Krzysztof Sworczak

Publications of Krzysztof Sworczak

• Hormonal activity in clinically silent adrenal incidentalomas.

  Authors: Anna Babińska, Małgorzata Siekierska-Hellmann, Krzysztof Błaut, Anna Lewczuk, Piotr Wiśniewski, Maria Gnacińska, Lukasz Obołończyk, Renata Swiątkowska-Stodulska, Krzysztof Sworczak

  Archives of medical science : AMS. 02/2012; 8(1):97-103.

  The rapid development of modern imaging techniques, has led to an increase in accidentally discovered adrenal masses without clinically apparent hormonal abnormalities. Such tumours have been termedThe rapid development of modern imaging techniques, has led to an increase in accidentally discovered adrenal masses without clinically apparent hormonal abnormalities. Such tumours have been termed "incidentalomas". The diagnostic work-up in patients with adrenal incidentalomas is aimed at the determination of hormonal activity of the tumour and identification of patients with potentially malignant tumours. The aim of our study was a retrospective analysis of selected clinical characteristics and hormonal studies in accidentally discovered adrenal tumours. Fourty hundred sixty-three patients with serendipitously discovered adrenal masses, diagnosed and treated in the Department of Endocrinology and Internal Diseases, Medical University of Gdansk as well as in the affiliated Endocrinology Clinic between 1993 and October of 2009 were included in the analysis. Out of all patients, 245 were referred for adrenalectomy. We found that clinically "silent" tumours often demonstrate subclinical hormonal activity. In our report, increased 24-h urinary excretion of cortisol correlated positively with tumour size (p < 0.001). Moreover, a statistical relationship was demonstrated between tumour size and serum cortisol concentration assessed in the 1 mg dexamethasone suppression test (p < 0.001). Increased values of dehydroepiandrosterone/dehydroepiandrosterone sulphate were more often found in malignant than in benign tumours (p < 0.01). Urinary concentrations of 17-ketosteroids correlate positively with diagnosis of adrenocortical cancer (p = 0.02). We found that clinically "silent" tumours often demonstrate subclinical hormonal activity (subclinical Cushing syndrome, subclinical pheochromocytoma, low-symptomatic adrenocortical cancer).

• Adrenal myelolipomas composed with adrenal nodular hyperplasia in the same gland.

  Authors: Anna Babinska, Adam Nałecz, Renata Swiatkowska-Stodulska, Krzysztof Sworczak

  Polish journal of pathology : official journal of the Polish Society of Pathologists. 01/2012; 63(1):45-8.

  Adrenal myelolipoma is a benign neoplasm composed of an admixture of hemopoietic elements and mature adipose tissue. The incidence of adrenal myelolipoma is reported as between 4% and 5% of adrenalAdrenal myelolipoma is a benign neoplasm composed of an admixture of hemopoietic elements and mature adipose tissue. The incidence of adrenal myelolipoma is reported as between 4% and 5% of adrenal incidentaloma. The association of an adrenal myelolipoma and adrenal nodular hyperplasia or adrenal adenoma is rare. Four cases of adrenal myelolipomas in the material of 702 incidentally discovered adrenal lesions treated in our center are presented in this paper (in a group of 294 operated patients). Two myelolipomas have been reported as isolated adrenal masses and two - in association with adrenocortical nodular hyperplasia.

• Evaluation of selected cognitive functions before and after surgery for primary hyperparathyroidism.

  Authors: Dominika Babińska, Marcin Barczyński, Tomasz Stefaniak, Tomasz Osęka, Anna Babińska, Dariusz Babiński, Krzysztof Sworczak, Andrzej J Lachiński, Wojciech Nowak, Zbigniew Sledziński

  Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie. 12/2011;

