J Järhult

Höglandet´s Hospital, Eksjø, Jönköping, Sweden

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Publications (17)25.53 Total impact

  • J Järhult · J Nordenström · L Perbeck
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    ABSTRACT: A retrospective analysis of 93 patients undergoing 128 re-explorations for persistent or recurrent hypercalcaemia is presented. Seventy-six patients (82 per cent) became normocalcaemic after between one and five reoperations. Nine patients had hypercalcaemia caused by sarcoidosis, familial hypocalciuric hypercalcaemia or metastatic disease, and two had parathyroid carcinoma. Fifteen patients (16 per cent) developed permanent hypoparathyroidism requiring vitamin D and/or calcium therapy and nine had permanent recurrent laryngeal nerve paralysis. Undetected adenomas (41 cases) and inadequate resection in hyperplastic disease (28) were the predominant causes of initial failure. Reoperation for persistent or recurrent hyperparathyroidism restored normocalcaemia in the majority of patients. This 'cure' was achieved at the cost of considerable morbidity and a careful risk-benefit analysis of each patient is recommended before performing reoperative parathyroid surgery.
    No preview · Article · Apr 1993 · British Journal of Surgery
  • S Abugassa · J Nordenström · J Järhult
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    ABSTRACT: To find out whether chronic hypercalcaemia and excessive secretion of parathyroid hormone (PTH) is associated with skeletal demineralisation in familial hypocalciuric hypercalcaemia (FHH). Open study. Huddinge University Hospital, Sweden. Nine affected and three unaffected members of two kindreds with FHH, and 12 age- and sex-matched controls. Measurement of bone mineral density (g/cm2) in the proximal femur and lumbar spine by dual photon absorptiometry, and of bone mineral content in the distal radius and midradius (g/cm) by single photon absorptiometry. Measurement of serum concentrations of PTH, total and ionised calcium, phosphate, and magnesium, and alkaline phosphatase activity, and 24 hour urinary calcium excretion were also made. Bone mineral density was significantly higher in Wards's triangle of the femur (p < 0.05) in the members of families with FHH than in control subjects. In the other parts of the femur and in the lumbar vertebrae it was slightly but not significantly higher, as was the bone mineral content of the distal radius and midradius. Family members with FHH all had increased total and ionised serum calcium concentrations, except for the index case in one of the families who developed hypoparathyroidism postoperatively. Twenty-four urinary calcium excretion was less than 5 mmol (the upper limit of the reference range for FHH) in all the affected patients. Chronic hypercalcaemia in affected members of families with FHH is not the result of an increase rate of bone mineralisation, because they have normal bone mass. They seem to be relatively insensitive to the deleterious effects of PTH on bone mineral state, because raised concentrations of PTH were not associated with reduced bone mass.
    No preview · Article · Aug 1992 · The European Journal of Surgery
  • J Järhult · P A Lindestad · J Nordenström · L Perbeck
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    ABSTRACT: A prospective study of the value of routine examination of the vocal cords in 239 patients before and after thyroid or parathyroid surgery is presented. From the patient's history and voice the surgeon assessed before and after operation whether vocal cord examination was necessary or not. The surgeon's judgement was compared with the phoniatrician's report. All except one of the documented recurrent laryngeal nerve palsies were suspected by the surgeon. No additional important clinical information was gained by the laryngologist's examinations. Routine vocal cord examination in connection with thyroid and parathyroid surgery is probably not necessary.
    No preview · Article · Sep 1991 · British Journal of Surgery

