bariatric surgery of their several months of training on a simulator populations. The Center for Medicare Services in the USA,the Dr. 0. Court and visiting and training with experts in Ontario Health Ministry and the Quebec Health Ministry are laparoscopic bariatric surgery Dr. NV Christou examples. performed the first laparoscopic RY Isolated gastric bypass at the MUHC on February 8th 2002. Dr. Marvin THE PRESENT Wexler assisted. The first case took 5 hours and 20 minutes to We currently are the largest laparoscopic bariatric surgery complete. The patient left the hospital in 60 hours! service in Canada. Dr.Christou and Dr.Court offer laparoscopic adjustable gastric banding, laparoscopic RY gastric bypass, With the arrival of Dr. Olivier Court (in mid 2005), a fellowship laparoscopic sleeve gastrectomy and laparoscopic duodenal trained laparoscopic bariatric surgeon with special interest in switch (PPDDS).We have the longest wait list in Canada for the biliopancreatic diversion with duodenal switch procedure bariatric surgery with the following statistics as of October (PPDDS),the demand for bariatric surgery only increased. His 11th 2007: recruitment permitted us to offer the surgical procedure that is most appropriate for the patient (since we can perform all the Patient has contacted our office to request 239 accepted bariatric surgical procedures laparoscopically) rather consultation --- the only procedure that is available. Information package sent to patient prior to 686 office consultation On October 10th 2007 we completed our 796th laparoscopic Information package received back from RYgastric bypass.These are all done using a hand sewn gastro- 564 patient (waiting for office consult) jejunostomy which permits pouch sizes fewer than 15 ml. Also the leakage rate (a potentially lethal complication) has been Office consultation date given to the patient to 158 shown to be less with the hand sewn technique. see the surgeon

Patient Evaluated by surgeon and waiting for Our results to date follow: 172 surgery • N=796 Patient file closed (cannot reach patient on • BMI range 39-105 (mean 54) 197 wait list database) • OR time 60-90 min • 6 leaks (all early technical problems in cases #9,#15,#26,#51, Total 2016 #321, #426 [ gastric staple line])) • 2 Pulmonary Emboli (Please see Bariatric on page 15) ~ THE SQUARE Sll] ~ 10

Medicine and Tissue Engineering, on Tract. He was also invited to participate November 30 at Chennai (Madas) India. in a Symposium on the management His talk was on Basic and clinical overview of Fissures and Hemorrhoids during the of stem cell research on myocardial Annual Meeting of the American Society regenerative therapy. of Colon and Rectal Surgeons at St. Louis, Mo. in June 2007. Dr. Nicolas V. Christou, Director of the Section of Bariatric Surgery, Achievements Division of General Surgery, MUHC was recently elected as the first president and Congrats of the Canadian Association of Bariatric Residents, Fellows Physicians and Surgeons, an organization and Medical/Research dedicated to improveing the health of morbidly obese canadians: Students (www.CABPS.ca).

Editor's Note: See article on Bariatric Surgery on page 8. Adil AI-Kindi (Card. DSurg. R-III) presented a poster entitled Cellular Cardiomyoplasty: Optimizing Cellular Dosage and Retention by Microencapsulation, at the Annal Meeting of the American Heart Association at Orlando, FL on November 6, 2007. He also presented a paper at the Canadian Cardiovascular Society at Quebec City on October 22, entitled Microencapsulation A recent CIHR-funded research porject to reduce mechanical loss of microspheres: by Dr. Peter Chan of the Division of Implications in myocardial cell therapy. His Urology entitled Complementary study research supervisor was Dr. Dominique of sperm chromatin quality in cancer Shum-Tim. ~ patients by flow cytometry was awarded the Annual Dr. Salman AI-Sabah (Gen. Surg. R-III). Clinical Diagnostic Award Congratulations on being awarded Best by the American Society Poster Experience with U27 Open and of Andrology at their 2007 Laparoscopic Roux-en- Y Gastric Bypasses annual meeting at Tampa, For the Treatment of Morbid Obesity FL. This work was co-authored presented at the CAGSmeeting Sept 2007. with Drs. Cristian O'Flaherty, Barbara Hales and Bernard Robaire of the Dr.PhilipH.Gordon Department of Pharmacology, _McGill chaired a session of University. Dr. Chan will also serve as Co- Digestive Disease Chair of a post-graduate course on Male Week meeting in Infertility Treatment and Prevention during Washington DC the 2007 Annual Meeting of the American in May 2007, and Urological Association at Anaheim, CA. delivered a State of the Art lectu re Dr. Ray Chiu was invited to deliver a on Development lecture at the Frontier Conclave 2007 of the Embryonic meeting of the Society for Regenerative Gastrointestinal Dr.Salman AI-Sahah THE SQUARE ~ ~ 11

