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The McGill Department of Surgery Newsletter

July, 1989

THE SQUARE KNOT

Vol.~~1.No. 1

DIVISION HIGHLIGHT:

ORTHOPAEDICS

This past year has seen theDivision of Orthopaedics giveup its traditional allegiance tohospital based training progr-ams and become truly integr-ated into a McGill Division ofOrthopaedic Surgery underthe Department of Surgery.This event was celebratedwith a banquet at the McGillFaculty Club where numeroustoasts and speeches sent uson our future course.

A SILK TIE!

The integrated program wascelebrated with sartorial eleg-ance. The McGill Orthopaedictie, and scarves for the ladies,sport alternate rows of theMcGill shield and the NicolasAndry orthopaedic logo.

These were distributed at thebanquet. Dr. James Urban-iak, visiting professor, was thefirst recipient of the tie outsidethe McGill Department of Sur-gery.•

Scholarly activity has beenbrisk this past year with theFaculty and resident staff pro-ducing ten papers in "peerreviewed" journals, five chap-ters in various textbooks andone textbook of orthopaedictechniques written by manyinternationally recognized aut-hors and co-edited by CarrollLaurin. This has been produ-ced in both English and Fren-ch. To this must be addedthe twenty-odd publications bythe ten scientists from theShriners Hospital laboratories.Francis Glorieux and hisgroup have identified the DNAsequence in one form of in-herited rickets.

In addition to the approx-imately two million dollars ofcompetitive research fundsraised by scientists at the Sh-riners, Drs. Hadjipavlou, Mit-chell and Zukor have won atotal of one-quarter milliondollars of competitive monies.Special honours go to Dr.Rennie who has been madeTreasurer of the CanadianOrthopaedic Association andeditor of the International Jou-rnal of Orthopaedic Opinion.Nora Shepard has been pro-moted from Assistant Profes-sor to Associate Professor of

Experimental Surgery. This isparticularly noteworthy as sheholds no university degreeand has achieved this by herconsiderable research outputwhile directing a laboratoryand teaching graduate andother students. Dr. RobinPoole won the Kappa DeltaAward of the American Acad-emy of Orthopaedic Surg-eons. Finally, Dr. DennisBobyn, in addition to receivinglarge research grants for hisconsiderable productivity, hasbeen named M.R.C. Scientist,one of only nine granted thisyear in Canada and the sec-ond to be won by a memberof the division of Orthopae-dics.•

SECOND ANNUAL L.D.MACLEAN VISITINGPROFESSORSHIP

From November 15 - 17,1989, Dr. John A. Mannick,Surgeon-in-Chief of the Brigh-am and Women's Hospitaland Professor of Surgery atHarvard Medical School, willbe viSiting the McGill Depart-ment of Surgery._

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1989 DAVISAND GECKWINNERS

FIRST PRIZE: Dr. Chen Lee(Dr. C. Kerrigan - Dr. L. Les-sard) - "Pathophysiology ofischemic flap failure"

SECOND PRIZE: Dr. RezaMehran (Dr. J. Symes - Dr.A. Graham) - ''The treatmentof abdominal aortic graft in-fections with vascularized tis-sue flaps"

THIRD PRIZE: Dr. DaoNguyen (Dr. D. Mulder) -"The effect of ward ischemiaon bronchoalveolar lavagecells"

All nineteen participantsshould be congratulated ontheir excellent presentations.The three prize winners haveclearly excelled, to be award-ed the prizes with such toughcompetition.

Pathophysiology of Ischem-ic Flap Failure

by Dr. Chen Lee

Some of themost chall-enging prob-Ie m sinplastic sur-gery involvethe restora-tion and re-constructionof normal form. This often

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demands the use of localautologous tissues to recreatethe normal form. When facedwith the problem of inade-quate local tissue to recon-struct a defect, microsurgicalfree transfer of tissue fromother anatomic sites providean elegant solution. However,10-15%of free tissue transfersare complicated by vascularthrombosis and tissue is-chemia. Up to half of thesecases progress to necrosisdespite re-establishing andmaintaining vascular patency.A failed free tissue transfersignifies morbidity for the un-resolved defect along withtissue loss from donor site.Our goals have been to gainan understanding of the path-ophysiology of the ischemia /reperfusion injury. Specifi-cally, alterations found in neu-trophil function induced by anischemic microenvironmenthave implicated it as potentialmediator of reperfusion injury.Ongoing work in our labora-tories to further clarify themechanism of reperfusioninjury will hopefully add to theframework necessary to de-velop an effective therapeuticrationale directed at minimi-zing ischemic necrosis.