  • No preview · Article · Jul 1991 · Lakartidningen
  • S Abugassa · J Järhult · J Nordenström
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    ABSTRACT: Photon absorptiometry was used to measure bone mass in the lumbar vertebrae, proximal femur, mid-radius and distal radius in eight pairs of closely matched female patients with primary hyperparathyroidism before, and 1, 3 and 6 months after operation. One of each pair was randomised to receive 3 g of oral calcium supplementation/day for three months postoperatively, and the other to serve as a control. After successful operations on the parathyroids, the bone mass in the lumbar vertebrae, proximal femur, and distal radius increased by roughly 7% during the first six months in both the treated and the control patients. This study shows that oral calcium supplementation after operation for hyperparathyroidism does not result in any additional increase in bone mass beyond the effect that is caused by the operation.
    No preview · Article · Jun 1991 · The European Journal of Surgery
  • A Kristoffersson · C Backman · K Granqvist · J Järhult
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    ABSTRACT: Renal function was investigated immediately before and 1 year following parathyroidectomy in 19 patients with moderate hypercalcaemia. On both occasions, all patients underwent five different tests of glomerular and tubular function: plasma creatinine, creatinine clearance, 51Cr-EDTA-clearance, β2-microglobulin excretion and the desmopressin test. Glomerular filtration rate, as assessed by plasma creatinine and clearance of both creatinine and 51Cr-EDTA, was normal in most patients, and was little affected by restoration of normocalcaemia. Renal concentrating capacity, as determined by the desmopressin test, was abnormally low in 14 of 19 patients, but increased significantly after surgery. It is concluded that serious renal damage is seldom encountered in present-day HPT patients, but that a treatable decrease in renal concentrating capacity often exists.
    No preview · Article · Jun 1990 · Journal of Internal Medicine
  • L Perbeck · J Järhult · J Nordenström · H Wallberg

