Medicine and Health Sciences Commons^™

Treatment Of Rectal War Wounds, O J. Van Waes, J A. Halm, J Vermeulen, Vivian C. Mcalister

Vivian C. McAlister

Treatment strategies for penetrating rectal injuries (PRI) in civilian settings are still not uniformly agreed, in part since high-energy transfer PRI, such as is frequently seen in military settings, are not taken into account. Here, we describe three cases of PRI, treated in a deployed combat environment, and outline the management strategies successfully employed. We also discuss the literature regarding PRI management. Where there is a major soft tissue component, repetitive debridement and vacuum therapy is useful. A loop or end colostomy should be used, depending on the degree of damage to the anal sphincter complex.

Reuse Of Liver Grafts Following Brain Death Of The Initial Recipient, Hideaki Tanaka, Vivian C. Mcalister, Mark Levstik, Cameron Ghent, Paul Marotta, Douglas Quan, William Wall

Vivian C. McAlister

AIM: To determine if there is a reasonable prospect of success of a re-use liver transplantation.

METHODS: We systematically searched for reports of liver graft re-use using electronic searches of PubMed and Web of Knowledge. We performed hand searches of references lists of articles reporting re-use of grafts.

RESULTS:A systematic review of the literature reveals 28 liver transplantations using previously transplanted grafts. First and second recipients ranged in age from 4 to 72 years and 29 to 62 years respectively. Liver disease in the first recipient was varied including 5 (18%) patients with fulminant liver failure who died subsequently of …

Absence Of The Genicular Arterial Anastomosis As Generally Depicted In Textbooks., Maher Sabalbal, Marjorie Johnson, Vivian C. Mcalister

Vivian C. McAlister

This article reviews the history of anatomical research, starting with John Hunter and Astley Cooper, into the arterial anastomosis at the knee and uses dissection to determine the reality. The final draft is available below. (Ann R Coll Surg Engl. 2013 Sep;95(6):405-9)

INTRODUCTION Textbook representations of the genicular arterial anastomosis show a large direct communication between the descending branch of the lateral circumflex femoral artery (DBLCFA) and a genicular branch of the popliteal artery but this is not compatible with clinical experience. The aim of this study was to determine whether the arterial anastomosis at the knee is sufficient, in …

Role Of Persistent Processus Vaginalis In Hydroceles Found In A Tropical Population, Vivian C. Mcalister, Vincent Trottier

Vivian C. McAlister

BACKGROUND:

Lymphatic obstruction by Wuchereria bancrofti is thought to be the mechanism for development of tropical hydrocele in men and for elephantiasis, mostly in women. Hydrocele prevalence is used to determine the effectiveness of para site eradication programs. METHODS:

We maintained a prospective log of operations performed at 1 Canadian Field Hospital during its relief mission to Léogâne, Haiti. Information regarding duration of symptoms, type of previous surgery (if any), surgical approach, associated inguinal hernia and volume and appearance of hydrocele fluid in patients with tropical hydroceles were recorded. RESULTS:

From January to March 2010, 4922 patients were seen, none …

Debate At The Royal College Summit On The Future Of General Surgery

Vivian C. McAlister

Royal College of Physicians and Surgeons of Canada Task Force to address the Future of General Surgery, in Ottawa 13 May 2013: Dr Vivian McAlister debating with Dr Bill Pollett

Slow Birth Of New-Wave Medical Journalism, Vivian C. Mcalister

Vivian C. McAlister

Half a century has passed since Sir Theodore Fox reflected upon his recently completed 40-year tenure as editor of The Lancet. He titled his farewell lecture series “Crisis in communication: the functions and future of medical journals.”1 Even though the number of journals had dramatically increased by the 1960s, submissions had proliferated to such an extent that Fox’s principal regret was the increasing fraction he was forced to refuse. In the late 19th century, the surgeon general of the United States was able to catalogue the entire body of medical knowledge up to that time in a volume that would …

Supporting Rebuilding Efforts In Afghanistan, Dialogue

Vivian C. McAlister

Civilian Trauma Care - Learning From The Military Experience, Vivian C. Mcalister

Vivian C. McAlister

In the 21st century, military and civilian trauma surgeons bring similar solutions to similar problems, learning one from another. The objective of this presentation is to review military trauma care in Afghanistan for aspects that may influence civilian practice at home.