  BACKGROUND AND AIMS: Cognitive functions have been reported to be impaired in patient with primary hyperparathyroidism (pHPT). The aim of this psychological study was to evaluate cognitiveBACKGROUND AND AIMS: Cognitive functions have been reported to be impaired in patient with primary hyperparathyroidism (pHPT). The aim of this psychological study was to evaluate cognitive disturbances in pHPT in relation to serum calcium levels before and after surgery. PATIENTS AND METHODS: A prospective, case-control study with 1-year follow-up of 35 pHPT patients versus 35 matched controls was undertaken. All patients were tested before surgery and at 12-18 months following surgery with a battery of selected cognitive function psychological tools: Benton Visual Retention Test (BVRT), Wisconsin Card Sorting Test (WCST), Memory Verbal Learning Test (DCS), The Rey's Auditory Verbal Learning Test (RAVLT), Trail Making Test A & B, Verbal Fluency Test, and Beck Depression Inventory. In addition to psychological testing, serum calcium, parathyroid hormone and phosphate levels were evaluated. RESULTS: The following cognitive functions of pHPT patients versus controls were deteriorated before surgery: impaired concentration, decreased nonverbal learning process, difficulties in using direct memory, verbal fluency and visual constructive abilities. However, no correlation was found between serum calcium levels and the results of neuropsychological tests. In longitudinal comparison of pHPT patients before and 1 year after surgery, there was a significant improvement in visual memory, visual-constructive abilities and direct memory. CONCLUSIONS: pHPT patients have significantly decreased concentration level, nonverbal learning process, access to verbal resources and constructional and visual memory ability. Thus, neuropsychological testing may be useful in the decision making for early surgery in patients with mild asymptomatic disease in order to avoid further deterioration of cognitive functions.

• The estimation of selected endogenous anticoagulation system parameters in patients with subclinical Cushing's syndrome.

  Authors: Renata Swiatkowska-Stodulska, Sonia Kaniuka-Jakubowska, Piotr Wisniewski, Anna Skibowska-Bielinska, Krzysztof Sworczak

  European journal of endocrinology / European Federation of Endocrine Societies. 09/2011; 165(6):865-71.

  An increased tendency towards thromboembolic events is observed in patients with Cushing's syndrome. There are much fewer publications available about thromboembolic complications in patients withAn increased tendency towards thromboembolic events is observed in patients with Cushing's syndrome. There are much fewer publications available about thromboembolic complications in patients with subclinical Cushing's syndrome (SCS). Therefore, a question arises whether hemostatic disturbances appear in this particular disease phase. Estimation of protein C (PC), free protein S (FPS), antithrombin (AT) activity, thrombomodulin (TM) concentration and activated PC resistance (APCR) in patients with SCS. We studied 35 patients with SCS. The control group consisted of 33 healthy volunteers. The activity of PC, AT, FPS, APCR and the concentration of TM was estimated in all representatives. The comparison of the examined coagulation parameters between the patients with SCS and the healthy individuals revealed significantly higher mean PC activity and mean FPS activity in the SCS group. Mean TM concentration was significantly lower in patients with SCS compared with the control group. The differences in APCR and AT activity were not significant. We did not prove any statistically significant correlations between the examined coagulation parameters and hormonal parameters. We did not find any correlation between the concentration of cortisol and basic coagulation parameters such as international normalized ratio, activated partial thromboplastin time or fibrinogen in the group with SCS either. The patients with SCS present disturbances in endogenous anticoagulation system defined as PC, FPS activity and TM concentration. This finding suggests an impact of mild autonomic cortisol overproduction on coagulation system.

• From struma ovarii to Hashimoto disease--an unusual diagnosis of primary hypothyroidism: case report.

  Authors: Monika Berendt-Obolonczyk, Malgorzata Siekierska-Hellmann, Szymon Wojtylak, Lukasz Obolonczyk, Krzysztof Sworczak

  Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 07/2011; 28(1):43-5.

  CAPSULE: Authors report a case of a 52-year-old woman after struma ovarii with chronic lymphocytic inflammation excision. Finally thyroxin treatment was started and patient's hypothyroidism symptomsCAPSULE: Authors report a case of a 52-year-old woman after struma ovarii with chronic lymphocytic inflammation excision. Finally thyroxin treatment was started and patient's hypothyroidism symptoms diminished. CASE SUMMARY: Struma ovarii is a type of mature teratoma in which thyroid tissue forms the main component. In most cases struma ovarii is composed of normal thyroid tissue while lymphocytic thyroiditis in struma ovarii occurs very rarely. The authors report a case of a 52-year-old woman after ovarian tumor excision. In histopatholgical examination struma ovarii with chronic lymphocytic inflammation was diagnosed. Additional studies revealed a typical ultrasonographic picture of Hashimoto disease in the thyroid gland and an increased concentration of thyroglobulin antibodies. A final diagnosis of Hashimoto disease was confirmed. Initially, thyroid gland function was normal but 11 months after surgery, supplementation therapy with thyroxin was administered. In this case, an early diagnosis of Hashimoto disease resulted from excision of struma ovarii with chronic lymphocytic inflammation. It induced early thyroxin treatment and allowed to reduce hypothyroidism symptoms.