This work has won, in additionto the Davis and Geck firstprize, the Peter J. GingrassMemorial Award from thePlastic Surgery ResearchCouncil..

July, 1989

SURGICAL MEETINGS

DATES TO REMEMBER

International Surgical Week -Sept 10-16/89, Toronto (Abst-racts due Dec 15/88)

American College of Sur-geons, Clinical Congress - Oct15-20/89 (Abstracts due Mar30/89)

Royal College of Physicians &Surgeons of Canada - Sept22-25/89, Edmonton (Abs-tracts due Mar 10/89)

Society of University Surgeons- February 8 - 10, 1990, LosAngeles (Abstracts due Sept-ember 1, 1989)

Kindly advise us of any up-coming meetings for yourdivision .•

POST-GRADUATESEMINAR

The Department of Urology isorganizing the PostgraduateSeminar of the NortheasternSection of the American Urol-ogical Association in Montrealin April 1990with heavy parti-cipation from the McGill Facu-lty and twenty guest speak-ers .•

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INTERNATIONALRELATIONS

Dr. C.J. Chiu (MGH) hasbeen an invited scientist to theUSSR and will soon sign anagreement whereby there willbe joint scientific collaborationon the cardiomyplasty project.Dr. Chiu and Dr. Mulder havebeen actively negotiating for ayoung Russian cardiovascularsurgeon to be the Grahamfellow of the American Associ-ation for Thoracic Surgery.Dr. Chiu has also had severalother international invitationsas visiting professor and hasbeen on faculty for the Ameri-can College of Cardiologymeeting at Lake Louise, Mar-ch,1989.

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Dr. A.R.C. Dobell (MCH) hasbeen named to give the JohnH. Gibbon Jr. Lecture at theAmerican College of Surgeonsin October, 1989. Dr. Dobell .was one of Gibbon's residentsand is the first to be so hon-oured to give this lecture inhis mentor's name.

Dr. Phil Gordon (JGH) was avisiting professor in Malaga /Marbella, Spain in February,1989.

Dr. M. Lucie Lessard (RVH)begins her one year fellowshipinmaxillofacialand craniofacialSurgery inGoteborg, Sweden,July 1, 1989.

Dr. Antoine Loutfi (RVH) hasspent the last year in Ethiopiaworking in surgery and in asurgery oncology clinic; !'liswife, Dr. Joyce Pickering, hasbeen participating in the Mc-Gill-EthiopiaCommunity Heal-th Program. Based upon hiswork and Dr. J.L. Meakins'visit, an application for a CIDAgrant to develop surgery inEthiopia will be made.

Dr. Uoyd D. MacLean (RVH)gave the Seventeenth GreyTurner Lecture at the Univer-sity of Newcastle upon Tyne,on the topic of "Sepsis in Sur-gical Patients", in April, 1989.

Dr. J.L. Meakins was an in-vited participant at the 18thannual Congresso Brasileirode Cirurgia in July 1988 andwas made an honorary mem-ber of the Brazilian College of

July, 1989

Surgeons. He was also plen-ary lecturer at the 10th WorldCongress, Collegium Interna-tionale Chirurgiae Oigestivaein Copenhagen, Denmark,August, 1988.

Dr. Jean-Fran~ois Morin(MGH) has completed fellow-ships in cardiac and vascularsurgery and thoracic surgeryin Bristol, England.

Dr. David S. Mulder (MGH)went to China on May 19th,1989 to participate as an or-ganizer of the 2nd Sino-Amer-ican conference on Burns andTrauma. A highlight of thevisit to Beijing and of worry toall were his frequent visits toTiananmen Square. Afterwhich, he travelled to Japanfor ten days as the "honouredtrauma professor" for the Jap-anese Association for Surgeryand Trauma. This involved avisiting professorship at uni-versities in Sapporo, Kyotoand Tokyo.

