Marek Grzywa

Publications of Marek Grzywa

• [Metabolic obesity in normal weight individuals and cardiovascular disease].

  Authors: Maria Nowak, Marek Grzywa

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 08/2011; 31(182):118-21.

  Since thirty years there is growing interest in normal weight individuals who have metabolic disorders. These individuals are identified as metabolically obese but normal weight (MONW). InsulinSince thirty years there is growing interest in normal weight individuals who have metabolic disorders. These individuals are identified as metabolically obese but normal weight (MONW). Insulin resistance, elevated arterial blood pressure, abnormal lipid profile and sedentary style of live are known risk factors of atherosclerosis in general population. On the other hand, increased amount of visceral and subcutaneous abdominal adipose tissue is associated with increased risk of metabolic abnormalities. These abnormalities existing in MONW individuals exert an effect on increased risk of cardiovascular diseases and non insulin dependent diabetes mellitus. Identification of individuals at risk is difficult not only because no clear definition of MONW is established but also due to common belief that the cardiovascular risk in nonobese is low. The awareness of association of metabolic abnormalities in MONW with atherosclerosis should argue physicians into early screening and modification of cardiovascular risk factors in nonobese individuals.

• [Bilateral ovarian luteinized thecoma associated with pregnancy--a case report].

  Authors: Małgorzata Kogut, Jarosław Janeczko, Małgorzata Trzcińska, Marek Grzywa

  Ginekologia polska. 02/2010; 81(2):131-4.

  Hormonally active, associated with pregnancy ovarian tumors can cause some diagnostic and therapeutic problems. In the following work we present a 28-year-old primigravida in the 21st week ofHormonally active, associated with pregnancy ovarian tumors can cause some diagnostic and therapeutic problems. In the following work we present a 28-year-old primigravida in the 21st week of pregnancy who was admitted to hospital with acute abdominal pain and virilizing symptoms. Bilateral luteinized thecoma of a considerable size, secreting testosterone, was diagnosed and the woman received surgical treatment. During the operation a rupture of the left tumor was discovered. Bilateral adnexectomy was performed. After the operation the symptoms subsided. The pregnancy continued until 38 weeks gestation. A normal female fetus without virilizing symptoms was delivered by caesarean section.

• Kikuchi-Fujimoto disease: case report.

  Authors: Aneta Kołodziej-Kłek, Renata Orłowska-Florek, Krystyna Gałazka, Marek Grzywa

  Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):826-9.

  We present the case of a 27-year-old woman with local cervical lymphadenopathy without other symptoms. Due to a gradual progression of lesions, a biopsy was performed, and a specimen excised from anWe present the case of a 27-year-old woman with local cervical lymphadenopathy without other symptoms. Due to a gradual progression of lesions, a biopsy was performed, and a specimen excised from an enlarged lymph node was subjected to histological examination. Kikuchi-Fujimoto disease (KFD), that is histiocytic necrotizing lymhadenitis, was diagnosed. Lymphadenopathy resolved without medical treatment over 6 months. KFD should be considered in the differential diagnosis of lymphadenopathy, even though this disease rarely occurs in Poland.

• [Two cases of serious hepatic injury caused by antithyroid drugs.]

  Authors: Marek Grzywa, Renata Orłowska-Florek, Anna Grzywa-Celińska

  Endokrynologia Polska. 01/2009; 60(5):396-400.

  We present two cases of severe hepatotoxicity caused by antithyroid drugs in women with Graves disease. The first medication in both cases was methimazole replaced by propylhiouracil due toWe present two cases of severe hepatotoxicity caused by antithyroid drugs in women with Graves disease. The first medication in both cases was methimazole replaced by propylhiouracil due to intolerance. The main symptom was jaundice lasting about 2 months. As a first step in the treatment we terminated the antithyroid drug administration and introduced prednisone and ursodesoksycholic acid therapy. The termination of thyrotoxicosis by means of 131 I administration had also positive influence on the course of disease. In summary we emphasise the significance of prompt discontinuation of antithyroid drug once toxic symptoms appeared and avoid replacement one thyrostatic drug for another in fovour of radioiodine treatment.

• [Broncho-pulmonary carcinoid with the cardiac arrhythmia manifestation]

  Authors: Jerzy Aleksander Kuczma, Marek Grzywa

  Polskie archiwum medycyny wewnȩtrznej. 11/2006; 116(4):971-3.

  We are presenting the case of a 60-year-old woman (OM ) with a bronchial-pulmonary carcinoid which the only, first and dominating symptom was paroxysmal atrial tachycardia, as well as ventricularWe are presenting the case of a 60-year-old woman (OM ) with a bronchial-pulmonary carcinoid which the only, first and dominating symptom was paroxysmal atrial tachycardia, as well as ventricular group extrasystoles. After 1.5 years of treatment with amiodarone, the patient was admitted to hospital because of haemoptysis. In the imaging examinations of the thorax, a cavernous structure of 36 x 47 mm in the III segment of the left lung was discovered. The patient underwent urgent surgery after an episode of massive pulmonary haemorrhage--surgery included excision of the upper lobe of the left lung containing the tumour and mediastinal lymph nodes. On microscopic examination, an atypical carcinoid was diagnosed. After the surgery, arrhythmia ceased and did not return for a period of 3 following years. The current imaging examinations and determinations of 5-HIO uringexcretion acid do not indicate relapse of the tumour.

