Jacek Gawrychowski

Silesian University of Technology, Gleiwitz, Silesian Voivodeship, Poland

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Publications (31)23.81 Total impact

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    ABSTRACT: Primary hyperparathyroidism (primary 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 contributes to the pathogenesis of this disease such as genetic predispositions due to the germline-inactivating mutations in the 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 aetiology 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 hyperparathyroidism. Head Neck, 2014.
    Head & Neck 03/2014; · 2.83 Impact Factor
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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. (Endokrynol Pol 2013; 64 (3): 215-219).
    Endokrynologia Polska 01/2013; 64(3):215-9. · 1.07 Impact Factor
  • 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 01/2013; 64(5):404-8. · 1.07 Impact Factor
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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.
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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. · 1.21 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. · 1.07 Impact Factor
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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 01/2010; 61(3):264-8. · 1.07 Impact Factor
  • Jacek Gawrychowski, Grzegorz Kowalski, Grzegorz Buła
    Polish Journal of Surgery. 01/2010; 82(2):88-94.
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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 01/2010; 61(5):427-9. · 1.07 Impact Factor
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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. · 0.36 Impact Factor
  • Polish Journal of Surgery. 01/2008; 80(9):465-468.
  • Polish Journal of Surgery. 01/2008; 80(1):6-13.
  • Jacek Gawrychowski, Grzegorz Kowalski, Agata Gawrychowska
    Polish Journal of Surgery. 01/2008; 80(9):506-515.
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    ABSTRACT: The authors showed that Władysław Biegański's postgraduate studies in Berlin played a significant rule in his scientific activity. They also presented the impact of lectures of F.T. Frerichs, S. Henoch, F.K. Westphal and R. Virchow. His stay in Berlin was for Biegański an advantage, giving him the opportunity to improve his medical knowledge, encouraged him to scientific works and made him aware of significance of problems connected with the theory of medical studies.
    Wiadomości lekarskie (Warsaw, Poland: 1960) 02/2007; 60(3-4):194-7.
  • Polish Journal of Surgery. 01/2007; 79(12):753-761.
  • Jacek Gawrychowski, Janusz Skalski, Stanislaw Gawrychowski
    Polskie archiwum medycyny wewnȩtrznej 07/2006; 115(6):605-11. · 2.05 Impact Factor
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    ABSTRACT: In order to evaluate the follow-up study of surgical treatment for primary adenosquamous lung carcinoma (ASC) we specified prognostic criteria, also in comparison with primary adenocarcinoma (AC). The study group consisted of 96 patients discharged between 1990 and 1999 after radical surgical treatment for ASC-80 (83%) men and 16 (17%) women aged 34-73, mean 56 years. Consequently, we evaluated 252 patients operated during the same time period for primary AC. Apart from grading, we did not find any significant differences between both ASC and AC groups of patients. Among the 96 patients operated radically for ASC median overall survival (OS) was 20 months. The cumulative postoperative survival rates at 5 and 10 years were 25.4 and 19.2%, respectively. By comparison, median OS for 252 patients with AC, discharged after surgical treatment in the same period, was 28.5 months and the cumulative postoperative survival rates at 5 and 10 years were 42.5 and 39.1%, respectively (P=0.006). At pathologic stages IA, the cumulative survival rate at 5 years was 63.3% for patients with ASC as compared with 72.1% for patients with AC (P=0.330). However, out of IB stage patients treated surgically for ASC 31.8% survived 5 years in comparison with 56.3% operated for AC (P=0.017). Study of survival rates did not differ significantly between ASC and AC patients at stage IIA (P=0.824) and stage IIB (P=0.217), respectively. Univariate analysis revealed that six factors of tumor size, T status, N status, as well visceral pleura involvement, tumor localization (central vs. peripheral) and tumor structure were significantly associated with the survival rate according to these variables. Multivariate analysis using Cox's proportional hazards model indicated that T factor, nodal involvement and one of the tumor components predominating were significant factors associated with the postoperative survival of patients with ASC. Our findings indicate that in patients after radical operation for ASC, predominance for one of the histopathological components (adenous or squamous) within primary tumor is attended by worst prognosis. Our study confirmed also that the prognosis of ASC of the lung was poorer than that of primary AC. Lack of generally accepted diagnostic criteria and unclear prognosis, even in the pathologic stage I suggest that there is a need for prospective studies in this respect.
    European Journal of Cardio-Thoracic Surgery 05/2005; 27(4):686-92. · 2.67 Impact Factor
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    Jacek Gawrychowski, Bozena Lackowska, Andrzej Gabriel