~ The paper by Dr. Danny Del Resection is Related to Parenchymal Fellow) also presented, at CAPS,a resident Duca (Card.Surg.R-III) et al. entitled Renal Transection Technique presented case presentation entitled Intestinal failureaftercardiacsurgery: Timingofcardiac at the CAGSmeeting Sept 2007. Venous Congestion as a Complication of catheterization and other perioperative risk Elective Silo Placement in Gastroschisis factors, published in the October 2007 The 39th Annual Meeting of the Canadian supervisors, Drs. Jean-Martin Laberge issue of The Annals of Thoracic Surgery, Association of Pediatric Surgeons was and Kenneth S. Shaw. Dr. Abdullah Ali had been selected for online journal held from August 23-27, 2007 in St- (from University of Western Ontario, Gen. Continuing Medical Education activities. John's Newfoundland. Several resident Surg.R-1I1)received "Best Resident Poster" The senior corresponding author is Dr. abstracts and posters were presented. Dr. Award for his poster presentation entitled Benoit de Varennes. Ismael Taqi (Gen.Surg. R-III) presented Diaphragmatic Pacing for the Treatment of an original paper entitled Outcome of Congenital Central Alveolar Hypoventilation Dr. Gerry Polyrhronopoulos (Gen. Laparoscopic Appendectomy for Perforated Syndrome (CCAHS),supervisor Dr. Helene Surg. R-IV). Congratulations on receiving Appendicitis in Children. A single center Flageole .• First Basic Science Award on The Risk of experience, supervisor Dr. Jean-Martin Gas Embolism During Laparoscopic Liver Laberge. Dr. Jon Ryckman (Ped. Surg.

Welcome of residency as part of the McGill Plastic and Reconstructive Surgery Program and plans on continuing his training in Aboard reconstructive microsurgery for the near future.

Salem AI-Ajmi received Dr. Marcin Czerwinski was born ~ hisD. Bachelor or Medicine M.B.B.ch from Moscow in Poland, moving to Montreal as a University in 1985 with further training teenager in 1993. He graduated from at AI-Jahra Hospital. He joined the McGill McGill University Medical School in 2003 University Plastic Surgery Training Program and then went on to pursue a residency in July, 2003. Following his graduation in in Plastic Surgery at McGill. His main June, 2008, he will complete a Fellowship interests include congenital and adult year in Plastic and Reconstructive Surgery post-traumatic craniofacial deformities. before returning home. Upon finishing his residency, he hopes to complete a one year fellowship in craniofacial surgery .• Dr. Sachin Chitte received his Bachelor of General Science at the University of Windsor and his Doctor of Medicine at Queen's University. In his third year of training at McGill, he completed a year of research A chirurgien should have for his Masters of Science in Experimental three dyvers properties Surgery. Following his graduation in June, 2008, Dr. Chitte plans to do a Fellowship in in his person. Paediatric Plastic Surgery. That is to saie, a harte as the harte of a lyon, Dr. Mario Luc was born in Sherbrooke, Quebec. He completed his Bachelor degree his eyes like the eyes of an hawke, in Pharmacy at the University of Montreal and his handes the handes in 1999 and then entered Medical School at Laval University. In 2003, Dr. Luc graduated of a woman. medical school, receiving both his MD and a - John Halle (7529-7568) Masters in Science. Dr. Luc then went on to "Epistle to the Reader" in his Translation complete his General Surgery Core training of Lanfranc's Chirurgia Parva at the University of Sherbrooke. Currently, he is in his final year THE SQUARE ~ ~ 12 wife Susan, for hosting the party at their home, the Fostering Esprit des Corps for General pa rty was a total success. All enjoyed the sun shiny day and Surgeons with a Family Touch the swimming pool was in full use for the staff and their children. Great food, great fun! • 0A great day had been had at the 2nd Annual Summer Party, Pictures courtesy of Rita Piccioni. _ Division of General Surgery. The party took place on August ~ 26, 2007. Thanks to Dr. Jeffrey Bark". and his charming THE SQUARE z::00:: ~ 13 All Work and No Play Makes a Surgeon ... Division of General Surgery: Annual Soccer/BBQ Event, July 21, 07 I!U!IOW 0PUI!WJV 'JO JI!Zl!ll!s-xaJOU OW!XI!W 'JO ll!~aJV !PllsnH P!l!l 'JO '

fOOl'Sl-Ll Jaqopo fOOl'l Jaqopo ,{.Ia6.1ns aAIs2AUI12WIUIW ,{.Ia6.1ns lelp.l2) .I0J .IossaJo.ld 6UI~ISIA 12~IUa6uo)JO.IossaJo.ld 6UI~ISIA Ula~S.la8-6.1aqula~s naqoO e)eu ,{UOIl~U\1lenUU\1lnOL ill b z: ::..: 3\1\100S 3Hl THE SQUARE ~ ~ 15

