In less than two weeks, we will be site-visited once again by the Royal College of Physicians and Surgeons (RCPS) for the Accreditation of our Post-graduate Medical Education programs in Surgery.  As I have spent the last several consecutive issues of Excelsior providing up-to-date information regarding the upcoming review April 7 – 12, 2013, you will be pleased to know that I am not planning to reiterate what has already been stated quite emphatically.  However, I do wish to thank all of our Program Directors in all surgical programs for their tremendous attention to detail, and their continuous preparations leading up to the review.  Rather, I would like to provide an update on what has been transpiring regarding the Resident Duty Hours agenda.  As most of you know, the Accreditation Council of Graduate Medical Education (ACGME) in the US deliberated in favour of an 80-hr workweek in 2003, with 1 day off in 7, and a maximum shift length of 24 hours exclusive of handoffs. Interestingly, in a recent follow-up National Survey to these Duty-Hour Regulations, almost half of residents responded that they disapproved of the these regulations (1).  Of concern in this survey were the responses by residents suggesting that the restriction on duty hours left them less well prepared for transitioning to independent practice.  Facing considerable pressure from the Institute of Medicine (IOM) and the public, in 2011 the ACGME restricted interns (PGY-1’s) to 16-hour shifts.  As if to follow step and go beyond these new restrictions, the FMRQ in the Province of Quebec instituted a 16-hour call duty policy for all residents.  This is why I am very pleased that the RCPS has organized a Pan-Canadian Task Force to review the issue of duty hours.  The Task Force met last week, and their efforts will be made known to us in the weeks ahead.  I want to personally thank Najma Ahmed, Program Director of General Surgery, for the tremendous amount of research and writing she and her colleagues in the surgical specialties did on behalf of all of us.  Two weeks ago, I organized a meeting of the program directors of the procedural specialties.  We met to discuss the issue of duty hours in the different Departments.  At the table were program directors from the Departments of Surgery, Obstetrics and Gynecology, Anesthesiology, Ophthalmology, and Otolaryngology.  We learned from each other’s experience, and respected the fact that what works well in one specialty, may not be the best for another. At a recent Senior Advisory Committee (SAC) in the Department of Surgery, we had an opportunity to review another recent perspective piece on the importance of “service” work in the education of residents (2).  These authors conclude that service to patients is fundamental to our roles as “professionals” and can be an invaluable mechanism for learning.  Most Departments firmly believe that some form of duty-hour regulation is important.  But, it is probably fair to state that a “one-size-fits-all” approach to residency training does not take into consideration the nuances of training that are inherent in the various specialties. 
1.  Drolet et al., Residents’ response to duty-hour regulations – a follow-up National Survey.  NEJM 366 (24):e35.doi: 10.1056/NEJMp1202848
2.  Kesselheim JC, and Cassel CK, Service:  An essential component of graduate medical education.  NEJM 368: 500-501, 2013


James T. Rutka, MD, PhD, FRCSC
RS McLaughlin Chair


Department of Surgery University Rounds
Friday, April 5, 2013
7:30 am – 8:30 am

Palmer Lecture 

Quan-Yang Duh, MD
Professor of Surgery
Division of General Surgery
Chief, Section of Endocrine Surgery
University of California, San Francisco
“Pheochromocytoma/paraganglioma:  Diagnosis and Management”
Hospital for Sick Children
Hollywood Theatre, First Floor, Elm Wing
Gallie Day 2013 will take place on Friday, May 10, 2013  
This year’s theme is “Personalized Medicine”, and Dr. John Niederhuber, CEO of Inova Translational Medicine Institute, Falls Church, VA, will be the Gordon Murray Lecturer.   The Gallie Day Reception and Annual Dinner will be held at the Windsor Arms Hotel. 
Department of Surgery Annual Faculty Development Day
Friday, May 24, 2013, The Metropolitan Hotel  –7:30 a.m. – 4:15 p.m. Please contact Nancy Latowsky ( to register for the day.
Annual Assembly of General Surgeons will be held on May 30, 2013 at the Metropolitan Hotel. 
SpineFEST will be held on Monday, June 24, 2013.

Harland Smith Lecturer
Dr. David Adams gave this year’s Harland Smith lecture at The Hospital for Sick Children on Friday, March 1, 2013.   The title of his talk was “Mitral Valve Pathoanatomy:  The Key to Valve Reconstruction.” (Photo, from left to right: C. Morshead, D. Adams and C. Calderone)


Department of Surgery New Office Space
The Department of Surgery office has now moved to the 5th floor of the Stewart Building, 149 College Street.  We are pleased to provide you with this first view of the space and the staff working within our new offices.  Please come by to visit us anytime.  