• [Clear cell carcinoma of the kidney and Conn's syndrome in a patient with arterial hypertension--a case report].

  Authors: Renata Swiatkowska-Stodulska, Ewa Swierblewska, Joanna Zielonko, Krzysztof Sworczak

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(2):104-8.

  Recognition of secondary arterial hypertension is one of the main purposes of diagnosis in patients with arterial hypertension. Secondary hyperaldosteronism is one of the most frequentRecognition of secondary arterial hypertension is one of the main purposes of diagnosis in patients with arterial hypertension. Secondary hyperaldosteronism is one of the most frequent endocrinological causes of arterial hypertension. Because of the increased risk of cardiovascular diseases in these patients, the early diagnosis and proper treatment of primary hyperaldosteronism play a crucial role. The aim of the study was presentation of a patient with secondary arterial hypertension. During the diagnosis of the hypertension cause, a renal tumor was found and then primary hyperaldosteronism due to aldosterone producing adrenal adenoma. The presented case proves the necessity of a thorough diagnosis of etiology of arterial hypertension, as it exists a possibility of coexistence of two independent causes, what can delay the diagnosis and make it more complicated.

• The role of vitamins in the prevention and treatment of thyroid disorders.

  Authors: Krzysztof Sworczak, Piotr Wiśniewski

  Endokrynologia Polska. 01/2011; 62(4):340-4.

  Although vitamin deficiencies are uncommon in Poland or other developed countries, many patients take vitamin supplements. Despite the widespread availability of vitamins and the universal beliefAlthough vitamin deficiencies are uncommon in Poland or other developed countries, many patients take vitamin supplements. Despite the widespread availability of vitamins and the universal belief that vitamins offer health benefits, few publications have addressed their role in the prevention and treatment of thyroid diseases. There is some evidence to suggest that the administration of vitamins with anti-oxidant properties in patients with hyperthyroidism can decrease the severity of clinical symptoms, and that vitamin D supplementation can have a beneficial effect on the bone system for these patients. It has also been suggested that patients with autoimmune thyroid diseases should be periodically screened for vitamin B12 deficiency. There has been no data to support vitamin supplementation in the primary or secondary prevention of thyroid malignancies.

• [Hypercortisolism and hemostasis]

  Authors: Renata Swiatkowska-Stodulska, Anna Babińska, Krzysztof Sworczak

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 03/2009; 26(152):142-4.

  Endocrinopathies can cause various changes in coagulation and fibrinolytic mechanisms. Glucocorticoids show particulary important influence on hemostasis. Increased tendency to thromboembolicEndocrinopathies can cause various changes in coagulation and fibrinolytic mechanisms. Glucocorticoids show particulary important influence on hemostasis. Increased tendency to thromboembolic incidents is observed in either endogenous hypercortisolism or glucocorticoids administration. The aim of this paper was to present the hemostatic disturbances in patients with hypercortisolism, with particular emphasis in their development on metabolic changes, endothelium damage, influence of pro-inflammatory cytokines and hiperhomocysteinemia. The problem of anticoagulant prophylaxis in this group of patients is also discussed.

• The profile of ErbB/Her family genes copy number assessed by real-time PCR in parathyroid adenoma and hyperplasia associated with sporadic primary hyperparathyroidism.

  Authors: Natalia Bednarz, Krzysztof Błaut, Krzysztof Sworczak, Tomasz Oseka, Krzysztof P Bielawski

  Acta biochimica Polonica. 02/2009; 56(1):83-8.