~ donor was being cared for in the Kevin Zorn completed his undergraduate aortic-aneurysm repair in under 7 hours. hospital from which the current donor had degree in 1996, doctorate of medicine in In fall 2007, he will work with Dr. Edgar come. I immediately called Dr. Dobell and 2000,and completed his urology residency Chedrawy (former McGill CVT graduate) the rest is history. in 2005 at McGill University. Following to develop a thoracic robotics program at Letters completion of his two-year fellowship Weiss Memorial hospital in Chicago, IL.. continued from page 2 I want to congratulate through the Society of Endourology in Regards, you on the publication of minimally invasive surgery in June 2007, Kevin C. Zorn, MDCM, FRCSC your seventh textbook on Dr. Zorn has joined the faculty at the Assistant Professor of Surgery Myocardial Revascularization and look University of Chicago and will offer Associate Residency Program Director Co-Director of the Minimally Invasive forward to receiving my next issue ofThe laparoscopic and daVinci robotic surgery Urology Fellowship Square Knot. for the treatment of various urologic University of Chicago Medical Center diseases. With a strong interst in prostate [email protected] Regards, cancer outcomes research, Dr. Zorn has J. Earl Wynands O.c. M.D. been appointed Assistant Professor of Professor Emeritus Surgery and will be the associate residency Department of Anesthesiology University of Ottawa program director and co-director of the minimally-invasive urology fellowship. Editor's Note: Dr. Wynands was a Professor and Chairman of Anesthesia With an experience of >400 robotic Department at McGill. prostatectomies, Dr. Zorn has assisted in the development of the university's gynecology and vascular robotic programs. In August 2007, Dr, Zorn and Dr.Kevin Zorn Dr. Hisham Bassiouny completed the first North American, robotic abdominal-

~ We currently operate on -150 cases per year at the plan for guaranteeing accessto bariatric surgery in the province MUHC so the mathematical wait time is 2016/150 = 13.4 of Quebec, soon to be announced by our health minister. years. Since some patients seek surgery elsewhere (usually with our colleagues in Laval), change their Editor's Note: This great team a great challenge. minds or have adverse outcomes while waiting, According to a recent article in The Gazette (71.10.2007), there Bariatric the realistic wait is -5-7 years. are 200,000 Quebecers who are morbidly obese, and 8 of 10 of continued from page 9 them are women age 31 to 45. More than 70 percent of them are Given these statistics it is easy to see why an already on the waiting list for bariatric surgery, or are seriously action plan for access to bariatric surgery in the Province of considering the surgery. (Also see "Kudos~re Dr. N. Christou) .• Quebec is desperately needed. The relative risk of death is 89% less in those who have the surgery compared to those who do not over a 5-year period! We are looking forward to the 5-year

