Jacek Gawrychowski

Medical University of Silesia in Katowice, Catowice, Silesian Voivodeship, Poland

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Publications (37)26.55 Total impact

  • Jacek Gawrychowski · Ryszard Mucha · Michał Paliga · Henryk Koziołek · Grzegorz Buła ·
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    ABSTRACT: Introduction: The purpose of the study was to assess the results of operative treatment of patients with tertiary hyperparathyroidism (tHPT) after kidney transplantation. Material and methods: The study included 30 patients in whom kidney transplantation was performed between 2006 and 2013, and in whom parathyroidectomy had to be performed at a later time because of tHPT. There were 17 (56.7%) women and 13 (43,3%) men in the group, aged 18-64, mean 46.1 years. In order to locate the lesion before the operation, all patients had to undergo USG, and 14 had scintigraphy MIBI in addition. Serum levels of PTH, ionised calcium, and creatinine were determined together with glomerular filtration rate (GFR). The results of control tests were compared with those performed one day before parathyroidectomy (PTX) and three days after the operation. Results: Among 30 patients, 19 (63.3%) underwent total resection of three parathyroid glands and 3/4 of the fourth. Two parathyroid glands were resected in eight (26.7%) patients, and one in the remaining three (10%) patients. Histopathological examination showed one parathyroid adenoma in six (20%) patients, and one parathyroid adenoma and hyperplasia of the remaining glands in one (3.3%) patient. Five (16.7%) patients had hyperplasia of two parathyroid glands whereas no changes were observed in two patients. On the other hand, hyperplasia of all glands was noted in 18 (60%) patients. Serum PTH level was significantly lower compared to the level before operation (p < 0.001), being 5.5-58.5 pg/mL, on day 3 postoperatively. Differences in the levels of serum-ionised calcium were also significant (p < 0.0001) after eight months. Conclusions: Surgical resection of parathyroid glands is a management of choice in patients after kidney transplantation accompanied by hypercalcaemia lasting longer than one year. Resection of 3 3/4 parathyroid glands because of hyperplasia in patients with hyperparathyroidism after kidney transplantation enables restoration of normal calcium metabolism. Moreover, resection of 3 3/4 parathyroid glands can allow avoidance of autotransplantation, which is necessary in cases of total resection of parathyroid glands. (Endokrynol Pol 2015; 66 (5): 422-427).
    Endokrynologia Polska 10/2015; 66(5):422-427. DOI:10.5603/EP.2015.0052 · 0.99 Impact Factor
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    ABSTRACT: Material and methods: A total of 3810 patients were treated for goiters between 2008 to 2013. Symptoms of postoperative ARF were recognized in 39 (1%) patients. Results: Symptoms of postoperative ARF were a postoperative hemorrhage in 31 (79.4%), lymphorrhagia in 1 (2.6%), bilateral paralysis of recurrent laryngeal nerves in 6 (15.4%) and acute circulatory - respiratory failure in 1 (2.6%). Postoperative hemorrhage appeared in 19 patients operated for nodular goiter, 4 with a retrosternal nodular goiter, 1x nontoxic recurrent retrosternal nodular goiter, 1x toxic recurrent retrosternal goiter nodular goiter, 2x Graves'goiter and 4x with malignant goiter. The cause of hemorrhage was parenchymal bleeding from the stumps and / or short neck muscles (29x), arterial bleeding (1x) and bleeding into the subcutaneous tissue (1x). Massive lymphorrhagia appeared as a result of damage to the thoracic duct after total thyroidectomy due to papillary thyroid carcinoma with cervical lymph node dissection on the left side. All patients who were diagnosed with bilateral paralysis of RLN, tracheostomy was performed. Of all 39 patients who underwent surgery two died - one in 6 days after surgery due to myocardial infarction, and another as a result of micropulmonary embolism and acute circulatory - respiratory failure in 18 hours after surgery. Conclusions: 1. The most frequent causes of acute respiratory failure in postoperative period are a hemorrhage from the operation site and bilateral paralysis of recurrent laryngeal nerves. 2. Acute postoperative respiratory failure is an indication for postoperative wound revision.