• [Antithyroid drugs and lithium carbonate administration relationship to the results of radioiodine treatment of hyperthyroidism]

  Authors: Marek Grzywa, Zbigniew Zuzak

  Polskie archiwum medycyny wewnȩtrznej. 05/2006; 115(4):366-70.

• [Volume and echostructure of the thyroid and ioduria in an urban population of adults in the southeastern Polish city of Rzeszów]

  Authors: Renata Orłowska-Florek, Marek Grzywa

  Polskie archiwum medycyny wewnȩtrznej. 09/2004; 112(2):937-43.

  The aim of this work was to determine the volume and echostructure of the thyroid and to examine urinary iodine excretion in an adult population of residents of Rzeszów, a city located in theThe aim of this work was to determine the volume and echostructure of the thyroid and to examine urinary iodine excretion in an adult population of residents of Rzeszów, a city located in the Carpathian endemic region for goiter, after the introduction of mandatory iodine prophylaxis in 1997. 984 subjects, aged 19-60, were examined (540 females and 394 males). The mean level of urinary iodine in the examined population was 104.17 microg/l (+/- 85.22). Higher urinary iodine levels were seen in the group of males (p = 0.005) and in those who were taking medication containing iodine (p = 0.002). The mean volume of the thyroid in the examined group was 18.69 (+/- 10.01) ml and was larger in the group of males than females (p < 0.005). Nodular lesions were found in 17% of the examined thyroids and a statistically significant prevalence in the group of females (20.8%) over the group of males (11.4%) was found (p < 0.0005). The occurrence of nodules increased with age and was significantly higher in the 40-60 year age group than in the 19-25 years age group (p = 0.001). In single--and multi--factor analysis, a correlation was found between the occurrence of nodules and the female gender (r-2.04, 3.48; p < 0.005, < 0.0005) and the occurrence of nodules and the volume of the thyroid (r-1.1, 1.11; p < 0.005, < 0.0005). The occurrence of nodules did not correlate with ioduria (r-1, p = 0.8). Iodine prophylaxis was shown to be highly effective, although the examined region does not yet meet the criteria for the elimination of iodine deficiency as formulated by the ICCIDD.

• [Reversible thyrotoxic cardiomyopathy--report of three cases]

  Authors: Maria Nowak, Dorota Madrzak, Jerzy Kuźniar, Marek Grzywa

  Polskie archiwum medycyny wewnȩtrznej. 11/2002; 108(4):979-82.

  Three patients with thyrotoxicosis, atrial tachyarrhythmia and congestive heart failure despite successful treatment of hyperthyroidism revealed atrial fibrillation/flagellation and left ventricularThree patients with thyrotoxicosis, atrial tachyarrhythmia and congestive heart failure despite successful treatment of hyperthyroidism revealed atrial fibrillation/flagellation and left ventricular systolic dysfunction. Congestive heart failure resolved and left ventricular systolic function normalized only after successful cardioversion to sinus rhythm. In some patients treated for hyperthyroidism, achievement of euthyroid state is not by itself sufficient to reverse left ventricular failure. Improvement after successful reversion of atrial tachyarrhythmia suggest its essential role in pathogenesis of thyrotoxic cardiomyopathy.

• The rising incidence of type 1 diabetes in south-eastern Poland. A study of the 0-29 year-old age group, 1980-1999.

  Authors: Anna Sobel-Maruniak, Marek Grzywa, Renata Orłowska-Florek, Andrzej Staniszewski

  Endokrynologia Polska. 57(2):127-30.

  INTRODUCTION: Studies carried out over the last few years have provided information about the increase in the incidence of type 1 diabetes in different parts of the world including the EuropeanINTRODUCTION: Studies carried out over the last few years have provided information about the increase in the incidence of type 1 diabetes in different parts of the world including the European countries bordering Poland. THE AIM OF STUDY: The aim of this study was to determine the long-term trends in the incidence of type 1 diabetes over the 20 years between 1980 and 1999 and to compare the incidence during the decades preceding and following the 1989 economic and political transformation in Poland. MATERIAL AND METHODS: The registration of type 1 diabetes among people aged 0-29 was drawn up according to the DERI recommendations using three data sources. We calculated the age-standardised incidence rates for five-year age groups and determined the long-term trend in the incidence of type 1 diabetes in south-eastern Poland. RESULTS: A significant growth in the incidence of type 1 diabetes was observed among people aged 0-29 in the Rzeszów Province in the period between 1980 and 1999. The mean age-standardised incidence rate was 6.1/100,000, and a statistically significant difference was noted between the 1980s and the 1990s (5.3 [95%CI 4.5-6.0] and 6.8 [95%CI 5.9-7.6]). The male incidence of 6.7 significantly exceeded that for females--5.5/100,000. There was also a higher incidence in the group aged 0-14 in comparison with the group aged 15-29 (6.4 and 5.8/100,000 respectively). The highest incidence was found in boys aged 10-14 (11.5/100,000) and a significantly rising trend was observed in children of 0-4 years old. CONCLUSIONS: The mean incidence of type 1 diabetes among the study population was low. Nevertheless, we demonstrated a significantly increasing trend in the incidence during the 20-year observation period. The incidence in the 1990s, both in general and for males, was significantly higher when compared to the 1980s.