  Hyperparathyroidism (pHPT) is a relatively frequent endocrinopathy, however, the molecular mechanisms of its etiology remain poorly understood. This disorder is mainly associated with benign tumoursHyperparathyroidism (pHPT) is a relatively frequent endocrinopathy, however, the molecular mechanisms of its etiology remain poorly understood. This disorder is mainly associated with benign tumours (adenoma) and hyperplasia of the parathyroid, hence, the focus is directed also to genes that are likely to be involved in carcinogenesis. Among such genes are ErbB/Her family genes already used in diagnosis of other tumours (e.g., breast carcinoma) and reported also to play a role in development of endocrine lesions. So far, ErbB-1/Her-1/EGFR expression has been detected in pHPT-associated adenomas and hyperplasia as opposed to no expression in normal parathyroid tissue. Moreover, losses or gains of the fragments of chromosomes where ErbB/Her genes are located have been reported. In this study, the gene dosage of ErbB/Her family genes were determined for the first time in parathyroid adenomas, hyperplasia and morphologically unchanged tissue in order to establish their putative role in the development of the disease. Genomic DNA was isolated from 33 patients with sporadic hyperparathyroidism and the gene copy numbers were assessed using real-time PCR. The ErbB/Her genes' profile was unaltered in most of the examined samples. Two low-level amplifications of ErbB-1/Her-1/EGFR gene, two deletions of ErbB-2/Her-2, and six deletions of ErbB-4/Her-4 were found. The ErbB-3/Her-3 gene remained unaffected. No correlation with clinical parameters was found for any gene. Both the low number of alterations and a lack of their associations with clinical parameters exclude the prognostic value of the ErbB/Her genes family in parathyroid tumourigenesis. Nevertheless, the ErbB-4/Her-4 deletions seem to be interesting for further investigations, especially in the context of PTH secretion.

• Assessment of alpha1-antitrypsin and alpha2-macroglobulin levels in obese patients.

  Authors: Renata Swiatkowska-Stodulska, Anna Babińska, Anna Skibowska-Bielińska, Krzysztof Sworczak

  01/2009; 118(12):713-8.

  INTRODUCTION: Epidemiologic data show a higher frequency of thromboembolic incidents in obese individuals compared with normal weight subjects. Pro-inflammatory factors seem to play an important roleINTRODUCTION: Epidemiologic data show a higher frequency of thromboembolic incidents in obese individuals compared with normal weight subjects. Pro-inflammatory factors seem to play an important role in their development. It has not been fully explained so far how alpha1-antitrypsin (alpha1ATp) and alpha2-macroglobulin (alpha2MG) act in obese subjects. Both proteins participate directly and indirectly in regulation of inflammation, coagulation and fibrinolysis. Thus alterations in serum levels of these protease inhibitors may play an important role in the development of vascular incidents in obesity. OBJECTIVES: To assess serum alpha1ATp and alpha2MG levels in obese patients. PATIENTS AND METHODS: The study involved 16 subjects with obesity and metabolic syndrome and 14 obese subjects with no disturbances of glucose and lipid profile or arterial hypertension. 20 healthy volunteers served as the control group. Levels of alpha1ATp and alpha2MG were determined in all subjects using immunonephelometry. RESULTS: No significant differences in alpha1ATp and alpha2MG levels between the patients and the control group were observed. Comparison of the tested parameters in the obese with metabolic syndrome and those without metabolic disturbances showed higher values of alpha1ATp levels in the former group. In this group positive correlations between alpha1ATp levels and fasting insulin levels were found. CONCLUSIONS: Metabolic disturbances in obesity are associated with an elevated level of alpha1ATp, which might confirm its important role in the development of vascular incidents in obese patients. An increased risk of vascular pathological lesions in obesity is probably not associated with alpha2MG levels.

• Myocardial infarction in a 30-year-old patient with pheochromocytoma and type 1 neurofibromatosis.

  Authors: Anna Babińska, Alicja Gnacińska, Renata Swiatkowska-Stodulska, Krzysztof Sworczak

  Polskie archiwum medycyny wewnȩtrznej. 10/2008; 118(9):517-23.