    Polish Journal of Surgery 09/2015; 87(7):331-335. DOI:10.1515/pjs-2015-0065
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    ABSTRACT: Material and methods: A total of 6110 patients were operated in our hospital between 1 January 2005 and 31 December 2013 for various goiters (5429) and various types of hyperparathyroidism (618). Laryngeal nerve was exposed during operation in 1700 patients from superior aperture of the chest to superior aperture of the larynx. Identification process of RLN was started with dissecting inferior thyroid artery (ITA) and its junction with the nerve. Then main trunk of the nerve was exposed backwards till the region of superior aperture of the chest together with the end portion till the nerve outlet to the larynx. Results: In the group of 1700 patients, RLN was exposed bilaterally in 1400 (82.4%) and unilaterally in 300 (17.6%). In the group of 3100 dissected RLNs the course of RLN was observed on the right side in 1710 patients and on the left in 1390. Irreversible nature RLN was shown in four cases (0.1%) - four women (02%) aged 42-55 (mean 49.3) - three operated for non-toxic nodular goiter and one for primary hyperparathyroidism. Each time the Non-RLN was seen on the right side. The other patients manifested recurrent character RLN. Moreover, interstitial course of RLN was found on the left side in one man. Conclusion: Non recurrent laryngeal nerve is a rare anatomical variation, occurring more frequently on the right side. Surgeon during surgery of the thyroid and parathyroid glands should be aware of its existence to avoid damage.
    Polish Journal of Surgery 09/2015; 87(7):336-339. DOI:10.1515/pjs-2015-0066
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    ABSTRACT: Background: Primary hyperparathyroidism (HPT) is one of the most common endocrine disorders, defined by hypersecretion of parathormone. Primary HPT can be caused by adenoma, hyperplasia, and carcinoma. A great amount of mechanisms contribute to the pathogenesis of this disease, such as genetic predispositions because of the germline-inactivating mutations in the multiple endocrine neoplasia type 1 (MEN1) and HRPT2 tumor suppressor genes. Somatic mutations in these genes were found also in sporadic parathyroid neoplasias. Cell cycle regulators, growth factors, apoptosis-inducing ligands, death receptors, and other transmitter substances have also been implicated in the etiology of primary HPT. Parathyroid carcinoma is often misdiagnosed as parathyroid adenoma and long-term survival is conditioned by the extent of the primary surgical resection, therefore, of great interest is the discovery of definitive diagnostic markers for carcinoma. This article presents current state of knowledge of the molecular pathogenesis of primary HPT.
    Head & Neck 02/2015; 37(2). DOI:10.1002/hed.23656 · 2.64 Impact Factor

  • Endocrine Abstracts; 04/2014
  • Jacek Gawrychowski · Grzegorz Buła ·
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    ABSTRACT: Primary hyperparathyroidism (PHP) is a benign condition characterised by malignant potential. Even in specialist wards, 5-10% of operations for PHP are unsuccessful. The main reasons seem to be ectopy of the parathyroid gland, numerous adenomas, multiglandular parathyroid hyperplasia, and intrathyroid location of the parathyroid. The last three decades have witnessed a rapid progression in imaging diagnostics.(Endokrynol Pol 2013; 64 (5): 404-408).
    Endokrynologia Polska 11/2013; 64(5):404-8. DOI:10.5603/EP.2013.0024 · 0.99 Impact Factor
  • Grzegorz Buła · Michał Paliga · Henryk Koziołek · Ryszard Mucha · Jacek Gawrychowski ·
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    ABSTRACT: Introduction: To present a clinical picture and management of goitre patients with acute respiratory failure. Material and methods: A total of 7,356 patients were operated on between 2000 and 2011 for various goitres, including 1,214 (16.5%) retrosternal or mediastinal types. Eight (0.1%) patients (six women and two men aged 61-84, mean 76.9 years) presented with acute respiratory failure on admission. Seven patients were intubated on admission, and one showed severe dyspnoea at rest accompanied by symptoms of peripheral cyanosis. Results: Giant retrosternal goitres were found in the eight operated patients. In two cases, the goitre was recurrent in character, and another two patients had previously suffered from hyperthyroidism (one treated pharmacologically, and one using J131). X-ray examination revealed tracheostenosis in all patients. No disorders in thyroid function was observed. Preoperative unilateral paralysis of laryngeal recurrent nerve was found in three patients. The operations were considered as most urgent. Four goitres were neoplastic: two were anaplastic carcinoma, one was follicular cell carcinoma and one was squamous cell carcinoma. These patients received partial resection to enable reduction of the goitre mass. In three patients, tracheostomy was necessary. On the other hand, four patients with non-malignant goitres underwent complete resection (one patient), nearly complete resection (two), and complete resection of one lobe and partial resection of the other (one). Three patients required mechanical ventilation postoperatively. Two of them, referred to the Intensive Therapy Unit, died from acute circulatory failure on day 6 and day 10 postoperatively. The rest were discharged in good general condition. Conclusions: 1. Acute respiratory failure caused by a giant goitre is a life-threatening condition that almost always requires an emergency intubation. 2. Due to a high risk of complications and high mortality, patients with acute respiratory failure caused by giant goitres should be operated in hospitals that are very experienced not only in thyroid but also in mediastinal surgery.