Dr. Harvey Sigman (JGH)presented a paper on "Rectaland Intestinal Mucosal BloodFlow in Rats Measured byHydrogen Gas Clearance:Effects of Hemorrhage andHypotension" to the 10thWorld Congress, CollegiumInternationale Chirurgiae Dig-estivae, Copenhagen, Den-mark, August, 1988.

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Dr. H. Bruce Williams (MGH)visited Japan in 1988and wasa visiting professor at KeioUniversity, Tokyo, from No-vember 28 to 30, 1988, aninvited speaker at MedtronicsInternational, Tokyo, on No-vember 29, 1988and a guestspeaker, Japanese Society ofReconstructive Microsurgery,in Kumamoto City, from Dec-ember 1 to 3, 1988.•

WORLDTRAVELLER

It is comfort-ing to knowthat whatMcGill mis-sed this win-ter, the worldgained. Dr.L.D. Mac-Lean wasawarded the prestigious SirArthur Sims CommonwealthTravelling Professorship andtravelledto NewZealand, Aus-tralia, Thailand, Hong Kongand Great Britain. We arepleased that he has returnedto us this summer to resumehis practice and research.Welcome home!.

IN MEMORIAM

o R.A. Forse (Sr.)o Leon Hellero C. (Sandy) Macintosho Herbert Oweno Arthur VinebergODonald R. Webster.

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TRANSPLANTATION

Dr. Lawrence Rosenberg(MGH), assisted by Dr. CarlNohr (RVH), did the first pan-creas-kidney transplant at Mc-Gill in December 1988. Thepatient and grafts continue todo well.•

L'equipe de transplantationcardiaque se rappellera du 29juin 1989 pour deux raisons.D'une part, les deux dernierestransplantations faites ce jour-18ont amene Ie total des gref-fes 8 100 dont 87 coeurs, 10coeur-poumons et 3 poumonssimples.

Juin Ie 29 sera aussi memora-ble dans I'histoire de la trans-plantation au Royal Victoriapour une autre raison.

En effet, I'equipe de transpla-ntation de l'h6pital Royal Vic-toria a fait la premiere transpl-antation cardiaque au Canadautilisant un donneur vivant.Un canadien francais Age de57 ans souffrant d'une amylo-'idose cardiaque en phaseterminale rec;utIe coeur d'uneinfirmiere de 40 ans de Queb-ec. Elle-meme souffrait d'unemaladie pulmonaire au stadeterminal (emphyseme) et rec;-ut Ie coeur et les poumons enbloc d'un donneur en mortcerebrale due 8 une hemorra-gie cerebrale. La famille avaitdonne non seulement Ie coe-ur et les poumons mais aussi

July, 1989

les reins, Ie foie et la cornee.

Trois equipes chirurgicales onttravaille simultanement pourfaire I;operation du donneurde coeur-poumons, la trans-plantation coeur-poumons etla greffe cardiaque .•

In an article about heart-lungtransplantation in the Paris-Match of April 27, 1989, Dr.Normand Poirier (RVH) wasquoted extensively about theneed for more cardio-pulmon-ary transplantations. Heblamed the long waiting list inQuebec on a lack of compati-ble donors, low awareness inboth the general public andhospital staff about transplan-tation, insufficient equipmentin some areas, and inade-quate co-ordination for organdonation. Hopefully the articlewill help to improve this situa-tion.•

SUMMER SOLSTICE PARTY

Dr. J.L .Meakinsand his wife,Dr.JacquelineMcClaran,hosted a "Summer SolsticeParty" on their farm, June 23,1989 for the RVH attendingstaff and residents in Sur-gery.•

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KUDOS

Dr. P. Belli-veau (RVH)has beennamed Pro-gram Coor-dinator for UndergraduateSurgical Teaching.

Dr. Dennis Bobyn (MGH)received an MRCScholarship,for the period April 1, 1989 toMarch 31, 1994.

Drs. Pnina Brodt and HaroldRode (Division of SurgicalResearch) have developedtwo new graduate courses,which will be presented in theFall Newsletter.