  Chromaffinoma of the adrenal medulla (pheochromocytoma--PHEO) is a rare cause of arterial hypertension which is diagnosed incidentally or run in a family as a component of disease syndromes of theChromaffinoma of the adrenal medulla (pheochromocytoma--PHEO) is a rare cause of arterial hypertension which is diagnosed incidentally or run in a family as a component of disease syndromes of the genetic origin. PHEO is diagnosed in about 5-10% of patients with type 1 neurofibromatosis (NF1). In a patient group with diagnosed arterial hypertension and NF1, PHEO is diagnosed with a much higher frequency, i.e. 20-56%. Myocardial injury in a patient without coronary risk factors is very rare. Increased circulating levels of catecholamines in patients with chromaffinoma may cause damage to myocardium without any atherosclerotic lesions in the coronary arteries. A correct diagnosis of PHEO allows the right treatment to be administered. The present paper discusses the case of a patient with NF1 and periodic arterial hypertension in the course of unidentified chromaffinoma, which was complicated with myocardial infarction. The evaluation of the secondary arterial hypertension led to the detection of the adrenal tumor. Based on the clinical presentation and the tumor characteristics, on computed tomography, PHEO was suspected. The level of methoxycatecholamines in a 24-hour urine sample significantly exceeded the reference values. The patient underwent laparoscopic, right-sided adrenalectomy, and the histopathological examination definitely concurred with the diagnosis of PHEO. During the post-surgical period, the arterial hypertension normalized without the administration of hypotensive drugs. The patient is still cared for by the clinic. The diagnosis toward PHEO is recommended if the patient with NF1 shows arterial hypertension. Proper diagnosis and treatment protects the patient against life-threatening cardiovascular complications.

• [Insulinoma misdiagnosed and treated as epilepsy].

  Authors: Maria Gnacńska, Anna Lewczuk, Krzysztof Sworczak

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 03/2008; 24(141):251-3.

  Although insulinoma constitutes almost 90% of neuroendocrine tumors localized in the pancreas, it is a rare disease. Quite commonly prior to the diagnosis there is a history of several years andAlthough insulinoma constitutes almost 90% of neuroendocrine tumors localized in the pancreas, it is a rare disease. Quite commonly prior to the diagnosis there is a history of several years and misdiagnosis as neurological or cardiological disease is not infrequent. Patient, 22 years old, since 7 years experiencing multiple incidents of neuroglycopenia with concurrent hyperadrenergic reaction. Consciousness disturbances and muscle tremor together with feeling of hunger and tachycardia occurred mainly in the morning hours, or after physical exercise, and subsided after glucose intake. Increase in body weight, typical for insulinoma, was also observed. The patient was hospitalized twice in Pediatric Department and although hypoglycemia was observed, no additional testing was performed to exclude insulinoma; reported symptoms and abnormalities in EEG recording after provocation resulted in diagnosis and treatment of epilepsy. During hospitalization in the Department of Endocrinology fasting test was performed, which revealed inadequately high insulin level with glucose level of 41 mg% and signs of neuroglycopenia. The image of pancreas was normal in the acquired abdominal ultrasound and in CT a tumor was found in the tail of pancreas. The patient underwent laparoscopic operation and the clinical diagnosis was confirmed by histopathology. Antiepileptic drugs were discontinued. Total remission of symptoms was achieved. The presented case demonstrates the difficulties in correct interpretation of reported symptoms, while the results of biochemical tests and imaging studies point precisely to the diagnosis. Focal neurological signs resulting from multiple episodes of hypoglycemia may lead to misdiagnosis and treatment of epilepsia.

• Side effects during interferon-alpha therapy of hepatitis C with special consideration of thyroid dysfunction.

  Authors: Lukasz Obołończyk, Małgorzata Siekierska-Hellmann, Krzysztof Sworczak

  Postȩpy higieny i medycyny doświadczalnej (Online). 02/2008; 62:309-21.