    Endokrynologia Polska 07/2013; 64(3):215-9. · 0.99 Impact Factor
  • Grzegorz Buła · Janusz Waler · Andrzej Niemiec · Ryszard Mucha · Jacek Gawrychowski ·
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    ABSTRACT: The aim of the study: was to present clinical picture, indications for surgery, immediate and remote results of surgical treatment for lateral and median cysts of the neck. Material and methods: A total of 17247 patients were operated between 1 January 1990 and 31 December 2011 for neck tumors. Results: Neck cysts were diagnosed in 34 (0.2%) patients, including lateral in 12 (35.3%) and median in 22 (64.7%). Lateral cyst once descended to the mediastinal. Nodular goitres were diagnosed in 17 (50%) of them--with the lateral cysts 4x and median cysts 13x. Guided fine-needle aspiration biopsy of the cyst-like lesions revealed the presence of protein masses in all patients. The lesions were found to have inflammatory character in 6 patients (17.6%) regarding median cysts (5x) or lateral cyst (1x). Out of them, 3 patients developed purulent inflammatory process. All patients were operated. The operation consisted of radical resection of the cyst only or plus partial resection of both thyroid lobes and total resection of pyramidal lobe if concomitant goitre was found. Two patients required one-stage resection of the enlarged lymph nodes in the neck. Suspected focus of thyroid papillary cancer was found by intra-operative examination in neck median cyst wall in one patient. However, paraffin tests did not confirm the suspicion. Another patient was found by histopathological examination to have active tuberculotic process within both lateral cyst and lymph nodes. The patient received intensive antituberculotic treatment postoperatively. Conclusions: 1. Median cysts of the neck are more often accompanied by thyroid tumor-like goitres than lateral cysts. 2. Radical resection of the cysts in operative treatment results in good long term patient condition and prevent in recurrence of the illness.
    Polish Journal of Surgery 10/2012; 84(9):445-8. DOI:10.2478/v10035-012-0075-3
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    ABSTRACT: Inflammatory bowel disease (IBD) is characterized by a chronic inflammation accompanied by procoagulation settings. However, tissue hemostasis in IBD patients was only incidentally reported. Accordingly, the current study characterizes changes in tissue hemostasis components in a colon inflammatory setting. Serial cryostat sections of endoscopic mucosal biopsy specimens taken from 26 consecutive IBD patients diagnosed de novo and normal colon resection specimens taken from 6 patients were immunohistochemically stained with monoclonal anti-human tissue factor (TF), tissue factor pathway inhibitor (TFPI), thrombomodulin (TM), as well as CD3 and CD68 positive cells. The hemostatic components studied differed significantly from the control subjects. Up-regulation predominated in the case of TF while down-regulation was mainly found in TM and TFPI in IBD. In the control sections, TF was observed in a few fibroblast-shaped cells in the lamina propria, while in the majority of IBD sections, TF positively stained small microvessels, infiltrating mononuclear cells and fibroblast-shaped cells tightly surrounding the colon crypts. Thrombomodulin intensively stained the endothelium of the small capillary vessels in the control, whereas such staining mainly accompanied infiltrating mononuclear cells of the IBD subjects. Tissue factor pathway inhibitor positively stained the endothelium of the small capillary vessels in the control group, whereas in the IBD group endothelial cells presented only weak TFPI staining. The mean number of CD3-positive lymphocytes in IBD was 23.3 ± 14.3, but the mean number of CD68-positive cells was 114.5 ± 55.8. In the control sections, it was 4.1 ± 2.4 and 39.6 ± 17.9, respectively. There was no relationship between CD3 and CD68 (+) cells and the hemostasis markers studied. The results of the current study indicate a shift of tissue hemostasis toward the procoagulant state irrespective of the severity of inflammatory infiltration. In addition, TF distribution in the colon sections of IBD patients may indicate a role in the restoration of the barrier function in injured intestinal mucosa.
