Day #4

Today we started with a tour of the Endocrinology Research Centre's post-operative ICU. There we reviewed the following cases:
- man with ectopic ACTH production from sources in lungs
- woman with Cushing's disease s/p surgery but with complications (ARDS and steroid-induced psychosis)

We then discussed the following surgical patients with Dimitry:
- Woman with primary hyperaldosteronism that was shown to lateralize to AVS (contralateral to adrenal nodule identified by CT!). She underwent surgery but this was complicated by chyle leak noted due to drain in the abdomen.
- 40 yo woman with asymptomatic incidentally noted 2cm neck mass. This was AUS on FNA initially but follicular neoplasm vs. follicular variant of PTC on repeat. She was also noted to be hypercalcemic with elevated PTH. Scinitgraphy demonstrated L parathyroid gland (nodule also on L). She had yet to undergo surgery, so Dimitry intended to remove the L lobe and try frozen section (understanding this has limitations). We discussed use of frozen section (used more frequently here) and intra-op PTH levels (they are unable to do these, turnaround for their lab is about 40 min but they check post-op and the following day).

We then briefly visited a transsphenoidal resection of pituitary surgery that was in progress. They perform many of these at Endocrinology Research Centre, often up to 9 per week. They have a large number of Cushing's disease cases. Their OR equipment for this was very similar to the US.

Afterward, we returned to Dimitry's office for a discussion of a few thyroid cancer cases and the possible uses of frozen section.

Then Dr. Sturgeon presented his talk entitled "The Diagnosis and Management of Papillary Thyroid Cancer in the United States" to a large audience at the Endocrinology Research Centre.

(Dr. Sturgeon demonstrates video of using ultrasound to visualize movement of vocal chords)

(Questions from faculty after the talk)

At the end of the day, we met Pavel Rumyantsev, MD, PhD, the Deputy Director at the Endocrinology Research Centre. He is also an expert on radiation-induced thyroid cancer and has treated and studied a large group of patients with exposures relating to Chernobyl. He also gave us his impressions regarding the developing cases that may be related to Fukushima.

He also gave us a tour of the new additions to the Endocrinology Research Centre that are currently under construction. We saw the new inpatient rooms which will hold 2-4 patient per room. We also saw the operating suites and the ICU.