Andrzej Lewiński

Instytut Centrum Zdrowia Matki Polki, Łódź, Łódź Voivodeship, Poland

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Publications (385)685.37 Total impact

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    ABSTRACT: Aim: It has recently been suggested that prolactin (Prl) level above the upper limit of normal range, recorded in a single measurement in serum is enough to diagnose hyperprolactinemia (HPrl). The aim of the study was the analysis of the circadian rhythm of Prl secretion in children with an increased morning Prl concentration in order to establish whether it is a real hyperprolactinemic state or not. Material and methods: The analysis comprised a group of 44 children (32 boys and 12 girls, aged from 4.2 to 14.1 years, mean±SD: 10.4±3.5 years) with either short stature or precocious puberty, with an elevated Prl concentration at 8:00 a.m., suggesting hyperprolactinemic state. In all patients the circadian Prl secretion profile was assessed on the basis of Prl concentrations in 9 blood samples, collected in 3-h intervals. An analysis of the circadian Prl rhythm was performed. Depending on the medical history and the magnetic resonance imaging result, the children were divided into the following groups: A - congenital disorders of hypothalamic-pituitary region (n=10); B - acquired disorders of hypothalamic-pituitary region (other than pituitary adenomas) (n=15), C - pituitary adenomas (n=19). The control group consisted of 14 healthy children (9 boys and 5 girls), aged from 5.2 to 14.3 years, mean±SD: 10.8±3.2 years. Results: In only 18 children (41%), apart from a higher morning Prl concentration, an elevated Prl concentration at other time points was observed and the circadian rhythm was disturbed, implying hyperprolactinemic state (2 children from Group A, 8 from Group B and 8 form Group C). In the remaining 26 children (59%), higher morning Prl concentrations were not accompanied by elevated Prl concentrations at other time points of the circadian profile. Conclusions: In children with elevated Prl concentrations in the morning, a circadian Prl secretion profile should be performed in order to avoid overdiagnosing of continuous HPrl. In children with the presence of pituitary adenoma and increased morning Prl concentrations, the diagnosis of Prl-secreting adenoma is not completely obvious. © Georg Thieme Verlag KG Stuttgart · New York.
    Experimental and Clinical Endocrinology & Diabetes 06/2015; DOI:10.1055/s-0035-1550018 · 1.76 Impact Factor
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    ABSTRACT: Autoimmune polyglandular syndrome is a constellation of signs and symptoms of simultaneous insufficiencies of several endocrine glands. Autoimmune polyglandular syndrome type 2 (APS 2) may be diagnosed when the adrenocortical insufficiency is associated with an autoimmune thyroid disease (Hashimoto's thyroiditis or Graves' disease), and/or insulin-dependent diabetes mellitus. Turner syndrome is the most common chromosomal disorder in females, caused by complete or partial X chromosome monosomy. We present the case of a 20-year-old woman with Turner syndrome, in whom APS 2 (Hashimoto's thyroiditis and adrenocortical insufficiency) has been diagnosed after introduction of recombinant human growth hormone (rhGH) therapy. In Turner syndrome, examination of the patient must regularly be conducted in order to diagnose a possible onset of autoimmune diseases; respective treatment must be applied as soon as the diagnosis is established. In particular, therapy of rhGH, used for short stature treatment, may be a trigger factor of adrenal insufficiency. The cortisol level in blood should be assessed before rhGH administration and carefully monitored during the therapy, especially in case of autoimmune thyroid disease coexistence.
    Neuro endocrinology letters 05/2015; 36(2):119-123. · 0.94 Impact Factor
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    ABSTRACT: It has always been very difficult to precisely define a goitre. For years, the borderline values have been sought which could be universally used in such evaluations. However, presented reference values were very often disappointing as they proved to be either too restrictive or too liberal. The aim of the study was to assess the two methods of goitre evaluation: 1) traditional, based on ultrasound reference ranges for the thyroid size, 2) based on the analysis of thyroid volume (V) referred to the body surface area (BSA). For this purpose, the study was conducted to evaluate the incidence of goitre and ioduria among 102 school-aged children in Opoczno, Poland. The study group comprised 59 girls and 43 boys; age range: 8-12 years. The incidence of goitre among the examined children varied from 1.0-11.8% in relation to the age, and from 0-14.5% in relation to the BSA, depending on the references ranges used. Analysis of V/BSA ratio is a better estimation of the size of the thyroid gland than the evaluation of thyroid size based on traditional ultrasound reference values. Summing up, relating the size of the thyroid gland to BSA is a good, sensitive tool for such analysis, and can be used for comparisons of different populations, as well as surveys conducted at different time points.