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    ABSTRACT: The aim of this study was to evaluate prognostic importance of cell ploidy and proliferation activity in non-small cell lung cancers. Survivals were compared according to the following factors: sex, age, histology, grading, DNA ploidy, tumour size, T factor, N factor and operative procedure. In a group of 191 patients in whom cytofluorometric examinations had been performed on archival tumour specimens, postoperative recurrences were observed. Postoperative recurrence was observed in 64 (64.6%) of 99 patients with aneuploid tumours and in 35 (38.0%) of 92 with diploid tumours (P<0.001). Overall survival (OS) rates for the group of 92 patients operated for diploid non-small cell lung cancer (NSCLC) at 5 and 10 years were 62 and 51.1%, whereas of other 99, operated for aneuploid tumours 33.3 and 25.9%, respectively (P<0.001). In the former group of patients disease-free survival (DFS) rates at 5 and 10 years were 58.7 and 51.4% but in the latter 29.3 and 26%, respectively (P=0.00014). Significant differences dependent on cell ploidy were also observed in OS and DFS rates of patients operated respectively for SCLC (P=0.0029; P=0.00318) and adenocarcinoma (AC; P=0.0241; P=0.02109). In general, the mean percentage of S-phase cells in non-small cell lung cancers was 14.0% (SD=13.1) in patients who survived 5 years, and 22.4% (SD=15.7) in those who had a recurrence or died (P<0.001). In our opinion the most important finding of our work is that determination of cell ploidy in NSCLC provides a valuable supplement to the TNM stage when evaluating late results of the surgical treatment. However, the paper demonstrates that aneuploidy, although unfavourable, is not an independent prognostic factor in the group of patients with NSCLC and in the subgroups - both with squamous cell carcinoma and adenocarcinoma. Our results show also that the percentage of S-phase cells is an independent, unfavourable prognostic factor in patients treated surgically for non-small cell lung cancer and in the subgroup with squamous cell lung carcinoma.
    European Journal of Cardio-Thoracic Surgery 07/2003; 23(6):870-7; discussion 877. · 2.67 Impact Factor
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    J Gawrychowski, A Gabriel, B Lackowska
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    ABSTRACT: The aim of the study was assessment of the heterogeneity of stage IIIA non-small cell lung cancers (NSCLC) and the late results of surgical treatment. The study group consisted of 83 consecutive patients discharged between 1988 and 1992 undergoing radical operative treatment for stage IIIA NSCLC. Squamous cell carcinoma was diagnosed in 54 (65.1%) patients, adenocarcinoma in 23 (27.7%), large cell carcinoma in 2 (2.4%) and mixed (i.e. adenoid-squamous type) in 4 (4.8%). In respect of pTNM staging, 19 (22.9%) patients had T3N1M0, 35 (42.2%) had T2N2M0 and 29 (34.9%) had T3N2M0. Overall, 13.3% of patients with stage IIIA NSCLC survived 5 years following the operation and 8.7% survived 10 years. Analysis of follow-up study indicated that this group was heterogenic. In T3N1M0 group 26.3% survived 5 years following the operation, in T2N2M0 group 14.3%, in T3N2M0 group 3.5% (P = 0.015). Of 23 patients with N2 disease and no metastases in hilar lymph nodes ('skip' metastases), 26.1% survived 5 years, whereas none of 41 patients with metastases spreading by continuity survived (P = 0.0015). If mediastinal lymph node metastases were diagnosed in one level, 25% patients survived 5 years, but if two or more levels were affected, 2.3% only (P = 0.0214): 85.7% of patients with well-differentiated (G1) cancer survived 5 years and 62.0% 10 years, whereas among those with moderately differentiated (G2) tumours, 11.8% and 8.8%, respectively. No patient survived 5 years after resection of poorly differentiated (G3) cancer (P < 0.001). (1) Patients operated for stage IIIA NSCLC are a heterogeneous group, which makes it difficult to predict late results. (2) Patients operated for stage IIIA NSCLC have a better prognosis if metastases are discovered in level one mediastinal lymph nodes, particularly in the superior part of mediastinum, or if 'skip' metastases (pulmonary hilus unaffected) are discovered, as compared to those with N2 disease. (3) Poor histologic differentiation of the tumour is a bad prognostic factor.
    European Journal of Surgical Oncology 03/2003; 29(2):178-84. · 2.61 Impact Factor
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    ABSTRACT: The aim of the study was to identify prognostic factors which could help evaluate both the treatment offered to patients with thymoma and late results. Forty patients were treated for mediastinal thymoma. The patients were staged clinico-pathologically (according to Masaoka) on the basis of the retrospective analysis of their operation protocols as follows: seven (17.5%)-stage I, 19 (22. 5%)-stage II, 17 (42.5%)-stage III, seven (17.5%)-stage IV. Analysis of DNA contents in cell nuclei of 23 thymomas was performed by the flow cytofluorometric method. From the whole group of patients, 65% survived for 5 years, 55% survived for 10 years and 43% survived for 15 years. We noted significant differences in survival time between stage I and stage IV (P<0.0012); stage II and stage IV (P<0.0006), as well as between stage III and stage IV (P<0. 005). Significantly worse prognosis was observed in the case of cortical thymomas as compared with medullary or mixed types (P<0. 0001 P<0.002). Analysis of DNA content showed signficantly higher probability of survival for the patients who had DI=1.0 (diploid), as compared with DNA >1.0 (aneuploid) (P<0.006). Of the 11 patients with diploid tumours, 91% survived for 5 years, but of the 12 aneuploid, only 23% survived. The most important positive prognostic factors influencing survival rate in patients with thymoma are: lower stage, medullary type (according to Muller-Hermelink classification), possibility of performing complete resection, diploidal nature of the tumour. Multivariate analysis of survival revealed clinico-pathological stage (according to Masaoka) and histological type (according to Salyer) as significantly independent prognostic factors.
    European Journal of Surgical Oncology 04/2000; 26(3):203-8. · 2.61 Impact Factor