PubMed Health⌕ Search

Biomedical subjects

H Jarosz

Publications and source records attributed to H Jarosz.

At least 19 recordsLinked to original sources
PubMed1994

Parathyroid autotransplantation in patients undergoing a total thyroidectomy: a review of 261 patients.

Parathyroid autotransplantation was first described in 1907 by Halsted. However, this simple and effective method of preserving parathyroid function has been used with increasing frequency only during the past 25 years. Beginning in the late 1960s, our group has transplanted normal parathyroid tissue into the ipsilateral sternocleidomastoid muscle whenever these glands could not be preserved in situ with adequate blood supply. In addition, if the blood supply of all four parathyroid glands appeared compromised, cryopreservation of parathyroid tissue was performed in case the autotransplanted tissue did not function after surgery. Since 1970, 393 patients underwent a total thyroidectomy. Parathyroid glands that could not be saved in situ were biopsied to confirm their identity by frozen section and then autotransplanted. Of the 393 patients who underwent a total thyroidectomy, 261 patients required transplantation of one or more glands. Among those 261 patients who underwent selective parathyroid autotransplantation, 33 (13%) required temporary calcium and vitamin D supplementation. Of these 33 patients, 2 (less than 1%) had permanent hypoparathyroidism and are receiving long-term vitamin D therapy.

Adolescent↗
PubMed1993

Primary papillary thyroid carcinoma presenting as cervical lymphadenopathy: the operative approach to the "lateral aberrant thyroid".

In contrast to a few follicles arranged in a wedge-shaped segment at the periphery of a lymph node, a significant amount of thyroid tissue in a cervical lymph node is considered evidence of metastatic thyroid carcinoma. In a consecutive series of 243 patients with papillary carcinomas, 52 presented with lateral cervical masses that proved to be lymph nodes with metastatic thyroid carcinoma, in the absence of readily palpable thyroid nodularity. The metastatic disease was demonstrated by excisional biopsy in 40 patients and fine needle aspiration cytology in 12 patients. Thirty-two (of the 52) underwent further diagnostic work-up, consisting of radionuclide scintigraphy and ultrasonography, with the demonstration of abnormalities consistent with a thyroid neoplasm in 75 per cent (24/32) of these patients. The remaining 20 patients had no additional studies except for chemical thyroid function evaluation. The operative treatment in all 52 patients was total thyroidectomy and unilateral or bilateral modified neck dissections, when extensive cervical adenopathy was encountered. Papillary thyroid carcinoma, ranging in size from 2 to 14 mm, was found in the lobe ipsilateral to the presenting cervical node metastasis, in all specimens. In addition, contralateral cervical lymph node metastases were found in five (10%) of these patients, with no evidence of thyroid carcinoma in the corresponding thyroid lobe. With a mean follow-up period of 9 years, all patients are alive with no evidence of recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

High phosphate diet-induced primary hyperparathyroidism: an animal model.

Primary hyperparathyroidism (PHPT) is increasing in incidence and detection, primarily because of the aging of our population and the widespread use of automated serum calcium determination. As a result, a substantial number of "early" cases or "biochemical" PHPT are being detected. The indications for parathyroidectomy in such early cases of PHPT are currently under debate, primarily because of economic issues. These factors underscore the importance of research into the basic mechanisms and natural history of PHPT. We investigated an animal model of diet-induced PHPT that retains two crucial aspects of PHPT: elevation of endogenously produced parathyroid hormone (PTH), accompanied by gross and microscopic changes in the native parathyroid glands. Female Long-Evans rats were divided into six groups of 15 each and fed a control diet (Ca/P of 1:2) or a high-phosphate diet (Ca/P of 1:7) for 1-, 2-, or 3-month intervals. Compared with the control animals, serum PTH levels were elevated at all three time intervals in the experimental group, whereas serum calcium levels were decreased at all time intervals. Serum creatine levels were also elevated at all time intervals, whereas serum phosphorus levels did not change. Parathyroid histopathologic studies demonstrated no change at 1 month, whereas nine of 15 experimental animals showed mild hyperplasia at 2 months and 13 of 14 showed mild to moderate hyperplasia with gland enlargement at 3 months compared with control animals. Histopathologic examination of the kidneys showed no change at 1 month but focal parenchymal inflammation with calcium deposition at 2 and 3 months in the experimental groups. In conclusion, the high-phosphate diet successfully induced the earliest changes of PHPT: elevated PTH levels and parathyroid hyperplasia. However, because renal function was mildly compromised early on, some element of early secondary (renal) hyperparathyroidism may have supervened quickly. Because this model is simple, it may be useful to investigate this complex syndrome further, as well as its natural history and the complications it produces in other organs such as the kidneys.

Animals↗
PubMed1991

Thyroid carcinoma and hyperparathyroidism after radiation therapy for adolescent acne vulgaris.