    Pathology - Research and Practice 07/2012; 208(9):553-6. DOI:10.1016/j.prp.2012.06.005 · 1.40 Impact Factor
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    ABSTRACT: A 72 year-old woman with primary hyperparathyroidism was operated for parathyroid crisis. PTH serum level was 808 pg/mL. During the operation, only two superior parathyroid glands were found. One was normal, and hypertrophy was revealed in the other. After the surgical procedure, PTH serum level was 726.5 pg/mL. Helical computer tomography examination showed a heterogeneous mass in the anterior mediastinum. The tumour was removed via a sternotomy approach. Histopathological examination revealed parathyroid carcinoma. PTH level dropped to 5.74 pg/mL. Cytofluorometric examination revealed diploidy (DI = 1) in both the hypertrophic and the unchanged upper glands, whereas parathyroid cancer was aneuploid. After the initial operation, the woman was discharged from the hospital on the 27th postoperative day. One year after surgical procedures, she is well. She has to take calcium.
    Endokrynologia Polska 01/2012; 63(2):143-6. · 0.99 Impact Factor
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    ABSTRACT: Malignant metastases are rarely found in the thyroid gland, the incidence reaching approximately 2% of all thyroid malignant neoplasms. They are most often caused by tumours of the kidneys, lungs, mammary glands, ovary, and colon or by melanomas. The aim of the study was to evaluate the usefulness of fine needle aspiration biopsy (FNA) for diagnosing tumour metastases to thyroid glands. A total of 15122 patients were operated between 1990 and 2009 for goitres. Malignant neoplasm was diagnosed in 733 (4.8%) patients. Malignant metastases to the thyroid gland were detected in 10 patients, namely 2 men and 8 women aged 48-89 years. The group made up 1.4% of all patients operated for malignant thyroid tumour. Preoperative diagnostic procedure consisted of thyroid scintigraphy, thyroid ultrasonography, and cytology of the material obtained through FNA. In addition, the hormonal activity of the thyroid gland was examined. The range of operation was established through clinical assessment of the tumour, preoperative cytology, and intra-operative histopathology. Among 7 patients with thyroid metastases from renal clear cell carcinoma, as diagnosed postoperatively, cytology of the thyroid material obtained through FNA revealed follicular tumour in 3 (43%) patients, tumour cells in 2 (28.5%) and atypical cells in the other 2 (28.5%). Intraoperative histopathology confirmed the presence of metastasis from renal clear cell carcinoma (1) and indicated thyroid medullary cancer (1), follicular tumour (4), or trabecular adenoma with necrosis (1). Among two patients with thyroid metastases from breast cancer, cytology confirmed a metastasis from breast cancer in one (the woman was disqualified for surgical treatment) and indicated follicular tumour in one. Intraoperative histopathology suggested thyroid anaplastic cancer. Examination of biopsy specimen revealed epithelial cells accompanied by cell atypia in one patient with thyroid metastasis from lung cancer. Intra-operative examination also indicated cellular atypia in the same patient. Follicular tumour diagnosed by fine needle aspiration biopsy in patients after treatment for other cancers, especially renal clear cell carcinoma, should alert the surgeon to the possibility that it could be a metastasis of this cancer to the thyroid gland.
    Endokrynologia Polska 09/2010; 61(5):427-9. · 0.99 Impact Factor
  • Grzegorz Buła · Henryk Koziołek · Andrzej Niemiec · Jacek Gawrychowski ·
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    ABSTRACT: Aim of the study was present personal observations connected with the management of patients referred to surgical treatment for secondary hyperparathyroidism (SHT) or tertiary hyperparathyroidism (THT), and to assess immediate results of such management. A total of 175 patients aged 21-80 years were treated surgically for SHT, and 16 patients aged 36-64 years were treated surgically for THT, between 1 January 1996 and 31 December 2008. The patients were classified for surgical treatment in cooperation with a nephrologist, internist, and anaesthesiologist. Each patient underwent bilateral exploration of the neck and assessment of all identified parathyroid glands. Subtotal parathyroidectomy or resection of parathyroid glands combined with autotransplantation (the latter in two patients with recurrent SHT) were performed. Ionized calcium concentration in blood serum, water-electrolyte equilibrium, and cardiovascular system were monitored postoperatively. A fall in ionized calcium levels was obtained postoperatively in all patients. Successful surgical treatment was confirmed by intraoperative macroscopic and immunochemical examinations. Intensive bleeding from the wound was noted in 2 (1%) patients, and intensified stenocardial symptoms in 15 (7.9%) patients with SHT. No deaths were noted during the perioperative period. Five (2.8%) patients with SHT required emergency dialyses. 1. Surgical treatment of secondary or tertiary hyperparathyroidism requires close cooperation between the surgeon, nephrologist, internist, and anaesthesiologist. 2. Successful results of the treatment, including minimum cardiovascular complications, can only be obtained in integrated cooperation with a dialysis centre.