Dr. Shaf Keshavjee
Shaf Keshavjee was featured in The Toronto Star on Wednesday, March 13, 2013 for his innovations in transforming how lung transplants are done.  
Dr. Andres Lozano
Andres Lozano was highlighted in the U of T News for his exciting new innovations with deep brain stimulation for severe cases of anorexia patients.
Dr. Gideon Cohen
Gideon Cohen has been appointed as Division Head of Cardiac Surgery at Sunnybrook Health Sciences Centre effective March 10, 2013.

Ren-Ke Li (Cardiac Surgery) has had his CRC Tier 1 Award renewed.
Carin Wittnich (Cardiac Surgery) received an Excellence in Undergraduate Teaching in the Life Sciences Award. 
Allan Okrainec (General Surgery) received a grant from CE Research and Development.
Andras Kapus (Scientist) received a 2013 NSERC Discovery Grant for his work on cytoskeleton-mitochrondrion interactions during cellular stress.  
Ron Levine (Plastic Surgery) is the winner of the 2013 Mickle Award.  This award recognizes an individual who has provided many years of service to medicine and medical education. 
Marku Nousiainen (Orthopaedics) received the 2013 PGME Award for Excellence in Development/Innovation.
Paul Greig (General Surgery) received the 2013 PGME Award for Teaching Performance, Mentorship and Advocacy.
Carol Anne Moulton (General Surgery) received the 2013 PAIRO Excellence in Clinical Teaching Award.