  Hepatitis C virus infection is a worldwide problem and its natural, unfavorable course is still a challenge for the hepatologist. The standard of treatment is combined therapy with interferon-alphaHepatitis C virus infection is a worldwide problem and its natural, unfavorable course is still a challenge for the hepatologist. The standard of treatment is combined therapy with interferon-alpha and ribavirin. This therapy is related to a wide spectrum of side effects that significantly reduce quality of life. Approximately 90% of patients suffer from at least one adverse effect; 15% will therefore have reduced drug dose and 5% will discontinue treatment. The most common acute side effects are flu-like symptoms and chronic effects are hematological, neuropsychiatric, and endocrinological (mainly the thyroid). The latest classification divides interferon-induced thyroid diseases into two groups: autoimmune (Hashimoto disease, Graves-Basedow disease, positive antithyroid autoantibodies in euthyroid patients) and non-autoimmune (destructive thyroiditis, non-autoimmune hypothyroidism). The most common complication of cytokine therapy is the induction of antithyroid autoantibodies de novo without thyroid dysfunction. It seems that destructive thyroiditis with typical biphasic course is more common in therapeutic regimens with ribavirin than in interferon-alpha monotherapy. Clinically overt pathologies very often have very discrete symptoms which cause diagnostic and therapeutic dilemmas. Interferon-induced thyroid disorders are usually mild and sometimes self-limiting; nevertheless, every overt thyroid disease requires endocrinological consultation and possible treatment. In this review the most important current information related to hepatitis C, interferon alpha and ribavirin therapy, and thyroid disorders is collected. A new classification of interferon-induced thyroid disease is proposed.

• Serum selenium concentration in patients with Wilson's disease.

  Authors: Renata Swiatkowska-Stodulska, Wojciech Dejneka, Irena Jabłońska-Kaszewska, Jerzy Lukasiak, Hanna Kiszkis, Piotr Wiśniewski, Monika Lubińska, Krzysztof Sworczak

  Hepato-gastroenterology. 10/2007; 54(78):1788-90.

  BACKGROUND/AIMS: Wilson's disease is a genetically determined disorder of copper metabolism in the liver. Due to the toxic accumulation of this trace element, body organs are damaged by free radicalBACKGROUND/AIMS: Wilson's disease is a genetically determined disorder of copper metabolism in the liver. Due to the toxic accumulation of this trace element, body organs are damaged by free radical generation, lipid peroxidase and inhibition of synthesis of some proteins. Behavior of anti-oxidative factors in Wilson's disease has not been completely evaluated yet. The aim of the study was to assess blood serum concentrations of selenium in patients with Wilson's disease. METHODOLOGY: Twenty-five patients with Wilson's disease and 30 healthy volunteers, constituting a control group were included in the study. The patients were in good clinical condition. In all the subjects blood serum concentrations of selenium were tested using the atomic absorption spectroscopy, hydride generation method. RESULTS: Selenium concentrations in the blood serum of the patients and healthy controls did not show statistical differences between both groups. Correlations between selenium concentrations and biochemical parameters: activity of alanine and aspartate aminotransferase, alkaline phosphatase, gamma-glutamyltranspeptidase, concentration of bilirubin, albumin and gamma globulin, international normalized prothrombin index as well as serum copper, ceruloplasmine and 24-h urine copper excretion were assessed. Statistically significant correlation was found only between selenium concentration and aspartate aminotransferase activity. No statistically significant differences between selenium concentrations in the serum of patients with different forms of Wilson's disease were found. CONCLUSIONS: On the basis of the results obtained in the study it can be assumed that in treated patients with Wilson's disease the antioxidant status measured as serum selenium concentration is comparable to healthy controls.

• [One-year follow-up of TSH level and thyroid volume in patients with bone marrow or peripheral blood hematopoietic stem cell transplantation following chemotherapy]

  Authors: Małgorzata Siekierska-Hellmann, Anna Babińska, Lukasz Obołończyk, Krzysztof Sworczak, Andrzej Hellmann

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 09/2007; 23(135):170-3.