    Endokrynologia Polska 05/2010; 61(3):264-8. · 0.99 Impact Factor
  • Jacek Gawrychowski · Grzegorz Kowalski · Grzegorz Buła ·
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    ABSTRACT: The aim of the study was to evaluate the clinical, surgical and pathological prognostic factors of postoperative disease progression in parathyroid cancer patients.Material and methods. This is a retrospective study of 19 patients operated on between 1983 and 2007 for parathyroid cancer at the Department of General Surgery of the Silesian Medical University constituting 4.6% of the total 416 patients operated on during that time for primary hyperparathyroidism.Results. The study is based on a group of 7 (27%) men and 12 (63%) women aged 27 - 77 (av. 56). On admission, serum calcium levels exceeding 3.5 mmol/L were observed in 11 (58%) patients with parathyroid cancer and in 4 (1%) of the 397 patients with benign changes. Serum parathormone (PTH) levels higher than 450 pg/ml were found in 9 (47.4%) and 11 (2.8%) patients, respectively. Whenever parathyroid cancer was suspected, an en block resection of the parathyroid tumor including a wide margin of adjacent tissue was performed. Ipsilateral thyroid lobectomy was performed on 14 patients but in 5 cases total thyreoidectomy was required. 14 (73.7%) patients underwent either ipsilateral (11x) or bilateral (3x) lymphadenectomy. Within the group of 19 patients a total of 41 operations were required, including 4 operations in other medical centers. Three patients underwent adjuvant radiation therapy. The cumulative postoperative 5-, 10- and 15-year survival rate for the 19 parathyroid cancer patients was 95%, 82.5% and 62% respectively. Local and/or regional recurrences as well as remote metastases were found in 7 and 6 patients, respectively. Of the former group six patients are still alive after 3, 7, 9, 10, and - in two cases - 12 years (the 7th patient died 14 years after the first operation). Of the latter group three patients died of cancer dissemination 5, 7 and 8 years after the initial operation, but three others are still alive after 7, 10 and 14 years while still displaying the disease symptoms. Six patients, all of whom underwent one-stage resection of parathyroid glands and both ipsilateral thyroid lobectomy and lymphadenectomy, are still alive 8, 10, 11, 13, 14 and 21 years after with no evidence of the disease.Conclusions. 1. Parathyroid cancer should always be suspected while dealing with primary hyperparathyroidism in patients with significantly elevated serum calcium and PTH levels. 2. Ipsilateral lymphadenectomy is advocated for parathyroid cancer patients already during the initial operation. 3. In order to avoid parathyroid cancer relapse even many years after the surgery, periodic checks are recommended for the rest of the patients' lives.
    Polish Journal of Surgery 02/2010; 82(2):88-94. DOI:10.2478/v10035-010-0014-0
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    ABSTRACT: The incidence rate of the thyroid gland diseases has been observed to grow at a increasing pace. Thyroid gland diseases occur more often (several times) in women than in men. Unfortunately, in many cases, surgical ablation of the thyroid gland is often the only way of effective treatment. Strumectomy is recommended for patients with gigantic goitre, with goiter giving compression symptoms on neighbouring organs, with goiter containing cold nodules (suspision of malignant neoplasm) or autonomous hyperfunction. It is vital for patients after strumectomy to be mobilized as early as possible after the operation and be subjected to selected procedures of comprehensive rehabilitation. This paper presents physiotherapeutic procedures employed in hospital rehabilitation before and after strumectomy, which the authors recognize as an indispensible element of treatment at surgical wards operating patients with thyroid gland diseases.
