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16 May (Wednesday)
ENT working group (Paul Mulkens, guest ENT surgeon and Irma Stoetman, guest surgery nurse) was collected at 19 hours from airport by Alena Sarancha (ENT doctor) with the company car of the hospital droven by Sacha, the driver of the hospital ‘s director Valery Yanin. This car with driver was reserved the whole week for the DEMMA guests transportation.
Check in Lecco hotel Letnaja Street 32 in Mytischy.
Dinner at 21 hours in the hotel and late meeting with Valery Yanin who had a lot to explain how the process had runned up to his new position as the head of the Central Mytischy hospital. Very interesting story. The previous director Vladislav Mirzonov got a new position as administration head of all the medical institutions in the whole Mytischy region.

17 May (Thursday)
Actually Ascension day, in NL an official holiday but locally here a normal working day. At 9.30 when we entered the hospital we did meet by chance the gynecologist Wladimir Davidyuk (Dwoyka 2007) just in advance of the warmly welcome at the ENT department staffed by:
* Ludmilla Sarancha, still head of the dept. At her age of 70 and mother of
* Elena Sarancha (Dwoyka 2007), most experienced in the rhino logical endoscopical procedures and professionally leading
* Nadjezda Nozdrecheva, member of the ENT medical staff since many years.
Three patients were scheduled for operation: two endoscopical rhino-sinus surgery in order to remove polyposis nasi (general anesthesia) to perform by the guest surgeon together with Elena S. The third patient had to underwent a conchectomy (local anesthesia) operated by Ludmilla S. Anesthesiology time is spare quality time, so the waiting delay between two operations normally is quite long. The anesthesiologist Konstantin Veresov (Dwoyka 2010) welcomed us first but referred the patients to the anesthesiologist Christina Markajan, 6 months pregnant but perfect speaking the English language. She might be a proper Dwoyka candidate in due course.

Some remarks around the surgery procedures:
• Elena does not have a sitting position during the operation resulting in reduced stability from her arms. So she was advised to try to change this.
• Irma gave a lot of instructions around hygienic conditions and she assisted during the procedures
• The equipment made in Russia (Kazan) was well enough and the Shaver was quite effective however missing automatically rinsing for continuous cleaning.
• Elena is very much interested in advanced and delicate sinus surgery but prior to step up she needs more practice in handling with the Shaver.
• The assistance of Tanja around the surgery and the polyclinic as well was quite sufficient.

After the work we had a traditional but late lunch at Ludmilla’s office room. Afterwards a short meeting again with Valery Yanin. The idea was launched to subscribe Elena to a endoscopical sinus surgery course, may be within the frame of Dwoyka 2012. The possibility came forward to request for a special arrangement with University hospital Groningen (Prof. Bernard van der Laan). The home basis for Elena might be Assen as guest of the family. Another matter of discussion was an instrumental issue concerning the headlights which are so fundamental important in the ENT practice. It turned out the quality of the headlight of Elena was absolutely not acceptable according professional standards. As a preferred headlight it was advised to purchase BFW Vista View II Portable Headlight System ( in the Netherlands available by the ATOS company (around € 2000,=) but may be less expensive in Russia or in Germany. This headlight system might be supposed as a top of the bill. Absolutely a must to have.

In the evening we were social guests in the family of Alexander Lebedev, cardiologist (Dwoyka 2009) with his wife Svetlana and children Margarita (5) and Fjodor (10 months). Their place was in Moscow in the Northern district Lianozovo, not so remote from Mytishchy. We were the first guests in their new flat. Prior to this they had to share a flat with their parents during more then 8 years. Before the dinner we had a walk through the Lianozovo park. A beautiful place including the Contemporary Art museum which we did visit with an exhibition of Konstantin Vasiliev who lived in the same building until his death in 1976. We spent a wonderful evening together with this happy family.