Thyroid and parathyroid disease after head and neck irradiation in infancy and childhood is well known. Patients irradiated for facial acne were older and received a comparatively lower dose of radiation. These mitigating factors suggest a decreased incidence of thyroid and parathyroid disease in these patients. Over the past 28 years (1961 through 1989), 347 consecutive patients were operated on for radiation-associated thyroid and/or parathyroid disease. One hundred and ten patients in this group were irradiated for treatment for adolescent facial acne vulgaris. The interval between radiation exposure and thyroidectomy ranged from 7 to 57 years (mean, 30 years). The overall incidence of thyroid carcinoma was 31% (34 of 110 patients). Regional metastases in 10 patients (29%) were treated with modified radical neck dissection. Hyperparathyroidism, detected in 31% (34 of 110 patients) of this population, was treated with sub-total parathyroidectomy in all cases. The association of thyroid carcinoma and hyperparathyroidism after adolescent radiation exposure for acne vulgaris appears to be more than coincidental. The incidence of thyroid and parathyroid disease may be independent of the timing and dosage of radiation treatment. These thyroid and parathyroid tumors may develop decades after the initial radiation exposure.

Acne Vulgaris↗
PubMed1990

Follicular cell predominance in the cytologic examination of dominant thyroid nodules indicates a sixty percent incidence of neoplasia.

The interpretation of aspiration cytologic smears that contain a predominance of follicular components often presents a dilemma to the clinician who is treating a patient who has a dominant thyroid nodule, especially when thyroid-stimulating hormone suppression does not produce any significant involution of the dominant nodule. We reviewed a consecutive series of 555 fine-needle aspiration cytologic examinations of dominant thyroid nodules. All specimens that contained colloid or follicular cells mixed with lymphocytes or Hürthle cells were excluded from this review. Additionally, nine aspirates contained degenerated follicular cells with insufficient material for cytologic diagnosis. The remaining 76 specimens contained a predominance of follicular cells: 27 specimens were interpreted as containing "normal" follicular cells, and the remaining 49 specimens were read as "atypical" follicular cells. Histopathologic examination of the resected specimens indicated a 60% incidence of neoplasia (30% carcinoma, 30% adenoma) in which the aspiration cytologic study was interpreted as "normal" follicular cells. On the other hand, a 63% incidence of neoplasia (27% carcinoma, 36% adenoma) occurred in which the cytologic study was read as "atypical." In conclusion, aspirates showing a predominance of follicular cells, whether "normal" or "atypical" indicate a 60% incidence of neoplasia in dominant thyroid nodules that do not decrease significantly in size with thyroid-stimulating hormone suppression.

Adenocarcinoma↗
PubMed1990

Parathyroid autotransplantation in total thyroidectomy.

Although parathyroid autotransplantation during the course of thyroidectomy was first described by Halsted in 1907, it is only during the past 20 years that this simple and effective method of preserving parathyroid function is being used by an increasing number of surgeons. Our group has autotransplanted normal parathyroids since 1965, whenever these glands could not be preserved in situ with adequate blood supply. With increasing experience, we find it much simpler to autotransplant parathyroid glands attached to the thyroid, than to dissect their precarious blood supply, hoping they will survive postoperative edema and fibrosis. Furthermore, it is our impression that in operations for thyroid carcinoma, attempts to preserve the blood supply to the parathyroids may compromise the completeness of the thyroidectomy or of the dissection of cervical nodes in the tracheoesophageal groove. In a review of our experience during the past four years (January 1, 1984 to December 31, 1988), 87 patients underwent total thyroidectomy. Parathyroid glands that could not be saved in situ were biopsied to confirm their identity by frozen section and autotransplanted in the ipsilateral sternocleidomastoid muscle. Among the 87 patients undergoing total thyroidectomy, 34 required no autotransplantation, whereas 52 had one to three glands autotransplanted, and one had four glands autotransplanted. Postoperatively, 23 patients (26 percent) developed hypocalcemia, whereas 18 required CaCO3 and five required vitamin D in addition. All patients (98%) except two had normal parathyroid function at four-month follow-up and thereafter, as judged by serum calcium, phosphorus and parathormone, when indicated.

Adult↗
PubMed1989

Selective postoperative radioactive iodine treatment of thyroid carcinoma.