    Fizjoterapia 01/2010; 18(4). DOI:10.2478/v10109-010-0073-0
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    ABSTRACT: The aim of the study was to analyze the gene expression of JUN and CCND1 in a group of parathyroid tissues obtained from patients with primary hyperparathyroidism in comparison to hyperplastic parathyroid and normal/atrophic parathyroid tissues by real-time quantitative PCR. Our goal was to validate the conclusion of Forsberg et al (2005) who reported overexpression of JUN in parathyroid adenomas by a joint microarray and QPCR study.Material and methods. The analysis of JUN, CCND1 was carried out by QPCR in 14 parathyroid adenomas, 8 hyperplasia cases and 50 normal/atrophic parathyroid samples taken intraoperatively. Expression of the examined genes was normalized to the reference index (geometric mean of reference genes expression: EIF3S10, UBE2D2, ATP6V1E).Results. We observed a decrease of JUN expression in parathyroid adenomas in comparison to both normal/atrophic and hyperplastic parathyroids. The fold change value was 0.71 in comparison of adenomas to normal/atrophic samples (p = 0.044) and 0.75 to hyperplastic glands (p = 0.003). For CCND1 we observed one case of parathyroid adenoma with a very clearly increased expression, while 3 adenomas (21.4% of all adenomas) exhibited the increase over the highest value seen in normal parathyroids (fold change = 3.52).Conclusions. In parathyroid adenomas we were not able to confirm any overexpression of JUN gene, as suggested by the previous study. On the contrary, we observed a distinct inhibition of JUN RNA expression in comparison to non-neoplastic parathyroids. For CCND1 gene overexpression in parathyroid adenomas, we report the frequency of 21.4%.
    Polish Journal of Surgery 10/2009; 81(10). DOI:10.2478/v10035-009-0075-0
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    G Buła · J Trompeta · A Niemiec · W Truchanowski · J Gawrychowski ·
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    ABSTRACT: Between 1 January 1990 and 31 December 2006, 13,279 patients were operated on due to various forms of goitre, of which five cases were diagnosed with purulent thyroiditis--one child aged 8, three women and one man all between 35 and 81 years of age. The course of the disease was unusual. In three of the patients cancer was suspected. In all of the patients hard nodules were discovered within the thyroid gland, ultrasonographically heterogeneous and hypo-echogenic, although scintigraphic examination showed "cold" nodules. The child presented regional lymph node enlargement. Except in one case, all patients were apyretic. The rapid growth of the thyroid gland and symptoms of compression were observed in 2 cases. In one of them, tracheostomy was required. Fine needle aspiration biopsy of the thyroid gland revealed the presence of profuse purulent infiltration in one case. Neither thyroid dysfunction nor autoimmune changes were detected. A subtotal thyroidectomy was performed in all patients. In the paediatric case, the enlarged lymph nodes were also resected. In 3 cases, thyroid abscess was diagnosed and drained and staphylococcus epidermidis, streptococcus epidermidis and streptococcus pyogenes were found. Microscopic examination proved the presence of aspergillus fumigatus in one case. Antibiotic therapy was applied postoperatively and all the patients recovered. CONCLUSIONS: (1) The clinical course of purulent thyroiditis leads to a diagnostic challenge. The surgical treatment of purulent thyroiditis allows for a faster recovery for the patient.
    Acta chirurgica Belgica 10/2009; 109(5):617-9. · 0.41 Impact Factor
  • Grzegorz Buła · Witold Truchanowski · Jacek Gawrychowski ·
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    ABSTRACT: The paper reports a female patient treated surgically for Riedel's goitre. A total of 4775 patients were treated surgically between 1 January 2000 and 31 December 2007 for various types of goitres. Thyroiditis was diagnosed in 193 (4.0%) cases. Among them Riedel's goitre was found in one (0.5%). A 51-year-old woman P.G. (case record No. 1377/2007) was admitted to our hospital with considerable dyspnea, both inspiratory and expiratory, accompanied by marked stridor and retrosternal goitre, the latter suspected of neoplasmic process. Thyroid gland was hard, its left lobe extending behind the sternum. No disorders in thyroid hormonal function or high antibody titre against thyroid peroxidase were observed. Ultrasonography revealed large thyroid gland with mediastinal invasion, nodulated and hypoechogenic. Fineneedle biopsy suggested thyroid colloidal tumor. X-ray of the chest and neck revealed wide upper portion of the mediastinum and narrow trachea. Laryngological examination confirmed paralysis of left vocal fold. The patient was operated under general endotracheal anesthesia. Both thyroid lobes were partially resected together with the isthmus, and malacic trachea was decompressed. No complications were observed during postoperative period. Paraffin histopathological examination confirmed the presence of Riedel's goitre. The patient was discharged in general good condition. She was under regular follow-up control and died 1.5 year after operation from further progress of the disease. Clinical course of Riedel's goitre may cause remarkable diagnostic problems, and requires a differentiation with thyroid malignant tumor. Surgical treatment of Riedel's goitres helps to quickly obtain correct diagnosis and improve both clinical condition and life comfort of the patients.