Dr. Harvey C. Brown (MGH)became a member of theCommittee on Trauma of theAmerican College of Sur-geons, and joined the Mem-bership Committee of theAmerican Society of Plasticand Reconstructive Surgeons.

Dr. N. Christou (RVH) hasbeen competitively funded byKendall-McGraw to assess anew solution and its effects onthe immune system.

.\

Dr. Rene J. Crepeau (MGH)was made an examiner, Plas-tic Surgery, for both the RoyalCollege of Physicians andSurgeons of Canada and theCorporation professionnelledes medecins du Quebec.He was also a program parti-cipant.on craniofacial surgeryat the annual scientific meet-

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ing, Canadian Society of Plas-tic Surgeons, in Edmonton,Alberta, June, 1989.

Dr. Claude Gagnon (RVH), .Director of the UrologyResearch Laboratory hasbeen nominated a Senior 2Exceptional Merit Scholarshipfor five years (1988 - 1993) bythe FRSQ. He has also beenpromoted to Full Professor.

Dr. Phil Gordon (JGH) be-came Associate Editor of Dis-eases of Colon and Rectum,examiner for The AmericanBoard of Colon and RectalSurgeons, "Ambassador byAppointment" for the Palaisdes Congres, City of Montre-al, and chairman of a panel onAnorectal Diseaseat the RoyalCollege of Physicians andSurgeons of Canada Post-graduate Course on Colonand Rectal Surgery. Dr. Gor-don also received an AgoraAward.

Dr. Alan Graham (RVH) wasappointed the Jack Wylie Tra-velling Fellow, a prestigioushonour. Hewill visit anumberof prominent vascular centresin the next academic year.

Dr. Carolyn L Kerrigan(RVH) is now the Surgeon-in-charge of Plastic Surgery atthe "Vic". She was also ap-pointed Associate Editor forthe Plastic and ReconstructiveSurgery Journal, received aresearch grant from the Can-adian ElectricalAssociatiOnforstudies on the pathophysiol-

July, 1989

ogy of electrical injuries, andwas named chairman of theFact Finding Committee onBreast Implant Surgery, spon-sored by the Health ProtectionBranch of the Department ofHealth and Welfare, Canada.

Dr. George Kiruluta (MCH)was granted tenure and be-came Associate Professor.

Dr. M. Lucie Lessard (RVH)was a panel participant onNasal Anatomy at the Cana-dian Society of Plastic Surge-ons annual scientific meetingin Edmonton, in June 1989.

Dr. Richard Margolese(JGH) was named Presidentof the National Cancer Insti-tute of Canada.

Dr. John C. Marshall, assoc-iate professor at Dalhousie,has received the Surgery Me-dal of the Royal College ofPhysicians and Surgeons ofCanada based on work doneat McGill.

Dr. J.L. Meakins (RVH) andDr. J.C. McClaran edited abook entitled Surgical Care ofthe Elderly, published in 1988.Dr. Meakins has also beennamed President of the Surgi-cal Infection Society.

Drs. N. Miller (JGH) andN.M. Sheiner (JGH) receivedtwo grants: one from theJewish General HospitalFoundation for July 1988 toJuly 1989, to study the Eval-uation of Graft Materials in the

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Venous System of the Dog;the other from a MulticentreStudy funded by the NationalHealthResearchand Develop-ment Program, to studyAsymptomatic Patients withCervicalBruits, Natural Historyand Effectiveness of AspirinTreatment.

Drs. B. Mitmaker (JGH) andN.M. Sheiner (JGH) receiveda grant from the Jewish Gen-eral Hospital Foundation for1988-89to study the "Effect ofVarious Gastrinemic Statesand Gastric Receptor Block-ades on Colon Carcinogene-sis Induced by Dimethydrazinein Rats."

Dr. Dao Nguyen (MGH) rec-eiveda research fellowship forhis upcoming work in the Uni-versity Surgical Clinic.

Dr. Lawrence Rosenberg(MGH) received an MRCScholarship for the time peri-od April 1, 1989 to March 31,1994,had his American Surgi-cal Association fellowship ren-ewed for a second year, andreceived an MRC grant inaddition to his NIH and Cana-dian Diabetes awards.