    Annals of agricultural and environmental medicine: AAEM 05/2015; 22(2):301-306. DOI:10.5604/12321966.1152084 · 3.06 Impact Factor
  • Konrad Szosland, Magdalena Stasiak, Andrzej Lewiński
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    ABSTRACT: Laboratory discrimination of pathologic hyperprolactinemia is an important step in the diagnosis of pathology influencing overall health and fertility. A major issue is the choice of time and circumstances for obtaining a blood sample for prolactin assay that would be representative for mean daily plasma concentration of a subject. The aim of the study was a comparison of reliability of single prolactin assessment on various time-points in a day with circadian prolactinemia profile in order to find the easiest, the least expensive, and the most reliable method of hyperprolactinemia diagnosis. The study was a retrospective analysis of 138 women, hospitalized in the Department of Endocrinology and Metabolic Diseases, Polish Mother`s Memorial Hospital - Research Institute, Lodz, Poland, in whom the circadian profile of prolactin (including assays at 8.00 am, 11.00 am, 2.00 pm, 5.00 pm, 8.00 pm, 11.00 pm, 2.00 am, 5.00 am and repeatedly at 8.00 am) had been assessed. On the basis of AUC (area under the curve) of prolactin concentrations, hyperprolactinemia was diagnosed in 34 subjects (24.6 % of the entire group). The attempts to diagnose hyperprolactinemia based on a single prolactin assay failed due to a high percentage of false negative and false positive results. Only significant hyperprolactinemia with mean prolactin concentration of about 100 µg/l or more appeared easy to diagnose. Combinations of several time points also appeared not reliable enough. The nine-point daily profile of prolactinemia in any patient with clinical suspicion of hyperprolactinemia seems the best mode for estimating mean circadian prolactin concentration.
    Annals of agricultural and environmental medicine: AAEM 05/2015; 22(2):332-337. DOI:10.5604/12321966.1152090 · 3.06 Impact Factor
  • 05/2015; DOI:10.1530/endoabs.37.EP132
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    ABSTRACT: Mitochondrial biogenesis is an essential process for cell viability. Mice with disruption of the growth hormone receptor (GHR) gene (Ghr gene) in the liver (LiGHRKO), in contrast to long-lived mice with global deletion of the Ghr gene (GHRKO), are characterized by lack of improved insulin sensitivity and severe hepatic steatosis. Tissue-specific disruption of the GHR in liver results in a mouse model with dramatically altered GH/IGF1 axis. We have previously shown increased levels of key regulators of mitochondrial biogenesis in insulin-sensitive GHRKO mice. The aim of the present study is to assess, using real-time PCR, the gene expression of key regulators of mitochondrial biogenesis (Pgc1α, Ampk, Sirt1, Nrf2 and Mfn2) and a marker of mitochondrial activity (CoxIV) in brains, kidneys and livers of male and female LiGHRKO and wild-type (WT) mice. There were significant differences between males and females. In the brain, expression of Pgc1α, Ampk, Sirt1, Nrf2 and Mfn2 was lower in pooled females compared to pooled males. In the kidneys, expression of Ampk and Sirt1 was also lower in female mice. In the liver, no differences between males and females were observed. Sexual dimorphism may play an important role in regulating the biogenesis of mitochondria.
    Aging 03/2015; 7(3):195-204. · 4.89 Impact Factor
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    ABSTRACT: Polycystic ovary syndrome (PCOS) is a diagnosis of exclusion. We present two cases of women with oligomenorrhoea and high concentration of androstendione, suggestive of possible androgen-secreting tumour; caused by assay interference. The first patient, investigated for oligomenorrhoea, had no significant hirsutism or acne. Androstendione concentration was above 10.0 ng/ml (rr: 0.3-3.3 ng/ml). In order to rule out possible androgen-secreting tumour or hypercortisolaemia we performed 48-hour low dose dexamethasone suppression test (LDDST). This failed to demonstrate adequate suppression of androstendione (6.05 ng/ml and 9.32 ng/ml after the first and the second day respectively). Pelvic ultrasound examination showed polycystic ovaries, while abdominal CTscan failed to show any ovarian or adrenal lesion. Despite such high androstendione concentrations, urinary steroid profile (gas chromatography/mass spectrometry method) yielded normal results. Hence a possibility of androstendione assay interference was raised. The second patient was also admitted for investigations of oligomenorrhoea. Clinical examination was unremarkable. There was a high concentration of testosterone 0.78 ng/ml (rr. 0.084-0.481 ng/ml) and androstendione above 10.0 ng/ml (rr: 0.3-3.3 ng/ml). LDDST failed to demonstrate any suppression of androstendione, while recalculated concentrations of androstendione after serial dilutions were markedly lower in comparison to initial values. Therefore, such high androstendione concentrations (i.e. above the upper limit of the assay) must have resulted from assay interference. In both cases a final diagnosis of PCOS was established. In the absence of clinical features, contrasting with unusually high androgen levels, a possibility of androgen assay interference should be considered in differential diagnosis of hyperandrogenism or PCOS.