Agnihotri S, Burrell KE, Wolf A, Jalali S, Hawkins C, Rutka JT, Zadeh G.  Glioblastoma, a brief review of history, molecular genetics, animal models and novel therapeutic strategies.  Arch Immunol Ther Exp (Warsz): 2013 Feb; 61(1):25-41.
Al-Ahmed IH, Boughamoura M, Dirks P, Kulkarni AV, Rutka JT, Drake JM.  Neurosurgical management of neurenteric cysts in children.  J Neurosurg Pediatr: 2013 Mar 1.  Epublished ahead of print. 
Arvin B, Kalsi-Ryan S, Mercier D, Furlan JC, Massicotte EM, Fehlings MG.  Pre-operative MRI imaging is associated with baseline neurological status and can predict postoperative recovery in patients with cervical spondylotic myelopathy.  Spine: 2013 Mar 4.  Epublished ahead of print.
Cahoon NJ, Naparus A, Ashrafpour H, Hofer SOP, Huang N, Lipa JE, Forrest CR, Pang CY.  Pharmacologic prophylactic treatment for perioperative protection of skeletal muscle from ischemia reperfusion injury in reconstructive surgery.  Plastic & Reconstructive Surgery:  2013 Mar; 131(3): 473-485.
Choi D, Morris S, Crockard A, Albert T, Bumnger C, Fehlings M, Harrop J, Kawahara N, Martin A, Massicotte EM, Mazel C, Oner FC, Peul W, Tomita K, Wang M.  Assessment of quality of life after surgery for spinal metastases.  Position statement of the Global Spine Tumour Study Group.  World Neurosurg: 2013 Feb 16.  Epublished ahead of print.
Clarkson PW, Sandford K, Phillips AE, Pazionis TJ, Griffin A, Wunder JS, Ferguson PC, Masri BA, Goetz T.  Functional results following vascularized versus nonvascularized bone grafts for wrist arthrodesis following excision of giant cell tumors.  J Hand Surg Am: 2013 Feb 27.  Epublished ahead of print. 
Clouatre E, Pinto R, Banfield J, Jeschke MG.  Incidence of hot tap water scalds after the introduction of regulations in Ontario.  J Burn Care Res: 2013 Mar; 34(2):243-248.
Cohen M, Bartels U, Branson H, Kulkarni AV, Hamilton J.  Trends in treatment and outcomes of pediatric craniopharyngioma, 1975-2011.  Neuro Oncol: 2013 Mar 13.  Epublished ahead of print.
Daghistani R, Miller E, Kulkarni AV, Widjaja E.  Atypical characteristics and behavior of dysembryoplastic neuroepithelial tumors.  Neuroradiology: 2013 Feb; 55(2):217-224.
David TE, Armstrong S, Manlhiot C, McCrindle BW, Feindel CM.  Long-term results of aortic root repair using the reimplantation technique.  J Thorac Cardiovasc Surg: 2013 Mar; 145(3):S22-25. 
Edem IJ, Banton B, Bernstein M, Lwu S, Vescan A, Gentili F, Zadeh G.  A prospective qualitative study on patients’ perceptions of endoscopic endonasal transsphenoidal surgery.  Br J Neurosurg: 2013 Feb; 27(1):50-55.
Elmaraghy AW, Pennings A.  Metacarpophalangeal joint extensor tendon subluxation: A reconstructive stabilization technique.  J Hand Surg Am: 2013 Mar; 38(3):578-582.
Erwin WM, Islam D, Eftekarpour E, Inman RD, Karim MZ, Fehlings MG.  Intervertebral disc-derived stem cells: Implications for regenerative medicine and neural repair.  Spine: 2013 Feb; 38(3):211-216. 
Fallah A, Ibrahim GM, Rutka JT.  Hemispherectomy; When half is better than the whole.  Journal of Clinical Neuroscience:  2013 Mar; 20(3):478.
Fan XY, Mothe AJ, Tator CH.  Ephrin-b3 decreases the survival of adult rat spinal cord-derived neural stem/progenitor cells in vitro and after transplantation into the injured rat spinal cord.  Stem Cells Dev: 2013 Feb; 22(3):359-373.
Finnerty CC, Jeschke MG, Qian WJ, Kaushal A, Xiao W, Liu T, Gritsenko MA, Moore RJ, Camp DG 2nd, Moldawer LL, Elson C, Schoenfeld D, Gamelli R, Gibran N, Klein M, Arnoldo B, Remick D, Smith RD, Davis R, Tompkins RG, Herndon DNM; for the Investigators of the Inflammation and the Host Response Glue Grant.  Determination of burn patient outcome by large-scale quantitative discovery proteomics.  Crit Care Med: 2013 Mar 15.  Epiublished ahead of print.
Fontebasso AM, Schwartzentruber J, Khuong-Quang DA, Liu XY, Sturm D, Korshunov A, Jones DT, Witt H, Kool M, Albrecht S, Fleming A, Hadjadj D, Busche S, Lepage P, Montpetit A, Staffa A, Gerges N, Zakrzewska M, Zakrzewski K, Liberski PP, Hauser P, Garami M, Klekner A, Bognar L, Zadeh G, Faury D, Pfister SM, Jabado N, Majewski J.  Mutations in SETD2 and genes affecting histone H3K36 methylation target hemispheric high-grade gliomas.  Acta Neuropathol: 2013 Feb 16.
Gandhi R, Perruccio AV, Rampersaud YR.  Predictors of willingness to undergo elective musculoskeletal surgery.  Patient Prefer Adherence: 2013; 7:191-197.