• Comprehensive trauma care system: guidelines,

registry, review

• Protocols for care: damage control; massive

blood transfusion policy; mass casualty care

• Techniques: resuscitative thoracotomy;

decompressive craniectomy; pelvic-gluteal

hemorrhage control

• Rehabilitation: Mild traumatic brain injury

• Delegated medical acts: medics / PAs

1 Canadian Field Hospital In Haiti: Surgical Experience In Earthquake Relief, Max Talbot, Bethann Meunier, Vincent Trottier, Michael Christian, Tracey Hillier, Chris Berger, Vivian Mcalister, Scott Taylor

Vivian C. McAlister

The Canadian Forces’ (CF) deployable hospital, 1 Canadian Field Hospital, was deployed to Haiti after an earthquake that caused massive devastation. Two surgical teams performed 167 operations over a 39-day period starting 17 days after the index event. Most operations were unrelated to the earthquake. Replacing or supplementing the destroyed local surgical capacity for a brief period after a disaster can be a valuable contribution to relief efforts. For future humanitarian operations/disaster response missions, the CF will study the feasibility of accelerating the deployment of surgical capabilities. L’hôpital déployable des Forces canadiennes, le 1er Hôpital de campagne du Canada, a …

Grand Rounds: Psoas Abscess With Group B Streptococcus, Adina Feinberg, Vivian C. Mcalister

Vivian C. McAlister

Case Report: A 43-year-old woman presented to the emergency room at University Hospital, London Health Sciences Centre with an eight-day history of lower back pain. She had presented one-week prior with similar symptoms and was treated conservatively for sciatica. Since then, her pain had progressively increased

The Life Of John Wishart (1850-1926): Study Of An Academic Surgical Career Prior To The Flexner Report., Emily Claydon, Vivian C. Mcalister

Vivian C. McAlister

BACKGROUND: The 1910 Flexner Report on Medical Education in the United States and Canada is often taken as the point when medical schools in North America took on their modern form. However, many fundamental advances in surgery, such as anesthesia and asepsis, predated the report by decades. To understand the contribution of educators in this earlier period, we investigated the forgotten career of John Wishart, founding Professor of Surgery at Western University, London Ontario.

METHODS: Archives at the University of Western Ontario, University of Toronto, London City Library, and Wellington County Museum were searched for material about Wishart and his …

Indications For Resection Of Metastatic Liver Lesions, Vivian Mcalister

Vivian C. McAlister

No abstract provided.

Pancreatic Cancer: Define Unresectable, Vivian Mcalister

Vivian C. McAlister

No abstract provided.

Causes Of Death In Canadian Forces Members Deployed To Afghanistan And Implications On Tactical Combat Casualty Care Provision., D Pannell, R Brisebois, M Talbot, V Trottier, J Clement, N Garraway, Vivian C. Mcalister, H Tien

Vivian C. McAlister

BACKGROUND: As part of its contribution to the Global War on Terror and North Atlantic Treaty Organization's International Security Assistance Force, the Canadian Forces deployed to Kandahar, Afghanistan, in 2006. We have studied the causes of deaths sustained by the Canadian Forces during the first 28 months of this mission. The purpose of this study was to identify potential areas for improving battlefield trauma care.

METHODS: We analyzed autopsy reports of Canadian soldiers killed in Afghanistan between January 2006 and April 2008. Demographic characteristics, injury data, location of death within the chain of evacuation, and cause of death were determined. …

Principles Of Combat Surgical Care In A Staged Evacuation System, Vivian C. Mcalister, Rob Stiegelmar, Brian Church, Ray Kao

Vivian C. McAlister

Background: The NATO hospital classification of hospitals describes an orderly transfer of patients with severe injuries through a series of increasingly sophisticated hospitals as they are brought from the point of injury to their home hospital. Forward hospital surgery is restricted to damage control and resuscitation while definitive surgery is performed at home by the destination surgical team. In reality many patients enter the hospital chain higher up and some receive definitive surgery as they proceed through the chain of evacuation. The purpose of this paper is to determine if clear doctrine exists to guide the performance of surgery on …