    Ginekologia polska 03/2015; 86(3):229-33. DOI:10.17772/gp/2067 · 0.68 Impact Factor
  • Konrad Szosland, Paweł Pawlowicz, Andrzej Lewinski
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    ABSTRACT: Hyperprolactinemia and polycystic ovary syndrome (PCOS) are on the list of the most frequent causes of female infertility. Both pathologies are characterized in common by several clinical features. At the same time, there are essential discrepancies in medical literature on mutual relations between PCOS and hyperprolactinemia. The objective of our study was to answer several questions, e.g. about frequency of hyperprolactinemia in PCOS patients, typical concentrations of prolactin (Prl) in PCOS patients vs women without polycystic ovaries and/or an assessment of circadian Prl level profiles vs single Prl sampling, as regards diagnostic usefulness. The study was retrospective analysis of medical records of female patients in whom nine (9) points daily profile of prolactinemia had been performed. Prl levels appeared to be slightly higher in women without PCOS but the difference did not reach a border of statistical significance. The incidence of elevated Prl concentrations in 8:00 AM and 11:00 AM samples was higher in women without PCOS than in PCOS patients (32.0% vs 16.3% - 8:00 AM, and 8.5% vs 4.6% - 11:00 AM, respectively). Also, elevated mean daily prolactinemia, assessed as area under the curve (AUC) of Prl concentrations, was more frequent in the group of women without PCOS than in those with PCOS (22.0% vs 13.9%). Polycystic overy syndrome is not associated with higher levels of Prl, measured in daily profiles. Hyperprolactinemia does not seem to be more frequent in PCOS women than in healthy subjects and it should not be considered as characteristic feature of PCOS - both are distinct clinical entities. Prolactin concentrations should be assessed in each woman with PCOS suspicion because of certain common clinical signs in both disorders. Every woman diagnosed with PCOS and hyperprolactinemia should further be examined in terms of the actual causes of hyperprolactinemia because the coexistence of these two disease entities - as distinct - is also possible.
    Neuro endocrinology letters 02/2015; 36(1). · 0.94 Impact Factor
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    ABSTRACT: Objective: Growth hormone (GH) deficiency (GHD) has recently been classified as secondary IGF-I deficiency but the significance of IGF-I measurement in diagnosing GHD is still discussed. The aim of the study was to assess the relationships between IGF-I secretion and GH therapy effectiveness in children with GHD. Patients and methods: The analysis comprised 300 children with isolated, non-acquired GHD (GH peak below 10 μg/l) who completed GH therapy and attained final height (FH). In all patients IGF-I concentration was measured before the treatment and IGF-I deficiency was diagnosed if IGF-I SDS for age and sex was below -1.0. The following auxological indices were assessed: patients' height SDS before treatment (H0SDS), FH SDS and improvement of FHSDS vs. H0SDS (ΔHSDS). Results: In the patients with IGF-I deficiency when compared with those with normal IGF-I secretion before treatment, significantly better FH SDS (-1.42±0.90 vs. -1.74±0.86, p=0.004) and ΔHSDS (1.64±1.01 vs. 1.32±1.05, p=0.010) were observed, despite similar H0SDS (- 3.07±0.78 vs. - 3.11±0.77, p=0.63) and GH peak (7.0±3.1 μg/l vs. 6.8±2.1 μg/l, p=0.55). The patients who achieved FH over 10(th) centile had significantly lower IGF-I SDS before treatment than those with FH below 10(th) centile (- 1.59±1.54 vs. - 1.20±1.64, p=0.04), despite similar GH peak (7.0±2.3 μg/l vs. 6.7±3.1 μg/l, p=0.45). The patients with ΔHSDS over the median value had significantly lower IGF-I SDS than those with ΔHSDS below the median value (- 1.59±1.71 vs. - 1.09±1.47, p<0.0001), despite similar GH peak (6.8±2.5 μg/l vs. 7.0±2.7 μg/l, p=0.86). Conclusion: In children with isolated, non-acquired GHD, secondary IGF-I deficiency is an important predictor of better GH therapy effectiveness. © Georg Thieme Verlag KG Stuttgart · New York.