Harris MA, Reynolds CC, Winters M, Cripton PA, Shen H, Chipman ML, Cusimano MD, Babul S, Brubacher JR, Friedman SM, Hunte G, Monro M, Vernich L, Teschke K.  Comparing the effects of infrastructure on bicycling injury at intersections and non-intersections using a case-crossover design.  Inj Prev: 2013 Feb 14. 
Hiyama Y, Marshall AH, Kraft R, Qa’aty N, Arno A, Herndon DN, Jeschke MG.  Effects of metformin on burn-induced hepatic endoplasmic reticulum stress in male rats.  Mol Med: 2013 Mar; 19(1):1-6.
Hodgson DC, Charpentier AM, Cigsar C, Atenafu EG, Ng A, Bahl G, Zadeh G, San Miguel J, Menard C.  A multi-institutional study of factors influencing the use of stereotactic radiosurgery for brain metastases.  Int J Radiat Oncol Biol Phys: 2013 Feb; 85(2):335-340.
Hutchison WD, Galati S.  Introduction to festschrift/special issue: Normal and abnormal neuronal oscillations in sensorimotor pathways.  Exp Neurol: 2013 Mar 4.  Epublished ahead of print. 
Jaja BN, Cusimano MD, Etminaan N, Hanggi D, Hasan D, Ilodigwe D, Lantigua H, Le Roux P, Lo B, Louffat-Olivares A, Mayer S, Molyneux A, Quinn A, Schweizer TA, Schenk T, Spears J, Todd M, Torner J, Vergouwen MD, Wong GK, Singh J, Macdonald RL.  Clinical prediction models for aneurysmal subarachnoid hemorrhage: A systematic review.  Neurocrit Care: 2013 Feb; 18(1):143-153. 
Karpova A, Arun R, Davis AM, Kulkarni AV, Massicotte EM, Mikulis DJ, Lubina ZI, Fehlings MG.  Predictors of surgical outcome in cervical spondylotic myelopathy.  Spine: 2013 Mar; 38(5):392-400.
Keith J, Pirouzmand F, Diamandis P, Ghorab Z.  Intraoperative cytodiagnosis of progressive multifocal leucoencephalopathy.  Cytopathology: 2013 Feb 15.  Epublished ahead of print.
Kraft R, Herndon DN, Finnerty CC, Shahrokhi S, Jeschke MG.  Occurrence of multiorgan dysfunction in pediatric burn patients: Incidence and clinical outcome.  Ann Surg: 2013 Mar 18.  Epublished ahead of print.
Lanzino G, Burrows AM, Tymianski M.  Advances in stroke: Vascular neurosurgery.  Stroke: 2013 Feb; 44(2):316-317. 
Lipsman N, Schwartz ML, Huang Y, Lee L, Sankar T, Chapman M, Hynynen K, Lozano AM.  MR-guided focused ultrasound thalamotomy for essential tremor: A proof-of-concept study.  Lancet Neurol: 2013 Mar 20.  Epublished ahead of print.
Lipsman N, Woodside DB, Giacobbe P, Hamani C, Carter JC, Norwood SJ, Sutandar K, Staab R, Elias G, Lyman CH, Smith GS, Lozano AM.  Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: A phase 1 pilot trial.  Lancet: 2013 Mar 6.  Epublished ahead of print. 
Lwu S, Goetz P, Monsalves E, Aryaee M, Ebinu J, Laperriere N, Menard C, Chung C, Millar BA, Kulkarni AV, Bernstein M, Zadeh G.  Stereotactic radiosurgery for the treatment of melanoma and renal cell carcinoma brain metastases.  Oncol Rep: 2013 Feb; 29(2):407-412.
Macdonald RL.  Reversing rat poison – Is faster better?  World Neurosurg: 2013 Mar 13.  Epublished ahead of print.
Moist LM, Lee TC, Lok CE, Al-Jaishi A, Xi W, Campbell V, Graham J, Wilson B, Vachharajani TJ.  Education in vascular access.  Semin Dial: 2013 Mar; 26(2):148-153.
Moore L, Thomas SH, Turgeon AF, Nathens AB, Sage NL, Emond M, Bourgeois G, Lapointe J, Gagne M.  Rates, patterns, and determinants of unplanned readmission after traumatic injury: A multicenter cohort study.  Ann Surg: 2013 Mar 8.  Epublished ahead of print.
Mueller CL, Jackson TD, Swanson T, Pitzul K, Daigle C, Pener T, Urbach DR, Okrainec A.  Linear-stapled gastrojejunostomy with transverse hand-sewn enterotomy closure significantly reduces strictures for laparoscopic roux-en-Y gastric bypass.  Obes Surg: 2013 Mar 24.  Epublished ahead of print. 
Munce SE, Perrier L, Tricco AC, Straus SE, Fehlings MG, Kastner M, Jang E, Webster F, Jaglal SB.  Impact of quality improvement strategies on the quality of life and well-being of individuals with spinal cord injury: A systematic review protocol.  Syst Rev: 2013 Feb; 2(1):14.
Naparus A, Ashrafpour H, Huang N, Hofer SOP, Zhong T, Forrest CR, Pang CY.  Combination of hypoxic preconditioning and postconditioning does not induce additive protection of ex vivo human skeletal muscle from hypoxia/reoxygenation injury.  Journal of Cardiovascular Pharmacology: 2012 Oct; 60(4):347-356.
Perruccio AV, Gandhi R, Rampersaud YR, thritis Program, University Health Network.  Heterogeneity in health status and the influence of patient characteristics across patients seeking musculoskeletal orthopaedic care – a cross-sectional study.  BMC Musculoskelet Disord: 2013 Mar; 14:83.