Dr. Gaston Schwarz wasnamed President of the Cana-dian Society of Aesthetic(Cosmetic) Surgery, 1989-90.

Dr. Henry Shibata (RVH) isPresident Elect of the Canad-ian Oncology Society andPresident of the CanadianSociety of Surgical Oncology

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and American Association forCancer Education.

Dr. Hanl Shennib (MGH),returning to McGill after a fel-lowship year in thoracic surg-ery at the University of Toron-to, received an operatinggrant from the Cystic FibrosisFoundation.

Dr. Harvey Sigman (JGH) isthe new head of General Sur-gery at the Jewish GeneralHospital.

Dr. Allen Spanier (JGH) ser-ved the Canadian Critical CareSociety as both a member ofthe Board of Directors and asProgram Chairman. Dr. Span-ier also was named Presidentof the Quebec Critical CareSociety and was a VisitingCritical Care Professor at theAlbany Medical Center's EllisHospital in Albany, N.Y.,March, 1989.

Dr. Jim Symes (RVH) hasbeen appointed to replace Dr.Morin as Chief of the RVHDivision of cardiovascular andthoracic surgery. Dr. J.E. Mo-rin stepped down from theposition of Chief after tenyears of responsibility.

Dr. C.A. Vasilevsky (JGH)joined the editorial staff ofScalpel, the official publicationof the Association des Chirur-giens Generaux du Quebec.

Dr. Marvin J. Wexler (RVH)has been appointed to theComite des Effectifs et de la

July, 1989

Pratique Chirurgicale of theAssociation des ChirurgiensGeneraux du Quebec. Hecompletes a five year term asSecretary of the CanadianAssociation of General Sur-geons and has been appoint-ed to the General SurgeryAdvisory Council of the ACSand to the General Council ofthe CMA. He also served asProgram Chairman of theCentral Surgical Association inBanff, Alberta, March 8 - 11,1989.

Dr. H. Bruce Williams (MGH)lent his expertise to the postsof: President of the AmericanSociety of ReconstructiveMicrosurgery, 1988; VicePresident of the AmericanSociety of Plastic and Recon-structive Surgeons, 1988 - 89;Chairman of the Strategic PlanTask Force for Long RangePlanning, American Society ofPlastic and ReconstructiveSurgeons and the Plastic Sur-gery Educational Foundation,1989 - 90; Visiting Professor,Colombia University, NewYork, June 1 - 3, 1988; and,Invited Lecturer to History ofHealth Sciences LectureSeries, Columbia University,New York, March 30 - 31,1989. He also was awarded acombined Medical ResearchCouncil/Industrial Grant for1988 - 90.•

A FACELIFT

The Royal Victoria Hospital'sbed reallocations in 1988haveconsolidated general surgery,vascular surgery, long-termcare facilities and transplantsurgery all in separately defi-ned units. Orthopaedics,plastic surgery and cardiothor-acic surgery were previouslyconsolidated and this trendwill continue. These new unitswill permit greater efficiency inpatient care, teaching andresearch as well as createmore attractive units for nurs-ing and other health care wor-kers.

The Surgical Laboratories at"the Vic" moved into the Her-sey Pavilion and have beenrenamed the L.D. MacLeanSurgical Research Labor-atories. Surgical Teachingnow has a meeting room wh-ich will also double as a studyroom. An "office head-quarters" for Plastic Surgerywas finally constructed on thethird floor of the main buildingof the RVH. Using existingspace, Plastic Surgery re-or-ganized and attractively rede-corated gaining an additionalsurgeon's office, and separateclerical and waiting roomspace. In CVT, a double of-fice was created on the eighthfloor of the surgical pavilion,thus creating a CVT centrewith a total of five surgeon'soffices, two examinationrooms and the Vascular Lab-oratory.

All of this was done with somehospital funding (includingsavings effected within theDepartment), with some per-sonal contributions of the sur-geons towards their own of-fice renovation / decoration -and with a great deal of ingen-uity.•

RESIDENTS' AND FELLOWS'AWARDS

Dr. Maziar Djoneidi receiveda research fellowship from theRVH Research Institute for1989-90.