    Experimental and Clinical Endocrinology & Diabetes 01/2015; 123(04). DOI:10.1055/s-0034-1395665 · 1.76 Impact Factor
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    ABSTRACT: A combination of traditional cytology methods with fluorescence activated cell sorting (FACS) analysis of fine-needle aspiration biopsy (FNAB) material is considered a powerful diagnostic tool in the differential diagnosis of thyroid lesions suspected of mucosa-associated lymphoid tissue lymphoma (MALT-L). The aim of this study was to demonstrate the FACS-based diagnostic process of thyroid lesions in a clinical situation where ultrasound and cytological examinations did not allow differentiation between Hashimoto's thyroiditis (HT) and MALT-L. The patients analysed in this study presented significantly different clinical courses of thyroid disease: quickly enlarging painless tumour of the thyroid right lobe in the first case, and chronic HT with palpable tumour in the thyroid isthmus in the second patient. Due to the suspicion of MALT-L resulting from indeterminate ultrasound and FNAB-cytology results, FNAB material was obtained from all the previously examined thyroid lesions and directly subjected to FACS assessment, encompassing κ/λ light chain restriction analysis, as well as measurements of B and T cell surface antigens. The FACS analysis of FNAB material obtained from our patients did not show any definite signs of light chain restriction. Although one of the samples showed a borderline value of κ/λ ratio (κ/λ = 0.31), further immunophenotyping confirmed clonal expansion in none of the examined thyroid regions. Histopathological findings documented the diagnosis of HT in both clinical cases. We believe that FACS represents a useful and reliable complementary diagnostic measure in FNAB-based differential diagnosis of lymphoproliferative thyroid disorders.
    Endokrynologia Polska 01/2015; 66(1):73-8. DOI:10.5603/EP.2015.0001 · 1.21 Impact Factor
  • Andrzej Lewiński, Magdalena Marcinkowska
    Thyroid Research 01/2015; 8(Suppl 1):A20. DOI:10.1186/1756-6614-8-S1-A20
  • Andrzej Lewiński, Zbigniew Adamczewski
    Thyroid Research 01/2015; 8(Suppl 1):A19. DOI:10.1186/1756-6614-8-S1-A19
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    ABSTRACT: To evaluate the level of oxidative damage to membrane lipids due to the breast cancer surgery in the early postoperative period. Blood samples were collected on the preoperative day and 24 hours postoperatively in 71 women operated for breast cancer, and preoperatively in 38 female patients with benign breast tumour. Lipid peroxidation (LPO) in the blood samples was estimated by measuring the concentrations of malondialdehyde+4-hydroxyalkenals (MDA+4-HDA) with spectrophotometry. tumour site, tumour histological findings, cancer stage, grade, tumour volume, state of lymph nodes, type of surgery for breast, type of surgery for axilla. Blood LPO level was similar in breast cancer patients and benign tumour patients (2.01±0.46 nmol/ml vs. 1.92±0.39 nmol/ml, respectively; p>0.05). In cancer patients, MDA+4-HDA increased on the first postoperative day, i.e. from 2.01±0.46 nmol/ml to 2.58±0.98 nmol/ml (p=0.0001). In women with benign breast tumour, LPO did not relate to the histological finding (p=0.8915). In the breast cancer group, preoperative LPO did not correlate with age, tumour volume and number of metastatic lymph nodes. Level of MDA+4-HDA was similar in stages I/II (2.03±0.46 nmol/ml) compared to stages III/IV (1.69±0.26 nmol/ml, p=0.1521). Consequently, levels of MDA+4-HDA did not relate to disease stage (p=0.1364). Surgery for breast cancer causes peripheral increase in oxidative damage to macromolecules in the early postoperative period. Therefore, perioperative antioxidant supplementation should be considered.