    Endokrynologia Polska 01/2009; 60(6):488-91. · 0.99 Impact Factor
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    G Buła · J Waler · A Niemiec · J Trompeta · K Steplewska · J Gawrychowski ·
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    ABSTRACT: The aim of this study is to assess late results of surgical treatment for primary non-Hodgkin lymphoma (PNHL), thyroid sarcomas (TS) and tumour metastases (TM) of the thyroid gland. Between January 1st, 1990 and December 31st, 2005, 12725 patients were surgically treated for various types of goitre. Malignant tumour was diagnosed in 617 (4.9%) cases, consisting of 597 (96.8%) patients with thyroid carcinoma and 20 (3.2%) with other tumours, which included 9 (1.5%) cases of PNHL, 9 (1.5%) cases of TM and 2 (0.2%) patients who showed TS. In the group of patients diagnosed with PNHL, variant B-cell lymphoma predominated (77.8%), and in cases of patients with TM renal cell carcinoma prevailed (77.8%). In all cases, hypo-echogenic nodules were observed in ultrasonography and cold nodules in scintigraphy. All patients were surgically treated with possible complementary chemotherapy and/or radiotherapy. At present, 5 patients with PNHL are alive--43-93 (average of 63.8) months after the operation. Others have died within a period of 2 days to 3 months after the operation. Two patients with TM are alive--19 and 46 (median 32.5) months after the operation. Others have died within a period of 3 to 62 (median 21) months after the operation. Patients with TS have died respectively 19 days and 13 months after the operation. 1. Patients with primary thyroid lymphomas should be approached individually using all available methods of treatment, including surgery and radiotherapy and/or chemotherapy. 2. Diagnosis of cold nodules in patients with oncological history should always arouse suspicion of metastases to the thyroid gland. 3. Diagnosis of non-thyroid cancer prior to surgery is difficult to obtain. 4. The need for surgery is usually based on local compression.
    Acta chirurgica Belgica 12/2008; 108(6):702-7. · 0.41 Impact Factor
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    ABSTRACT: The aim of the study was to look for unfavourable prognostic features in colorectal cancer patients after their surgical treatment as weE as to evaluate the prognostic value of cellular ploidy and proliferative activity. Material and methods. A group of 71 colorectal cancer patients discharged from the hospital after surgical treatment in the years 1995-2000 was studied. The examined material was acquired from paraffin blocks of tumour segments. After histopathological verification, the tumour segments recovered from paraffin blocks were used for cytofluorometric analysis of cellular ploidy according to the Hedley method. Results. Diploid tumours were found in 45 of 71 (63.4%) colorectal cancer patients. No significant relationship between DMA ploidy and sex, age, complications, inherited susceptibility to a disease, tumour magnitude, grade of histological malignancy, or grade of clinical progression was observed. After colorectal cancer surgery, the probability of five- and ten-year survival was 44.4% and 37.1%, respectively, for the patients with diploid tumours (DI= 1.0), and 38.5% and 9%, respectively, for the patients with aneuploid tumours (DI≠1.0). These differences were not statistically significant (p=O.120). Conclusions. 1. Classical clinicopathologic factors are still the best prognostic criteria for the evaluation of the future results of colorectal cancer patients' surgical treatment. 2. Determination of cellular ploidy and proliferative activity of colonic adenocarcinoma cannot increase the ability to predict prognosis based on surgical treatment.
    Polish Journal of Surgery 01/2008; 80(1):6-13. DOI:10.2478/v10035-007-0126-3
  • Jacek Gawrychowski · Grzegorz Kowalski · Agata Gawrychowska ·

    Polish Journal of Surgery 01/2008; 80(9):506-515. DOI:10.2478/v10035-008-0072-8