Day #3

This morning we visited the Russian Scientific Center of Radiology and Nuclear Medicine. This is one of only two government regulated facilities for diagnostic and therapeutic nuclear medicine in the Moscow region. Their diagnostic scans are completed as outpatient but all treatment doses of radio-iodine require hospitalization with very strict isolation measures . Patients stay in one of 10 rooms that are separate from staff. They stay hospitalized until radioactive is at acceptable levels (measured by whole body emission at 1 meter). All excreted radioactive isotope are collected and stored underground below the facility. 

(Cord sturgeon discusses a case with a technitician)

After our tour of the facility, we ate lunch at one if Daria's favorite restaurants, Propaganda:  

Then we quickly visited a couple of the churches in the Kremlin:

Finally, we were given a guided tour of the State Tretyakov Gallery (provided by a grateful patient of Dimitry):

Day #2

Another busy day. 

We met Tatyana soldatova, PhD who is the head of the ultrasound department. Dimitry showed us his FNA biopsy technique.

We were then presented a number of fascinating cases by fellows and attendings of the Endocrinology Research Center including:

- secondary hyperparathyroidism (ESRD on HD) with bone disease from Osteitis fibrosis cystica.

- new onset hyperpigmentation of unclear cause with a pituitary micronodule

- Acromegaly 

- Mccune Albright 

- Graves disease with severe eye manifestations (near blindness) and severe gout (tophi)

- MEN2a with medullary TC & pheo

- patient with classical CAH with adrenal rests in testis

- Thyrotoxicosis with cardiac dysfunction (Graves)

(photo of my hand next to hand of a man with long-standing acromegaly)

(severe gout in a man who also has Graves' disease)

After lunch, I presented interesting cases from my fellowship training to an audience of residents and physicians at the Endocrine Research Center. Topics included primary hyperparathyroidism and primary aldosteronism with discussion of the use and interpretation of AVS. The presentation was well-attended and there were questions and discussion regarding the management of asymptomatic hyperparathyroidism.

(At lunch we had a sweet drink made from boiled fruit... Daria says this is common in Russian homes where they often make it with fruit from their garden)

For dinner, our hosts took us to Cafe Pushkin, which is one of the most famous restaurants in Moscow. Our hosts ordered us a variety of classic Russian foods. We were also given a tour of the restaurant.

(Bill Clinton sat in this chair when he dined at this restaurant)

(Kofi Annan's chair)

(16-17th century books in the restaurant's library)

(Smoked salmon, sturgeon, caviar, pickled vegetables for appetizers)

(Sampling of Russian foods for dinner including 'Russian ravioli', beef stroganoff, blintz, and chicken Kiev)

(A Russian whiskey which they don't allow to be exported... The ice is made of frozen 'birch juice' which is a common beverage in Russia. It is produced by tapping the sap of a birch tree)

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.

Arrival in Moscow

We've arrived safely in Moscow (Sunday evening) without any problems. Dr. Dmitry Beltsevich very kindly picked us up at the airport and drove us to our hotel. There was much discussion of the events ahead... lots to look forward to. 

Here's a few photos from the drive (not great scenery since we needed to avoid Moscow's busy traffic).

  

And here's our Hotel Korston (a renovated casino with 15 restaurants)! It also happens to be really close to Endocrine Research Center.

(That's Cord Sturgeon in front)

On our way! (via Zürich)

Travel to Moscow

Today Dr. Cord Sturgeon and I travel from Chicago to Moscow, Russia to visit the Endocrinological Scientific Center, Russian Academy of Medical Science. This is part of the Endocrine Society's Ambassador Exchange Program for 2014. I will document our trip through photos and updates in this blog. Stay tuned.... 

Also be sure to follow Cord Sturgeon's bog:
http://endoambassadors.blogspot.com/2014/04/the-ambassador-exchange-program-is.html


For more information regarding the goals of the Ambassador Exchange Program:
https://www.endocrine.org/advocacy-and-outreach/ambassador-exchange-program