On our way to It was shortly after the year a U.S. I was sued by a patient and before a judge when the plaintiff's President was almost impeached by the lawyer asked me: "Dr. Cooley, I heard people saying you are the the hotel ... Congress because he was thought to have "greatest" cardiac surgeon in the world. Do you really think so?" committed perjury in relation to an affair I replied without hesitation: "Think of it, you are right!" The with a White House intern. McGill Division of Cardiothoracic lawyer said:" Sir, aren't you a bit too arrogant to say so about Surgery invited a prominent cardiac surgeon, Dr.Denton Cooley, yourself?" I responded: "Well, you may be right, but you know I from Texas as our annual Stikeman Visiting Professor. On the am under oath!" • way to the hotel from airport where I picked him up, he could RayChiu not wait to tell me his favorite story: .... a4l le a)!AJaS Ala6msomau a4l JO Ja!4) SeM aH U! asmo) eWOld!O pue S)\I~ 'S)~~ 10J pa!J!lla) pue 'saa16ap 'moJ Ol suoa6msolnau JO laqwnu a4l l46n01q UOle) s!nol Ala61ns lelUaW!1adx3 U! )SlN 'IN)OlN 6U!A!a)al 'alenpe16 -uear pue uosple4)!~ lalad JO SlUaWl!nnal lalel 'lel!dsOH 1I!9)lN e seM aH 'lel!dsOH A1el!l!lN lealluolN a4lle laWI pue s,ualPI!4) lealluolN a4lle lIapunl9 u40r 4l!M a6elaAO)-SSOn 'uoa6ms e se uoslaN Apel S)'lAJ'H a4l uo paAlas pue 'Sdl0) leuo!se))o 46no14l AIUOal!dsal 6u!u!e6 'lel!ds04 a4l le lie) le)!palN AW1\1ue!peue) leAo~ a4l U!U!elde) e seM A4dmlN '10 uo sAeMle seM a4 '~96 L U! pl0~ qog JO leA!11e a4l l!lUn 'laam S!4 JO lsal a4l10J lelaua9 Wa1luolN a4l le paU!eWal 'aJ!1aA!DnpOld 6uOI AlaA e laije AeMe passed A4dmlN '10 aor 'AlaA!Dadsal Ala6ms pue aup!palN JO sluawlledao a4l '1I!9)lN le Ala61ns 1elmseAO!ple) )!lle!pad U!laauo!d Apea u\l JO SUO!S!A!PaWQ)aq Pln04s Ala61nsolnau pue A6olo1nau le4l (LOOl- L l6LJ 'O'W 'ilfdJnw 'N P!ADO pue papueqs!p aq Pln04s Ala61nsolnaN pue A6olomaN JO luawl1edao lel!ds04 a4l le4l AllUa)al pappap pe4 pleog ...... le)!palN lel!ds04 a41 'ja!4)-U!-uoa6msomau se lel!dsOH lelaua9 lealluolN a4l Ol uosllaqo~ a~)o~ Aq pal!nnal seM aor 'l96L ul Olfd 'OW '!lD/!lfH DJDJsnW '1I!9)lN le Ala6ms JO 'dn016 a4l JO slaqwaw luawlledao a4l pue A6ol01n JO UO!S!A!Oa4l Ol pua!1J lea16 pue Aa~ JO a1nlledap a4l Ol pal we1601d ale) 4llea4 leSlaA!Un e lS!6ol0m pawaalsa 'an6eaIl0) pa4S!la4) e seM Uouu!)pelN '10 a)npOllu! OlluawulaA06 lepU!AOld a4l Aq Siesodold 6U!MOIIOJ Sa!SlaAOlluO) le)!paw sno!1as Aialeunll0JUn 'InJssmns 'a)U!AOld a4l punOle sla4l0 4s!lqelsa padla4 pue sl411elN Al6u!pUelSlno seM aWil l104s e 10J 4)!4M ueMa4)le~Ses JO 'lS W l!Un ale) aAile!lled e paDal!p a4 a1a4M 4S!u06!lU\l Al!SlaA!Una4lle l!un Ala6msolnau pue A6olomau e dn Pl!nq Ol paumlal a4 lUaWal!lal-!WaS ul 'Al!SlaA!Un a!sn04leo le Ol sla4lo pue 'lalXeg uoO 'Iapu!a~ lI!g 4l!M pa~10M a4 19 A6ol01n JO 10ssaJold l)Un[p\l pue AleWl!Jul xeJ!leH a4lle JjelS -9~6 L W01~ 'lel!dsOH s,uelalafl A1elN uaano a4l pue lel!dsOH JO Ja!4) awe)aq a4 a1a4M Z86 LU!e!lQ)S eAoNOl paUlnlal Aa41 lelaua9 lealluolN a4l le uoa6msomau luellnsuo) se 9-~~6 L 'lel!dsOH ue4~ e6\1 a4l JO 10l)al!0 aA!lmax3 seM a4 a1a4M 6L6 L U! pO!1ad Ja!1q e 10J paAlas a4 A)Uap!Sal S!4 JO UO!laldwQ) uO U! eAua~ '!qol!eN Ol paAow UU\l aJ!M S!4 pue Uouu!~)elN '10

