Day #1

We had a very busy and fascinating first (full) day.

(Newspaper with breakfast)

After breakfast in our hotel, Daria drove us to Endocrine Research Centre where we joined Dimitry just as he was beginning hist first surgical case of the day: resection of a 7cm pheochromocytoma.

(Cord on Left, Dmitry operating on pheo)

(Metal surgical instruments)

We then toured much of the facility and met the directors of pathology and laboratory services.
We had tea with the Director of the Institute of Clinical Endocrinology and Metabolism, Galina Melnichenko, who showed me the Russian translation of Williams Textbook of Endocrinology (of which she is an editor).

(Russian translations of Williams Texbook of Endocrinology - each book is a section)

(Max Flynn, Galina Melnichenko, Daria Gazizova, and Cord Sturgeon)

She discussed with us some of the challenges faced by the Endocrine Research Centre, particularly that many of the patients travel from very far (rural Russia and former soviet republics) and often have had extensive (but often inappropriate) workup and management at their local facilities. She shared that the average time from presentation of Cushing syndrome to the patient seeing an endocrinologist in Moscow is 4 years. 

We next returned to see part of Dimitry's second case: a thyroidectomy, bilateral central neck, and right modified radical neck dissection of a 46 yo woman with papillary thyroid cancer.

(Cord and Dimitry)

We then visited the thyroid biopsy clinic with Dr. Vladimir Vanushko. There was a long line of patients waiting in the hallway for biopsy. Dr. Vanushko performed the biopsies very quickly with the assistance of an ultrasound technician to hold the probe and isolate the nodule. He utilized a 20g needle with syringe for suction. Only one pass is made and one slide is prepared per nodule. Slides were air-dried only so we discussed the possibility of using alcohol fixation as well to preserve nuclear features. 

 (Ultrasound technician for FNA biopsy clinic)

(Each slide represents a distinct nodule biopsied... a busy clinic!)

After Daria dropped us off at the hotel, Cord and I decided to brave the Moscow "metro" system to go downtown for dinner. 

We managed to negotiate the signs and maps (mostly written in cyrillic) to find Red Square and captured some beautiful night-time photos of the Kremlin and St. Basil's Cathedral.