Utilization Profile Of The Trauma Intensive Care Unit At The Role 3 Multinational Medical Init At Kandahar Airfield Between May 1 And Oct. 15, 2009., Sha K, Pirie S, Compton L, Vivian C. Mcalister, Brian Church, Ray Kao

Vivian C. McAlister

Background: In the war against the Taliban, Canada was the lead North Atlantic Treaty Organization (NATO) nation to provide medical and surgical care to NATO soldiers, Afghanistan National Army soldiers, Afghanistan Nation Police, civilians working in and outside Kandahar Airfield and Afghanistan civilians at the Role 3 Multinational Medical Unit (R3MMU) from February 2006 to October 2009. Methods: We obtained data from the Joint Theatre Trauma Registry between May 1 and Oct. 15, 2009; 188 patients were admitted to the R3MMU intensive care unit (ICU). We analyzed the ICU data according to types and causes of trauma, mechanical ventilation prevalence, …

The Role 3 Multinational Medical Unit At Kandahar Airfield 2005-2010., R Brisebois, P Hennecke, R Kao, Vivian C. Mcalister, J Po, R Stiegelmar, H Tien

Vivian C. McAlister

In late 2005, Canadian Forces Health Services (CFHS) was tasked with the command of the NATO Role 3 Multinational Medical Unit (R3MMU) on Kandahar Airfield in southern Afghanistan. Preparations drew on past experience and planning. Eight complete hospital contingents were trained and deployed in rotation. Near-reality simulation training was undertaken with the combat brigade, including complete deployment of the field hospital in the exercise area. Standard operating procedures (SOP) were developed and applied by each rotation so successfully that they were adopted by the new command in late 2009. The Canadian period at R3MMU had the highest survival rate ever …

The Role Of Surgery In Building Resilience To Blast Attacks, Vivian C. Mcalister

Vivian C. McAlister

Blast attacks are the commonest form of terrorist attack on civilians. Blast often causes injury from industrial accidents. Blast injury is the most common cause of injury and death in modern combat. A recent review of Canadian fatal casualties in Afghanistan found 81% to have been caused by blast, almost four times the number killed by gun shot wounds. Improvised explosive devices (IED) caused 78% of the blasts with another 20% being due to rocket propelled grenades (RPG).1 The purpose of this review is to outline the mechanisms of injury, to define the surgical response and to understand the implications …

Drills And Exercises: The Way To Disaster Preparedness, Vivian C. Mcalister

Vivian C. McAlister

Catastrophes, natural or man-made, are very rare events in the life of hospitals in the developed world. None of the hospitals that coped with well known recent events such as Hurricane Katrina or the Madrid bombings had actually experienced or prepared for such an occurrence. A mass casualty incident (MCI), sometimes called “MASCAL,” is a situation in which a hospital receiving multiple casualties does not have the resources to deal with the patients simultaneously. Bottlenecks may occur at any point from the trauma bays to the point of discharge. There are 2 phases in which hospitals fail to cope. In …

“Noted Surgeon, Fine Citizen”: The Life Of Archibald E Malloch, Md 1844–1919 By Charles G. Roland, Chloe Mcalister, Vivian C. Mcalister

Vivian C. McAlister

No abstract provided.

Composite Tissue Allotransplantation To Treat Veterans With Complex Amputation Injuries, Vivian C. Mcalister, Ray Kao, Brian Church, Markus Besemann, Rob Stiegelmar

Vivian C. McAlister

Amputee rehabilitation may be limited by complexity of injury (e.g. bilateral arm amputation), associated injury (e.g. colostomy) or by the level of amputation (e.g. high above knee). Our objective is to assess the potential for composite tissue allotransplantation (CTA) to overcome these barriers. Medical literature was searched and programs were surveyed regarding the current status of CTA. Results CTA remains an experimental reconstructive option that involves a large collaborative (physiatry, orthopaedic, plastic and transplant surgeons). Limb transplantation has evolved out of limb reimplantation surgery and organ transplantation. Approximately 10 programs world wide, with almost a decade of experience, report 90% …

Do Older Patients Utilize Excess Health Care Resources After Liver Transplantation?, Neil Shankar, Mamoon Albashir, Paul Marotta, William Wall, Vivian C. Mcalister, Natasha Chandok

Vivian C. McAlister

INTRODUCTION: Liver transplantation is a highly effective treatment for end-stage liver disease. However, there is debate over the practice of liver transplantation in older recipients (age ≥ 60 years) given the relative shortage of donor grafts, worse post-transplantation survival, and concern that that older patients may utilize excess resources postoperatively, thus threatening the economic feasibility of the procedure.