  Bone Hematopoietic Stem Cell Transplantation (HSCT) following high-dose chemo- and radiotherapy became treatment of choice in various numbers of hematological and hereditary or acquired immuneBone Hematopoietic Stem Cell Transplantation (HSCT) following high-dose chemo- and radiotherapy became treatment of choice in various numbers of hematological and hereditary or acquired immune disorders. Protocols preparing to allogenic transplantation have a few aims: eradication of neoplastic disease, suppression of defense system of recipient (reduction of transplant rejection), preparation of bone marrow microenvironment to implantation donor's cells. Chemotherapy is combined with acute side effects as nausea, vomiting, diarrhea, hair loss, mucositis, and hemorrhagic cystitis. Late toxic effects also appear, it require prolonged observation and care. Among them most common is dysfunction of thyroid and gonads in adults and growth inhibition in children. The aim of this study was prospective evaluation of thyroid function in adults with autologous and allogeneic BMT or HSCT following myeloablative chemotherapy. MATERIAL AND METHODS: 23 patients (16 females and 7 males) treated in Department of Hematology and Transplantology Medical University of Gdańsk were included. Average age was 34.3 years with range from 17-50 years. Each patient had endocrinological interview, physical examination of thyroid, TSH level assessment and ultrasonographic thyroid volume measurement before HSCT Identical control examinations were performed in third and twenty month after transplantation. TSH level and thyroid volume were tested for significant differences before and after transplantation using paired t-tests. A P-value of < 0.05 was considered statistically significant. RESULTS: 12 months after HSCT following myeloablative chemotherapy we noted on average decrease in volume of thyroid from 17,5 ml to 13.5 ml (females to 9.7 ml). This difference was statistically significant with p = 0.002. Also 12 months after the procedure progressive rise in TSH level was noted from 2.0 mU/l to 3.2 mU/l. Nevertheless this tendency was not statistically significant with p = 0.08. CONCLUSIONS: We suggest control of TSH, fT4 level and thyroid ultrasound examination at least twice--before and 12 months after transplantation. Myeloablative chemotherapy before HSCT may cause early (after 3 months) hypothyroidism--it may last one year after procedure. In case of high TSH level we suggest individually adapted L-thyroxine replacement therapy.

• [Thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus successfully treated with plasma exchange and corticosteroids]

  Authors: Piotr Wiśniewski, Monika Szarejko-Kaska, Krzysztof Sworczak, Andrzej Hellmann

  Polskie archiwum medycyny wewnȩtrznej. 09/2007; 117(8):375-8.

  Thrombotic thrombocytopenic purpura (TTP) is a rare dynamic life-threatening disease with systemic formation of platelet thrombi in the microvasculature within all the organs. Until recently theThrombotic thrombocytopenic purpura (TTP) is a rare dynamic life-threatening disease with systemic formation of platelet thrombi in the microvasculature within all the organs. Until recently the mortality in TTP has exceeded 90%. The progress of medical research in the last two decades has significantly improved our understanding of the pathogenesis of TTP and allowed a reduction in mortality. This paper describes a case of a 36-year-old female patient with systemic lupus erythematosus (SLE) who was admitted to our hospital for jaundice and speech disturbances. Laboratory tests revealed hemolytic anemia with a negative Coombs test. Abundant schistocytes were present in peripheral blood smear. During the first day of hospitalization progression of neurological signs was observed -the patient received high-dose corticosteroids (1000 mg of methylprednisolone daily for 5 consecutive days) and underwent plasma exchange therapy. We observed significant improvement of the patient's condition, as well as a complete resolution of clinical and laboratory abnormalities. In the following 24 months there have been no signs of the relapse of TTP. The article contains also a brief update of this unusual disease.

• Homocysteine, folate and cobalamin levels in hypothyroid women before and after treatment.

  Authors: Anna Orzechowska-Pawilojc, Krzysztof Sworczak, Anna Lewczuk, Anna Babinska

  Endocrine journal. 07/2007; 54(3):471-6.

  Hypothyroidism may result in accelerated atherosclerosis. Hyperhomocysteinaemia is an independent risk factor for premature atherosclerotic vascular disease. The aim of the present study was toHypothyroidism may result in accelerated atherosclerosis. Hyperhomocysteinaemia is an independent risk factor for premature atherosclerotic vascular disease. The aim of the present study was to assess plasma total homocysteine (tHcy), folate and cobalamin concentrations in hypothyroid patients before and after treatment. Thirty-one hypothyroid and thirty health young women were studied. The hypothyroid patients were investigated in the untreated state and again after restoration of euthyroidism. The levels of homocysteine, folate, cobalamin and thyroid stimulating hormone (TSH), free thyroxine (fT(4)), free triiodothyronine (fT(3)) and renal function were measured before and after treatment. In hypothyroidism tHcy was higher but not statistically significant than in control group. Serum level of folate was higher and serum cobalamin was lower in the hypothyroid state. Following L-thyroxine therapy tHcy significantly decreased as well as the concentration of cobalamin. Level of folate remained unchanged. Univariate analysis in hypothyroid group indicated that tHcy negative correlated with creatinine clearance, fT(3), fT(4), cobalamin and positive with TSH. In multivariate analysis tHcy correlated with creatinine clearance, cobalamin and fT(4). Thyroid status influences the plasma tHcy. Free triiodothyronine and next free thyroxine have the greatest negative influence. This would account for hyperhomocysteinemia in the hypothyroid state and premature atherogenesis.