    Neuro endocrinology letters 12/2014; 35(7):602-607. · 0.94 Impact Factor
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    ABSTRACT: The cyclooxygenases are a group of enzymes catalyzing the formation of prostaglandins from arachidonic acid. Cyclooxygenase-1 (COX-1) is a constitutive form, thought to be a "housekeeping gene", with constant levels of expression in most tissues. COX-1 expression in the thyroid gland, except for medullary thyroid carcinoma, has not been a subject of much interest. Cyclooxygenase-2 (COX-2) can be expressed in response to various stimuli, such as mitogens, hormones, cytokines, growth factors. The product of COX-2 activity has been implicated in carcinogenesis. Recent studies have shown that up-regulation of COX-2 is associated with numerous neoplasms. Hereby, we present a study analysing COX-1 and COX-2 expression in papillary thyroid carcinoma (PTC), Hashimoto thyroiditis (HT) and nontoxic nodular goitre (NNG) in fine needle aspiration biopsy (FNAB) washouts and in postoperative tissue. Cytological specimens from 120 patients (105 females and 15 males) have been studied, including patients with HT, PTC and NNG. Moreover, we have examined postoperative tissue specimens from 51 patients with PTC and NNG. The methods of molecular analysis have included extraction of total RNA from FNAB cytological material and postoperative tissues, spectrophotometric assessment of the RNA purity, cDNA synthesis in reverse transcription reaction and an analysis of genes expression data by real-time PCR. The performed analysis has revealed statistically significant higher expression level of the COX-2 gene in PTC group, in comparison with HT and NNG groups (in both cytological and postoperative material). In PTC patients, COX-2 gene expression levels in the material obtained by FNAB were similar to those in the postoperative thyroid tissue. No correlations between COX-2 gene expression level and TNM staging in PTC samples have been observed. There were no correlations between COX-2 expression and anti-TPO antibodies level, or patient's sex or age in the studied groups. Also, there were no correlations of COX-1 gene expression level among PTC, HT and NNG groups. Our results suggest that COX-2 gene does not participate in the mechanisms involved in molecular association of HT with PTC. However, in case of PTC itself, it may play some role in neoplastic transformation.
    Thyroid Research 12/2014; 7(1):10. DOI:10.1186/s13044-014-0010-2
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    ABSTRACT: introduction and objective. In Poland, the assessment of nocturnal GH secretion has gained the status of screening test; however, this procedure is not included in international recommendations. The aim of the study was to assess the accuracy and predictive value of the test of nocturnal GH secretion as a screening procedure in diagnosing GHD, and to check the adequacy of the cut-off value for GH peak in this test on the level of 10 ng/ml. materials and methods. The analysis comprised the data of 1,000 children with short stature. In all the patients, GH secretion was assessed in a screening test (after falling asleep) and in 2 stimulating tests (reference tests), with simultaneous assessment of IGF-I secretion before stimulating tests. The indices of screening test accuracy, likelihood ratios and predictive values were assessed. The cut-off level of GH peak after falling asleep, ensuring its 95% sensitivity, was calculated in ROC curve analysis. results. Sensitivity of the screening test was 70.4%, while the specificity - 61.2%, positive likelihood ratio - 1.842, negative likelihood ratio - 0.482, positive predictive value - 0.462, negative predictive value - 0.812. The sensitivity of the test of GH secretion after falling asleep is too low with respect to the requirements for screening test. The ROC curve analysis showed 95% sensitivity for the screening test on the level of 19.0 ng/ml; however, with a very low specificity - below 25%, thus making this test completely useless as a screening procedure. conclusions. The obtained results strongly contradict the opinion that the assessment of GH secretion after falling asleep should be a screening test in diagnosing GHD in children with short stature.
    Annals of agricultural and environmental medicine: AAEM 11/2014; 21(4):893-7. DOI:10.5604/12321966.1129954 · 3.06 Impact Factor
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    ABSTRACT: Iodine, bivalent iron (Fe(2+)), and hydrogen peroxide (H2O2), all significantly affecting the red-ox balance, are required for thyroid hormone synthesis. Intracellular iodine excess (≥10(-3) M) transiently blocks thyroid hormonogenesis (an adaptive mechanism called Wolff-Chaikoff effect). The aim of the study was to evaluate the effects of iodine, used as potassium iodide (KI) or potassium iodate (KIO3), in concentrations corresponding to those typical for Wolff-Chaikoff effect, on the level of oxidative damage to nuclear DNA (nDNA) and mitochondrial DNA (mtDNA) isolated from porcine thyroid under basal conditions and in the presence of Fenton reaction (Fe(2+)+H2O2 → Fe(3+)+(·)OH + OH(-)) substrates.