    No preview · Article · Mar 1990 · Lakartidningen
  • A Kristoffersson · K Grankvist · J Järhult
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    ABSTRACT: Calcium, parathyroid hormone, follicle-stimulating hormone, luteinizing hormone, and estradiol were measured in 15 postmenopausal women with primary hyperparathyroidism before and 1 year after parathyroidectomy. Normalization of serum calcium concentrations (from 2.87 to 2.29 mmol/l) was followed by a highly significant fall in serum LH and FSH concentrations. No significant alteration occurred in plasma estradiol concentration.
    No preview · Article · Apr 1989 · Acta endocrinologica
  • A Kristoffersson · P Bjerle · N Stjernberg · J Järhult
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    ABSTRACT: Muscle function in ten hyperparathyroid patients and six patients with benign thyroid disease was assessed by measuring maximal expiratory (Pe max) and inspiratory (Pi max) pressures before and 6-12 months after neck surgery. Pe max was improved in all the hyperparathyroid patients postoperatively (p less than 0.002), while the median value of Pi max was unchanged. In the control (thyroid) group there was no significant postoperative change in either Pe max or Pi max. It is concluded that normalization of hypercalcemia improves respiratory muscular capacity, which can be quantified by measuring maximal expiratory pressure.
    No preview · Article · Jan 1988 · Acta chirurgica Scandinavica
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    ABSTRACT: Three hundred and eleven patients with presumed hyperparathyroidism were operated upon between the years 1961 and 1983 at the two surgical clinics in Northern Sweden equipped with pathologic facilities. Eighty per cent were women. All of the patients were hypercalcemic. Parathyroid hormone (PTH) levels were elevated in 66 per cent of the patients. The correlation between serum calcium and PTH levels was only 0.38. Serum creatinine levels were normal in 92 per cent of the patients while renal concentrating ability was depressed in 79 per cent. The main patient symptoms were fatigue, mental disturbances and renal stones. Eighteen per cent were asymptomatic at the time of the operation. Most patients were diagnosed during in-hospital investigations. Many were also found to be hypercalcemic at regular outpatient controls. At operation, adenomas were found in 80 per cent, different kinds of hyperplasia in 15 per cent, normal histologic finding in 4 per cent, while cancer was found in less than 1 per cent of the patients. At follow-up study, 79 per cent were normocalcemic while 3 per cent were hypocalcemic and 11 per cent were still hypercalcemic--7.5 per cent were lost to follow-up study. Nine patients had a permanent paralysis of the recurrent laryngeal nerve.
    No preview · Article · Mar 1987 · Surgery, gynecology & obstetrics
  • A Kristoffersson · L Boquist · D Holmlund · J Järhult
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    ABSTRACT: A retrospective study of the long-term effects of surgery for normocalcaemic hyperparathyroidism in 82 patients is presented. The median postoperative follow-up time was 96 months. In most of the patients recurrent renal calculi had been the main preoperative symptom, and intermittent peaks of hypercalcaemia were recognized in more than 50% of them. Of the 19 patients with severe tendency to calculus formation, 12 appeared to have been cured by parathyroidectomy. These cured patients were found at operation to have parathyroid adenoma or hyperplasia, or even normal glands. Preoperatively depressed renal function normalized in about 50% of cases, as assessed by the desmopressin test. No patient had paralysis of the recurrent laryngeal nerve, and all were normocalcaemic during follow-up. Parathyroid surgery should be considered for this category of patients, although it is very difficult to distinguish between those who stand to benefit and those who do not.
    No preview · Article · Feb 1987 · Acta chirurgica Scandinavica
  • A Kristoffersson · L Boquist · J Järhult
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    ABSTRACT: A retrospective analysis of 34 patients undergoing 45 re-explorations for persistent hypercalcemia is presented. Thirteen out of the 20 enlarged parathyroid glands were found at reoperation to be normally located, indicating that the initial exploration had been incomplete. A follow-up study of the reoperated patients showed that 25 (74%) were normocalcaemic. Three patients had permanent unilateral recurrent laryngeal nerve damage and 2 patients required calcium and/or vitamin D therapy. Ultrasonography was effective in the diagnosis and localisation of residual parathyroid adenoma in patients with persistent postoperative hyperparathyroidism.
    No preview · Article · Feb 1986 · Urological Research
  • A Kristoffersson · B Sandzén · J Järhult
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    ABSTRACT: A randomized study of the value of drainage in thyroid and parathyroid surgery is presented. Fifty patients were provided with surgical drains and another fifty patients were allocated to a control group without drainage. Complications were few in either group and the rate of subjective discomfort from the collar incision was equally low in both groups. The observations suggest that the provision of drainage is not necessary after uncomplicated neck surgery.
    No preview · Article · Feb 1986 · British Journal of Surgery
  • A Kristoffersson · J Järhult
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    ABSTRACT: The relationship between extent of surgery and calcium levels 6-12 months postoperatively has been analysed in 177 patients in whom a parathyroid adenoma was found at exploratory surgery of the neck. The analysis showed that the frequency of postoperative hypocalcaemia and the need of longterm calcium and vitamin D supplements increased if macroscopically normal glands were extirpated and/or biopsied in addition to removal of the adenoma. It was also shown that the frequency of postoperative hypercalcaemia was similar in patients in whom the peroperative histopathological examination of macroscopically normal glands showed normal cellularity or hyperplasia. The data favour a more conservative approach in parathyroid surgery.
    No preview · Article · Feb 1985 · Annales chirurgiae et gynaecologiae
  • A Kristoffersson · S Emdin · J Järhult
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    ABSTRACT: Choriocarcinomas are rare malignancies which occasionally cause acute abdominal symptoms, mainly in the form of hemorrhage. We here describe a patient with metastatic choriocarcinoma presenting as acute intestinal obstruction and splenic hemorrhage. This seems to be the first report in the literature of a choriocarcinoma causing invagination of the small intestine. The abdominal manifestations of the neoplasm are briefly discussed.
    No preview · Article · Feb 1985 · Acta chirurgica Scandinavica
  • J Järhult · A Kristoffersson · B Lundström · L Oberg
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    ABSTRACT: The value of high-resolution real-time ultrasonography in locating parathyroid adenomas was compared with that of computed tomography (CT). In 21 patients with a single parathyroid adenoma verified at neck exploration, preoperative ultrasonography and CT detected the adenoma in 15 and 11 cases, respectively. Ultrasound gave false-positive results in four patients and false-negative in two, whereas CT was false-positive in four patients and false-negative in six. Most false-positive reports were due to misinterpretation of small thyroid nodules. For acceptable accuracy both methods require an experienced radiologist. Technical and interpretive problems seem to be somewhat less frequent with ultrasonography than with CT. Ultrasonography has therefore become the method of choice for preoperative location of enlarged parathyroid glands at our hospital, and CT is used as a complementary procedure, e.g. when a mediastinal adenoma is suspected.
    No preview · Article · Feb 1985 · Acta chirurgica Scandinavica
  • A Kristoffersson · S Dahlgren · J Järhult · L Wählby
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    ABSTRACT: Thirteen patients with primary hyperparathyroidism were treated for 4-8 weeks with the H2-blocker cimetidine at a daily dose of 1 g. The drug had no effect on the serum concentrations of calcium or parathyroid hormone, nor did any of the patients improve clinically during the period of treatment. The recently reported efficacy of cimetidine in primary hyperparathyroidism is strongly questioned by the present results.
    No preview · Article · Jan 1984 · Journal of endocrinological investigation