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Question to Dr. Yakobashvili


Tell me, please, at which age child's hearing should be checked-up if we were informed at the hospital before discharge that one ear does not hear. At the moment the child’s age is 1.5 months. Thank you.

Якобашвили Ираклий - оториноларинголог–хирург клиники оториноларингологии, хирургии головы и шеи ЕМС. Лечение паралича голосовых складок.

These tests done in the hospital are often false negative. Hearing can be tested now, it is necessary to make an appointment to the audiologist.

Problems with teeth


I have a huge problem with my teeth - all the teeth were treated, metalless ceramics were fixed in some places, a few teeth need to be removed. The treatment was carried out abroad, but the caries problem was beyond control, despite regular professional hygiene and specially selected tools. What range of dental examinations, in addition to specialist’s consultation, I can count on in EMC Moscow?

Various dental diagnostic methods are available in our Dentistry Department: computed tomography of all teeth of both jaws, which gives a three-dimensional image and allows the doctor to more accurately diagnose; orthopantomography gives a flat image of all the teeth; the targeted x-ray tooth image. Tooth extraction is performed surgically, mostly under local anesthesia. Diagnostic and treatment methods are determined individually by the attending doctor on consultation. Thank you for your message!

Dermoid cyst and pregnancy


An ultrasound revealed a mass in my left ovary during the first pregnancy. I was told that it is a dermoid cyst. Five years have passed since then. I gave birth to a second child. An ultrasound was performed annually. There were differences in size, but not significant. Since I’m going to have the 3rd child, another ultrasound was done today. The doctor said that the cyst had increased. I am concerned about it. Don't know where to start. What tests are needed? Thank you.

Максимова Юлия Владимировна – акушер-гинеколог, эндохирург клиники гинекологии и онкогинекологии ЕМС. Цифровая маммография во втором мнении.
Obstetrician and gynecologist, endosurgeon

Surgical treatment is strictly indicated in your case given the long history of the mass in the ovary and its rapid growth in recent times. In our clinic, we perform such an intervention laparoscopically through 3 small punctures. Patients go home next morning after the surgery and may return to work after 3 days. This surgery must be as delicate to preserve healthy ovarian tissue (considering your reproductive plans) as radical at the same time to remove the mass together with the capsule. At the preoperative stage an expert level ultrasound with Doppler is required, as well as blood tests for Ca-125 and НЕ-4 tumor markers. The decision concerning the necessity of FEGDS and colonoscopy is taken based on the results of these tests.

Prostate cancer


I am 74 years old. Prostate cancer was diagnosed. Total PSA was 25.8 ng/ml. Outpatient check-up was carried out. Are "Zoladex" injections enough? Biopsy revealed moderately poorly-differentiated small-acinar prostate adenocarcinoma. Where to start?

You should start with an extended examination, namely: skeleton scintigraphy, pelvic MRI, oncological examination. If the results of these tests will be the normal: surgery or radiotherapy may be offered (both with/without “Zoladex” therapy). If the results are abnormal: radiation therapy with/without “Zoladex” therapy or “Zoladex” therapy may be offered.

Malignant kidney tumor


CT scan revealed a malignant kidney tumor in my brother. The tumor size is 3x7, which corresponds to stage 2. Tell me, please, how long does it take for such a tumor to be developed? And is it possible to remove the tumor surgically (total kidney removal)?

For a more precise answer we need to assess patient’s CT scans ourselves. At the EMC’s Urology clinic, both total and partial kidney removal with tumor is performed using the da Vinci robot. These surgeries are very gentle with fast postoperative recovery.



My left jaw started to hurt me after giving birth. The pain was accompanied by a crunch, clicks, discomfort when chewing. Arthrosis was diagnosed at local institution. What should I do?

The symptoms of pain and the crunch may occur following precipitating factors. It can be a trauma of the maxillofacial area, ENT-organs infections, sitting with mouth open for a long time when visiting the dentist, hypothermia, overload. Perhaps, pregnancy and childbirth were such a factor in your case. The treatment goal in arthrosis is to reduce the load in temporomandibular joint. Treatment depends on the cause or the complex of causes that triggered the arthrosis. This may be due to the anatomical mismatch between the articular head size and the glenoid fossa. This also can be due to the long-term overload resulted from irregular bite and muscle imbalance. If increased tone of the masticatory muscles has led to increased abrasion of teeth, method of treatment with the restoration of the chewing surfaces and cutting edges of all teeth is optimal. But before that, splint therapy (mouth guards) is mandatory, which ensures the optimal position of the articular heads in articular fossae. Treatment is designed depending on the cause of changes in the joint. If the irregular bite is present pre-treatment by the orthodontist may be worthwhile.

Radiation therapy for prostate cancer


What to expect during radiation therapy for prostate cancer?

Салим Нидаль – радиотерапевт, онколог ЕМС. SBRT радиохирургия для облучения опухолей вне головного мозга и позвоночника.
SALIM Nidal (Israel)
Director Institute of Oncology, M.D., Clinical Oncologist, Radiation Oncologist

The procedure of external radiotherapy is similar to conventional x-ray examination. Radiation is invisible, has no smell and gives no sensations, side effects do not appear until 2nd or 3rd week of treatment. Radiotherapy for prostate cancer is a local treatment; therefore, you may experience some side effects only in those parts of the body that are exposed.

Diagnosed infertility - what to do?


I’m 27 years old, diagnosed infertility since 5 years ago, tubal factor and only one working ovary. Have gone through 3 tries of in vitro fertilization, one was stimulated, had no response, in all 3 cases I had only one oocyte. AMH 0,91. Do you think I have a chance for a pregnancy with my own oocyte? Sperm quality is good.

Yes, of course, you should fight for your oocytes. There is a variety of minimal stimulations: modified cycles, natural cycles etc. If these methods don’t work, so we will think about donor cells. But you must definitely give your ovaries a chance.

Break iafter the last course of chemotherapy


Why a break is necessary after the last course of chemotherapy?

In cases where chemotherapy is not enough effective, some cells of the tumor does not die as a result of exposure and only slow down their biological processes temporarily, so they do not accumulate diagnostic radiopharmaceutical that can lead to a false negative result. After 2-3 weeks, tumor cells return to their normal state and can be seen at the PET/CT scan. Thus, the break after the last course of chemotherapy should be done in order to obtain reliable results of the quality of treatment.

Рancreatic cancer


My wife of 64 years was diagnosed with pancreatic cancer in the autumn of 2014. Stage 4 was concluded. Surgery is impossible. There is a massive thrombosis. Three biopsies were carried out. A benign tumor was revealed. She lost a lot of weight. An episode of severe pain took place about one month ago. Currently, a significant problem is the ascites, swollen legs; food is poorly digested, general discomfort. What can you recommend? Is it necessary to remove the fluid and what might be the consequences?

Копосов Павел Валентинович – онколог, химиотерапевт института онкологии ЕМС. Примерный расчет стоимости предстоящего курса лечения по акции «Второе мнение».
Deputy Director Institute of Oncology, Chief Consultant of Medical Oncology, M.D., Professor

The picture you described is consisted with the concept of "metastatic ascites". Laparocentesis is appropriate as a therapeutic and diagnostic approach. Given the negative cytology, it is likely that the patient has a neoplastic disease of the colon, ovaries or stomach. Our experts will hold a consultation on the same day and perform the procedure to verify the diagnosis and consider the possibilities of palliative treatment.

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