    European Journal of Nutrition 11/2014; 54(2). DOI:10.1007/s00394-014-0797-6 · 3.84 Impact Factor
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    ABSTRACT: Introduction Cohort study evaluated dendritic cells (DCs) subsets in portal and peripheral blood of patients with pancreatic cancer (PC) and chronic pancreatitis (CHP). Material and Methods Myeloid type 1 (mDCs1) and 2 (mDCs2), plasmocytoid (pDCs) and SLAN+ DCs were assessed in PC (n=20) and CHP (n=6) patients. Results Percentage of mDCs1 was significantly lower in PC patients when compared to CHP (0,48±0,26 vs 0,76±0,3; p=0,038) only in portal, but not peripheral blood. Discussion Further studies to assess the functional properties of portal blood DCs and their applicability in anticancervaccination are needed.
    Pancreatology 09/2014; 14(5). DOI:10.1016/j.pan.2014.07.009 · 2.50 Impact Factor
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    ABSTRACT: Recent reports suggested dendritic cells (DCs) to be important players in the pathogenesis of autoimmune thyroid processes in humans. However, there are virtually no data addressing the influence of thyroid autoaggression-associated disturbances of thyrometabolic conditions on DCs biology. The aim of the study was to evaluate the influence of L-thyroxine supplementation on conventional and plasmacytoid peripheral blood DCs subtypes in patients with hypothyroidism due to Hashimoto's thyroiditis (HT). Eighteen patients with newly diagnosed hypothyroidism due to HT were included into the study. All patients received L-thyroxine treatment with doses adjusted to reach euthyroidism. Peripheral blood DC subtypes structure and immunoregulatory phenotype were analyzed by flow cytometry in the same patient prospectively at two time points: (i) beforeand (ii) 3 months after beginning of L-thyroxine treatment (hypothyroidism vs. euthyroidism, respectively). Percentage of plasmacytoid DCs in peripheral blood mononuclear cells fraction was significantly decreased in the course of L-thyroxine treatment (0.27 ± 0.19 vs. 0.11 ± 0.08; p < 0.05), whereas we did not observe any changes in the number of conventional DCs. However, the phenotypic analysis showed a significant increase of conventional DCs expressing CD86 and CD91 (64.25 ± 21.6% vs. 86.3 ± 11%; p < 0.05 and 30.75 ± 11.66% vs. 44.5 ± 13.3%; p < 0.05; respectively) in euthyroid patients. Standard L-thyroxine supplementation in HT patients exerted significant immunoregulatory effects, associated with quantitative and phenotypic changes of peripheral blood DC subpopulations.
    Folia Histochemica et Cytobiologica 07/2014; 52(2):138-143. DOI:10.5603/FHC.2014.0013 · 1.00 Impact Factor

Publication Stats

2k Citations
685.37 Total Impact Points

Institutions

  • 2003–2015
    • Instytut Centrum Zdrowia Matki Polki
      Łódź, Łódź Voivodeship, Poland
  • 1999–2015
    • University of Lodz
      Łódź, Łódź Voivodeship, Poland
  • 2013
    • Children's Memorial Health Institute
      Warszawa, Masovian Voivodeship, Poland
  • 1984–2013
    • Medical University of Łódź
      Łódź, Łódź Voivodeship, Poland
  • 2012
    • Instytut Medycyny Wsi
      Lyublin, Lublin Voivodeship, Poland
  • 2011
    • Jagiellonian University
      • Department of Endocrinology
      Kraków, Lesser Poland Voivodeship, Poland
  • 2007–2008
    • Wroclaw Medical University
      • Department and Clinic of Endocrinology, Diabetology and Isotope Therapy
      Wrocław, Lower Silesian Voivodeship, Poland
  • 2004
    • Centrum Medyczne Ksztalcenia Podyplomowego
      Warszawa, Masovian Voivodeship, Poland
  • 2001
    • University of Texas at San Antonio
      San Antonio, Texas, United States
  • 1985–2001
    • University of Texas Health Science Center at San Antonio
      • Department of Cellular and Structural Biology
      San Antonio, TX, United States
  • 2000
    • Wojskowy Instytut Medyczny
      Warszawa, Masovian Voivodeship, Poland