Dr. David Latter (RVH) willbegin a fellowship in transpla-ntation at Stanford and is ex-pected to return to McGill in1990.

Dr. Sarkis Meterissian plac-ed first among all McGill Sur-gical residents writing the1989 CAGS In-training exami-nations in surgery, and rankedfifth among 426 participants inCanada.

Dr. Leopoldo Sanchez-Cantu received the 1989-903M-Surgical Infection SocietyFellowship.

Dr. Jose Tellado-Rodriguezhas won the Lederle Fellow-ship from the Canadian Surgi-cal Research Fund.

Dr. Jian Wang received theDavidSteard Memorial Fellow-ship for 1988-89, and alsowas awarded an internal sch-olarship from the Faculty ofMedicine.•

(From the Gazette, Wednes-day, June 14, 1989, A-3.)

DOCTOR WINS $40,000PRIZE

Dr. Uoyd MacLean, formersurgeon-in-chief at Royal Vic-toria Hospital, has won theGairdner Foundation's$40,000 Wightman Award forhis lifetime achievements.

MacLean, 64, seNed at RoyalVictoria for 27 years until lastNovember. He also teachessurgery at McGill University.

He has received internationalrecognition for his pioneeringwork with kidney transplants.MacLean is an Officer of theOrder of Canada and receivedan honorary doctorate of sci-ence this month from the Uni-versity of Alberta, his almamater.

The Gairdner Foundation, acharitable organization basedin OntariO, presents theWightman Award to Canad-ians who have "demonstratedoutstanding leadership inmedicine and medicalscience.".

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GRADUATION LIST FORSPRING 1989

M.Sc. Degree

Corbisiero, Raffael: An is-chemia reperfusion compart-ment syndrome model in thecanine hindlimb. Supervisor:Dr. J.F. Symes.

Kochamba, Gary: Skeletalmuscle powered cardiac as-sist. Supervisor: Dr. R. Chiu.

Matsui, Yasumoto: Bioche-mical and immunochemicalstudies of proteoglycans andother matrix molecules in bov-ine growth place in relation toendochrondral calcification.Supervisor: Dr. A.R. Poole.

Shestowsky, William: Prod-uction and characterization ofa monoclonal antibody andorgan-selective variant of theLewis lung carcinoma. Super-visor: Dr. P. Brodt.

Terraza-Calderon, Oscar:Autografts for tracheal recon-struction. Supervisor: Dr. E.Attia.

Zeit, Ronald: The electricalinjury enigma. Supervisor:Dr. R.K. Daniel.

Ph.D. Degree

Nohr, Carl: Humoral immun-ity in surgical patients. Super-visor: Dr. J.L. Meakins .•

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OUR FUTURE

To survive in the increasinglyhostile world of diminishingresources, the McGill Depart-ment of Surgery is going tohave to clearly define its prior-ities and implement a wellthought out course of actionto help preserve the excel-lence of established programsand to allow for future devel-.opment. To this end, the Exe-cutive Committee of the McGillDepartment of Surgery hasestablished a Strategic Plann-ing Committe to be chaired byDr. H.B. Williams.

The Committee is designed tobroadly represent the Depart-ment: Drs. A.R.C. Dobell, M.M. Elhilali, G. Fried, R. Mar-golese, J.L. Meakins, D.S.Mulder and W. Rennie.

All members of the Depart-ment are encouraged to offertheir input - it is our future .•

ACKNOWLEDGEMENT

We would like to thank thoseof you who wrote to tell usabout your activities. Some ofyour submissions will beappearing in upcomingeditions .•

July, 1989

BRAVE BEGINNINGS

This is our first newsletter.We have taken this initiative toensure that there is an oppor-tunity to acknowledge all ofyour achievements with pride.We strongly urge you to offeryour comments and to keepus up to date on your activi-ties. We are looking forwardto developing this newsletterformat and to hearing fromyou. Please watch for the nextnewsletter announcement inthe fall .•

Royal Victoria HospitalDepartment of Surgery,S10.36687 Pine Ave. WestMontreal, QuebecH3A 1A1

Attn: Jane Hutchison