18 May (Friday)
At 10.00 one rhinoplasty procedure together with extraction of nasal polyps (with Shaver but not endoscopical) was scheduled.
Remarks on the procedure:
• Russian instruments again did work well especially a specific rigid suction tube (Guillain like but with the suction mouth not completely at the tip)
• Missing: collumella clamp, proper Blakesley forceps
• The surgery head light, too heavy including the heavy cable was terrible.
At 11.30 coffe break and short meeting with Valery Yanin in Ludmilla’s office. A short briefing on the tomorrow program in Moscow was held.
At 14.00 the next venue was in the Koroliev (previously named Kaliningrad) hospital. By MSD (Merck Sharp and Dome) a clinical conference was organized to an audience of medical doctors of different specialism (ENT, paediatry and pulmonology) coming from Koroliev and Mytishchy as well . The program issue was OSAS. The first speaker came from a snoring center which was specialized in the CPAP therapy. The second speaker came up with a presentation about the surgical options in treating snoring. His name was professor Wladimir Swistoechkin (he was the former teacher of Elena S. until 2004) and he came from the well known MONIKI hospital in Moscow .

At 16.30 the whole audience was invited by MSD for a small dinner to socialize. Afterwards the plan was to drive to Moscow but that was skipped due to the heavy traffic jams (propka’s).

19 May (Saturday)
At 10.00 hrs. departure from Lecco hotel direction Moscow, together with Elena S., to visit the new ENT policlinic of Elena Toshakova (Troyka 2005). The name of the clinic is GMS (Global Medical Systems, ) . Only for consultations, no surgery. Elena S. was very much interested in this modern commercial clinic. May be there will be in the future an option to link this GMS with the Mytishchy hospital in providing surgery services? After this visit at 15.30 the professional program was ended for today. Strolling around the Kremlin, sitting and dining at the Red Square Bosco restaurant terrace was a very nice option especially together with the fine weather conditions with 25 degrees. The way back very simple by metro to terminal station Medvedkovo and transit direction Mytishchy by shuttle bus 169, bus stop right in front of the hotel. Total time elapsed from Red Square to the hotel: 48 minutes only.

20 May (Sunday)
Touristic travel day together with Valery Yanin and his girlfriend Xenia Chebitova. The destination was a monastery in the place Svenigorod, west of Moscow, 60 kms from Mytishchy. It was a nice and sunny day, most relaxed. Afterwards outside dinner at Valery’s place. In the mean time also some conversation concerning the planned 2012 projects.

21 May (Monday)
In the morning some ENT consultations including an extensive demonstration on the new Zeiss (up to date!) surgical microscope. Also a brief visit to the department of Valery.
After lunch meeting at the Erisman institute with Ludmilla Saarkoppel (Dwoyka 2010) together with Alexander Aliev (Dwoyka 2009) and Andrey Melentev (Dwoyka 2011). Also present the senior head neurologist prof. Afanawitch. These Erisman doctors confirmed the invitation for two young NL doctors for two weeks next autumn. DEMMA have to select two candidates (focal point Jur Niewold). Additionally a brief meeting with the Mytishchy hospital anesthesiologists Konstantin (Dwoyka 2010) and Christina. Christina would be a perfect Dwoyka candidate in 2013 and she would accept an invitation as she said.
After the meeting we were the private guests of Alexander (Sasja) Aliev for a short trip to the South of Moscow to visit a very beautiful park including a fully (by the former mayor Loeskov) restaurated palace named Tsaritsino. Good atmosphere together with impeccable summer weather. Sasja explained us he was busy in a new specialization (radiology) in order to get a new job elsewhere.
22 May (Tuesday)
Flight back departure scheduled at 10.45 was missed due to too many propka’s, taking 70 additional minutes, impossible to manage sufficiently by our driver Sasja. Next flight eventually that we could catch was at 18:00 hours. The seven Sjeremetjevo airport waiting hours turned out to be useful in composing this visit report.

Moscow, 22 May 2012
Paul Mulkens