Phillips JJ, Aranda D, Ellison DW, Judkins AR, Croul SE, Brat DJ, Ligon KL, Horbinski C, Venneti S, Zadeh G, Santi M, Zhou S, Appin CL, Sioletic S, Sullivan LM, Martinez-Lage M, Robinson AE, Yong WH, Cloughesy T, Lai A, Phillips HS, Marshall R, Mueller S, Haas-Kogan DA, Molinaro AM, Perry A.  PDGFRA amplification is common in pediatric and adult high-grade astrocytomas and identifies a poor prognostic group in IDH1 mutant glioblastoma.  Brain Pathol: 2013 Feb 25.  Epublished ahead of print. 
Roche-Nagle G, Bachynski K, Nathens AB, Angoulvant D, Rubin BB.  Regionalization of services improves access to emergency vascular surgical care.  Vascular: 2013 Mar 18.  Epublished ahead of print.
Rotondo F, Kovacs K, Macdonald RL, Prud’homme GJ, Latta E, Munoz D.  Non-small cell bronchial carcinoma metastasizing into a prolactin-producing pituitary adenoma.  Int J Surg Pathol: 2013 Feb; 21(1):68-71.
Salehi F, Jalali S, Alkins R, Lee JI, Lwu S, Burrell K, Gentili F, Croul S, Zadeh G.  Proteins involved in regulating bone invasion in skull base meningiomas.  Acta Neurochir (Wien): 2013 Mar; 155(3):421-427.
Salewski RP, Buttigieg J, Mitchell RA, van der Kooy D, Nagy A, Fehlings MG.  The generation of definitive neural stem cells from piggyback transposon-induced pluripotent stem cells can be enhanced by induction of the NOTCH signaling pathway.  Stem Cells Dev: 2013 Feb; 22(3):383-396.
Schweizer TA, Kan K, Hung Y, Tam F, Naglie G, Graham SJ.  Brain activity during driving with distraction: An immersive fMRI study.  Front Hum Neurosci: 2013; 7:53.
Serletis D, Carlen PL, Valiante TA, Bardakjian BL.  Phase synchronization of neuronal noise in mouse hippocampal epileptiform dynamics.  Int J Neural Syst: 2013 Feb; 23(1):1250033
Sharma S, de Mestral C, Hsiao M, Gomez D, Haas B, Rutka J, Nathens AB.  Benchmarking trauma center performance in traumatic brain injury: The limitations of mortality outcomes.  J Trauma Acute Care Surg: 2013 Mar; 74(3):890-894. 
Shih LC, Vanderhorst VG, Lozano AM, Hamani C, Moro E.  Improvement of pisa syndrome with contralateral pedunculopontine stimulation.  Mov Disord: 2013 Feb 6.  Epublished ahead of print. 
Srejic lr, Valiante TA, Aarts MM, Hutchison WD.  High-frequency cortical activity associated with postischemic epileptiform discharges in an in vivo at focal stroke model.  J Neurosurg: 2013 Feb 15.
Takeshita H, Shiozaki A, Bai XH, Iitaka D, Kim H, Yang BB, Keshavjee S, Liu M.  XB130, a new adaptor protein, regulates expression of tumor suppressive microRNAs in cancer cells.  PLoS One: 2013; 8(3):e59057.
Tetreault LA, Karpova A, Fehlings MG.  Predictors of outcome in patients with degenerative cervical spondylotic myelopathy undergoing surgical treatment: Results of a systematic review.  Eur Spine J: 2013 Feb 6. 
Tso M, Macdonald RL:  A need for a standardized cognitive outcome measure in subarachnoid hemorrhage clinical studies.  World Neurosurg: 2013 Mar 15.  Epublished ahead of print.
Van Arsdell G.  Invited commentary.  Ann Thorac Surg: 2013 Mar; 95(3):955.
Walsh RA, Sidiropoulos C, Lozano AM, Hodaie M, Poon YY, Fallis M, Moro E.  Bilateral pallidal stimulation in cervical dystonia: Blinded evidence of benefit beyond 5 years.  Brain: 2013 Mar; 136(Pt 3):761-769.
Walter T, Zadeh G, Hawryluk G, Krzyzanowska MK.  Nocardia brain abscess in a patient treated with everolimus for a metastatic insulinoma.  J Clin Oncol: 2013 Feb; 31(6):e73-75.
Yang RY, Jaskolka JD, Tan KT, Roche-Nagle G.  Prevalence and significance of extravascular incidental findings on computed tomographic angiography and magnetic resonance angiography.  Vascular: 2013 Mar 14.  Epublished ahead of print. 
Zakrison T, McFarlan A, Wu YY, Keshet I, Nathens A.  Venous and arterial base deficits: Do these agree in occult shock and in the elderly?  A Bland-Altman analysis.  J Trauma Acute Care Surg: 2013 Mar; 74(3):936-939.
Zhong T, Wong KW, Cheng H, Ojha M, Srinivas C, McCluskey SA, Clarke H, Jacks L, Hofer SO.  Transversus abdominis plane (TAP) catheters inserted under direct vision in the donor site following free DIEP and MS-TRAM breast reconstruction: A prospective cohort study of 45 patients.  J Plast Reconstr Aesthet Surg: 2013 Mar; 66(3):329-336. 

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