AIM: To determine if patients ≥ 60 years of age utilize more health resources following liver transplantation compared with younger patients.

MATERIAL AND METHODS: Consecutive adult patients who underwent primary liver transplantation (n = 208) at a single center were studied over …

Mass Casualty Training Exercise At The Canadian Surgery Forum

Vivian C. McAlister

On September 18, 2011 second year Schulich School of Medicine & Dentistry students helped run the first mass casualty training exercise, directed by Dr. Vivian McAlister, Division of General Surgery, at the Canadian Surgery Forum held this year at the London Convention Centre.

2010 Newsmakers: Celebrating Our Own, Paul Mayne, Jason Winders

Vivian C. McAlister

How will we remember 2010? Probably through these faces. This year, the Western News starts a new, if not wholly original, tradition. Our Newsmakers 2010 section celebrates the best of research, academia and volunteer spirit that we have to offer on this campus. We spotlight, in brief words and striking images, the accomplishments of some of our favourites from the last year. One of the most powerful women in Canada. A student with an eye for the greater good. And a man who would do anything, including posing with a zebra, for the United Way. A football coach. A ground-breaking …

A Pioneer Of Urologic Surgery From A Small Town In Ontario, Canada: A Tribute To Abraham Groves (1847-1935)., Yves Caumartin, Vivian C. Mcalister, Patrick Pw Luke

Vivian C. McAlister

Background: Abraham Groves worked as a general practitioner and surgeon in the small town of Fergus, Ontario, Canada. Several priority claims have been attributed to Groves’ life in surgery, including aseptic surgery (1874), appendectomy (1883) and the use of surgical gloves (1885). He was also an early practitioner of urological surgery.

Objective: The purpose of this paper is to describe and objectively assess his contributions as a pioneer in urological surgery.

Methods: A systematic search of contemporary journals was made for articles by or about Groves. These articles and his 1934 autobiography were reviewed. The information was assessed not only …

Western News: Rewriting The Record On Legs, Lesley Craig, Paul Mayne

Vivian C. McAlister

No abstract provided.

Civilian Versus Military Trauma Management, Vivian C. Mcalister

Vivian C. McAlister

In the 21st century, military and civilian trauma surgeons bring similar solutions to similar problems, learning one from another

The Maple Leaf: Saving Lives, Saving Legs, Leslie Craig

Vivian C. McAlister

No abstract provided.

Management Of Devastating Ocular Trauma--Experience Of Maxillofacial Surgeons Deployed To A Forward Field Hospital, Mark Ansell, J Breeze, Vivian C. Mcalister, Michael Williams

Vivian C. McAlister

Combat-related eye injuries continue to increase in frequency and are generally secondary to Improvised Explosive Devices. Many ocular injuries are potentially preventable by the wearing of ballistic eye protection. The management of penetrating eye trauma is normally outside the routine practice of maxillofacial surgeons in the UK. The aim of this paper is to describe the surgical techniques used in the modern management of devastating ocular trauma including selected case examples managed by British military maxillofacial surgeons deployed to Afghanistan.

In–Theater Peritoneal Dialysis For Combat-Related Renal Failure, Joseph Pina, Soraya Moghadam, Howard M. Cushner, Greg J. Beilman, Vivian C. Mcalister

Vivian C. McAlister

BACKGROUND: Complications of renal failure may prevent timely evacuation of injured soldiers. Conventional renal replacement therapy is not available in forward surgical units.

METHODS: Records of in-theater improvised peritoneal dialysis (IPD) in level III hospitals or forward surgical units in Iraq or Afghanistan were reviewed to determine the following: cause of renal failure and associated injuries; type of dialysate, peritoneal access, and exchange technique; and patient outcome. These data were used to propose method for IPD using commonly available materials.

RESULTS: IPD is described in four patients. Abdominal or chest drains were used with either improvised dextrose-electrolyte solution or commercial …