• Analysis of the sodium iodide symporter expression in histological slides from a nodular goiter.

  Authors: Anhelli Syrenicz, Małgorzata Wolny, Andrzej Kram, Krzysztof Sworczak, Małgorzata Syrenicz, Barbara Garanty-Bogacka, Mieczysław Walczak

  Archives of medical research. 03/2007; 38(2):219-26.

  BACKGROUND: The aim of the study was analysis at both the level and the cell site of the sodium/iodide symporter (NIS) in histological slides from hot, warm, and cold nodules and extranodularBACKGROUND: The aim of the study was analysis at both the level and the cell site of the sodium/iodide symporter (NIS) in histological slides from hot, warm, and cold nodules and extranodular parenchyma according to scintigraphy. METHODS: The study population consisted of 97 people who underwent surgery for a toxic nodular goiter (26 patients) or a non-toxic nodular goiter (71 patients). Immunohistochemical study was performed with 198 histological slides from hot, warm, and cold nodules (study slides) and the extranodular parenchyma (control slides). The level of NIS expression was estimated objectively using the computerized image analysis system, Quantimet 600S (Leica, Cambridge, UK). RESULTS: We found significantly higher NIS expression in hot nodules than in cold nodules and in warm nodules than in cold ones. We found significantly higher NIS expression in hot and warm nodules than in the surrounding parenchyma. The level of NIS expression did not differ significantly between cold nodules and the collateral tissues. CONCLUSIONS: Our data indicate that NIS protein participates in the development of hyperthyroidism in the course of a nodular goiter. We confirm that the functional state of a nodular goiter is determined by NIS expression in nodules, not in collateral parenchyma. The low metabolism of cold nodules does not simply result from decreased level of NIS protein or its defective targeting to the cell membrane. The observation of NIS in the cell cytoplasm of hot nodules seems to indicate that the intracellular localization of NIS does not determine loss of its activity.

• [Effect of selected hormones on particular parameters of hemostasis]

  Authors: Renata Swiatkowska-Stodulska, Anna Babińska, Krzysztof Sworczak

  Wiadomości lekarskie (Warsaw, Poland : 1960). 02/2007; 60(7-8):390-3.

  Endocrinopathies belong to the group of heterogenic diseases in course of which hemostatic disturbances can occur at any stage of the disease. On one hand they could include an increased riskEndocrinopathies belong to the group of heterogenic diseases in course of which hemostatic disturbances can occur at any stage of the disease. On one hand they could include an increased risk ofthromboembolic events, on the other hand an increased tendency to development of bleeding complications. The aim of this paper was to examine the influence of different hormones on hemostasis and fibrinolysis with particular emphasis on blood clotting factors, platelets' function and parameters of fibrinolysis.

• [Classification of thyroid gland disease on the basis of selenium concentration in serum]

  Authors: Wojciech Dejneka, Krzysztof Sworczak, Lukasz Obołończak, Jerzy Lukasiak

  Roczniki Państwowego Zakładu Higieny. 02/2007; 58(3):563-7.

  The aim of this study was to estimate the concentration of total selenium in serum women with thyroid gland disease. Selenium was determined by atomic absorption spectrometry using the hydrideThe aim of this study was to estimate the concentration of total selenium in serum women with thyroid gland disease. Selenium was determined by atomic absorption spectrometry using the hydride generation method (HG-AAS). Research was determined in 94 patients with thyroid gland disease and in 28 healthy controls. Selenium concentration of serum was variously in patients than in control group and patients with different thyroid gland diseases. Concentration in control group was 0.06231 microg/ml, in goitre group--0.05612 microg/ml, in hyperthyroidism--0.07149 microg/ml and in hypothyroidism--0.09088 microg/ml.