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9L sz :.: 311VnOS 3Hl THE SQUARE ; ~ 17 ~ Montreal General Hospital for 30 years overseeing its clinical , and, with Alan Edwards, worked towards development with foresight and equanimity. development of what is now the McGill Pain Centre. He worked over many years to establish and maintain a palliative care unit In the 1960's, Joe collaborated with other surgeons, at the hospital. At McGill, Joe served as a member ofthe Senate particularly with Jim Shannon and Fred Wool house, to create and, subsequently, was called upon to mediate in troublesome a multidisciplinary trauma team, groundwork which bore fruit academic situations. After he eventually retired, he was asked some 20 years later as a key programme of the MGH. With to write a history of neurosurgery at McGill. At national level, Bob Ford and a devoted coterie of nurses, Joe established a he was president of the Canadian Neurosurgical Society and close-knit neuro-intensive care unit on the 14th floor of the a member of the board of directors of the Victorian Order of hospital. Residents on the service, whether destined for careers Nurses for many years. in neurosurgery or in other surgical specialities, recognised Joe for his courtesy, his calm under pressure in the operating A recital of professional accomplishments does not portray the room, his anecdotes, and his teaching of clinical judgement. As respect that Joe Stratford commanded in the English Montreal a Royal College examiner, he is remembered as exceptionally community over decades. His awareness, judgement, and kindly. The nurses appreciated his patience and insight into quiet eloquence made him a valued advisor for many. His life- non-surgical aspects of clinical care. long passion for the visual arts brought him much satisfaction. He helped to maintain the historically strong relationship In 1963, Joe helped to recruit his good friend Don Baxter to the between the community and McGill's hospitals. MGH as neurologist-in-chief. Joe and Don established a joint clinical neurology-neurosurgery unit on 7East Pine in 1966 After the death of Aurelie in 1983, Joe never remarried. He and fostered a cordial and prosperous academic environment remained close to his daughter, Leslie, and son, Huntly, and in neurosurgery and neurology. The achievements in neurology maintained a group of fortunate friends. He had no enemies. and neurosurgery at the MGH during the 1960's and 1970's are Peter Richardson, MD, PhD recorded in an article in The Canadian Journal of Neurological Sciences 27, 79-83 (2000). Editor's Note: Dr. Richardson succeeded Dr. Stratford as Director of Neurosurgery at the Montreal General Hospital. He is currently Joe started a multidisciplinary pain clinic in the 1970's, Professor of Neurosurgery at University of London, UK. • continued his work in pain even after withdrawing from ......

"While change is the law, certain It has often been said .~\lIi;~~~~ great ideas flow fresh through the that to make discoveries, ~ .\\1111. ~ ages, and control us effectually as in one must be ignorant. the days of Pericles. Mankind, it has This opinion ..... means that been said, is always advancing, man it is better to know nothing is always the same. The love, hope, fear than to keep in mind fixed ideas and faith that make humanity, and the elemental based on theories whose confirmation passions of the human heart, remain unchanged, we constantly seek, and the secret of inspiration in any literature is neglecting meanwhile everything the capacity to touch the cord that vibrates in a that fails to agree with them .. sympathy that knows not time nor place': - Claude Bernard (1873-7878) - Sir William Osler An Introduction to the Study of (1849-7979) Experimental Medicine. THE SQUARE ~ ~ 18 ...... And a look into the future

SURGICAL REPAIR OF THE WOUND:

(1) Have an ant bite the wound edges together, then (2) Twist the head off so the "stitch" won't run away I...... Ancient Indian Medicine (in Majno, Guido: The Healing Hand ... Man and wound in the ancient world. Harvard University Press,1975). Simple and Cheap!

SURGICAL REPAIR OF THE WOUND:

(1) Where are the surgeons? Are they still needed?

(2) Robotic Surgery @ Glen Yard Super-Hospital (20xx)? Complex and Expensive! THE SQUARE z:0: ~ 27 r- -'I

Tie one on for McGill ! The McGill Department of Surgery invites you to tie one on for the old school! The McGill blue silk tie and scarf with CREST,SQUARE KNOT and FLEAM are available for purchase from the Alumni Office as follows: McGill Dept. of Surgery Alumni, Montreal General Hospital 1650 Cedar Avenue, Room L9.420, Montreal (Quebec) H3G 1A4 Telephone: (514) 934-1934, ext. 42028 Fax: (514) 934-8418

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McGILL SURGERYALUMNI & FRIENDS Write to us ! Send us your news ! Contributions of $50.00 are appreciated in ensuring the continued publication of "The Square Knot" and supporting McGill We want to hear from our readers! Surgery Alumni activities. Pleasemake If you have any information you want published in cheque payable to the McGill Department of Surgery and forward to Maria Bikas, THE SQUARE KNOT, comments about our newsletter McGill Surgery Alumni & Friends, or suggestions, we want to hear from you! The Montreal General Hospital, 1650 CedarAvenue, Room: 19-420, Send submissions to: Montreal (Quebec) CanadaH3G1A4 E.D. Monaghan, M.D.• Editor· THE SQUAREKNOT· The Royal Victoria Hospital Telephone: (514) 934-1934, ext.: 42028 687 Pine Ave. w., Room: S7.30, Montreal (Quebec) Canada H3A 1A1 Fax: (514) 934-8418. CAll US at: (514) 934-1934, local 42835 FAX US at: (514) 934-8289 E-MAIL USat:[email protected] MOVING? [email protected] If you change your address,or if you know [email protected] someone who would like to receive this newsletter, please drop us a line.

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