In a consecutive series of 234 patients with differentiated thyroid carcinoma of follicular cell origin (Hürthle cell tumors excluded), a radioactive iodine (131I) scan was obtained 3 to 6 months after thyroidectomy and 4 weeks after cessation of thyroid hormone treatments, only if extrathyroidal tumor extension or nodal or distant metastases were present. Twenty-one patients (9%) with 131I uptake of 3% or more (group 1) were treated with 150 to 200 mCi of 131I. Forty-four patients (19%) with less than 3% uptake (group 2) and 169 patients (72%) without evidence of metastases or extrathyroidal spread (group 3) were treated only with thyroid hormone. All patients initially underwent total thyroidectomy and modified neck dissection if cervical lymph node metastases were present. Three patients in group 1 and one patient in group 2 had recurrent tumor with a mean follow-up of 8.9 and 8.4 years. There were no recurrences in group 3 with a mean follow-up of 7.2 years. Death rate from thyroid carcinoma was 5% in group 1 (one patient) and 0% in groups 2 and 3. In conclusion, 131I scanning and therapy may be omitted in patients with differentiated thyroid carcinoma in the absence of local tumor extension or regional or distant metastases. Therapy with 131I is not demonstrated to be of benefit in this population of patients.

Adenocarcinoma↗
PubMed1989

Improving postoperative recurrence rates for carcinoma of the thyroid gland.

Differentiated carcinoma of the thyroid gland is regarded as an indolent disease. However, this notion is dispelled when the population is stratified according to age, gross and microscopic tumoral characteristics and according to the occurrence of local and distant metastases in the early postoperative period. The adverse effect of local and distant recurrences on survival time has been emphasized in multiple series from the United States and Europe. However, the critical question that has yet to be answered is whether or not inadequately treated differentiated carcinomas of the thyroid gland seemingly cured in younger patients will recur as aggressive, malignant tumors when the same patients reach the graying golden years. A provisional answer to this question may indeed be found in the incidence of early postoperative nodal and distant recurrence rates. Some authors have concluded that the extent of operative treatment does not have a major influence on the course of differentiated carcinoma of the thyroid gland. This conclusion prompted the present follow-up study of 250 patients with differentiated carcinoma of the thyroid gland to examine the clinical course and results of therapy. We report a cumulative mortality rate of 2.4 per cent and a recurrence rate of 1.6 per cent, consisting of a 1.2 per cent incidence of cervical nodal recurrence and a distant recurrence rate of 0.4 per cent (one patient), after a median follow-up period of seven years and a mean of six years. Since there were no differences in treatment and outcome in 191 patients we studied who had papillary and 59 who had follicular carcinoma, they were analyzed as a single group for this report. Total thyroidectomy was the minimal treatment of all operable patients. In addition, 21.0 per cent required a modified dissection of the neck and 8.4 per cent of the patients had postoperative radioactive iodine administered to ablate either remnants of normal tissue or previously undetected metastases to cervical nodes or lungs. Potential factors contributing to improved local and distant recurrence rates included early detection of disease, especially in children who had irradiation and who were recalled and screened (34 per cent in this series); the use of needle aspiration cytologic study, leading to earlier diagnosis and treatment; total thyroidectomy, and the effective use of radioactive iodine administered as a single large dose within the first six months after thyroidectomy.

Adenocarcinoma↗
PubMed1988

Resection of parathyroid tumor in the aorticopulmonary window without prior neck exploration.

Of 522 patients with hyperparathyroidism operated on from 1973 to 1987 at our institution, there were seven (1.3%), each with an ectopic, hyperfunctioning mediastinal parathyroid adenoma, who required median sternotomy. In three of these seven patients, the tumor was located in the aorticopulmonary window. A 61-year-old woman with primary hyperparathyroidism had a preoperative thallium-technetium subtraction scan that showed thallium uptake at the base of the heart without any uptake in the neck. After further workup and without prior neck exploration, a parathyroid adenoma was found in the aorticopulmonary window through a median sternotomy. Six months later, serum calcium, phosphorus, and parathyroid hormone values remain normal. Two other cases of parathyroid adenoma in the aorticopulmonary window are presented. Of these two patients, the thallium scan was a key element in the immediate mediastinal exploration of one, who was transferred from another hospital comatose and intubated, in acute hypercalcemic crisis. Since mediastinal parathyroid tumors that necessitate median sternotomy occur in less than 2% of patients with primary hyperparathyroidism, we do not advocate routine preoperative localization studies before an initial cervical operation; localization, however, may be justified in selected cases, such as in critically ill patients or in instances of acute hyperparathyroidism, when the first operation needs to be curative.

Adenoma↗
PubMed1988

Nodular thyroid disease in children and adolescents: a high incidence of carcinoma.

Over a period of 32 years from 1954 to 1986, 65 patients under the age of 21 years, 52 girls and 13 boys, were operated for nodular thyroids: the overall incidence of carcinoma was 37 per cent. It was 46 per cent in those patients presenting with a solitary nodule. Among the 24 patients with a malignancy, the carcinoma was of the papillary variety in 63 per cent, follicular in 25 per cent and medullary in 12 per cent. Two thirds of the patients had metastatic disease at the time of presentation. All patients with thyroid carcinoma were treated with total thyroidectomy. Other measures included neck dissection and radioactive iodine. When the eight patients with a history of head and neck irradiation and the three patients with medullary carcinoma were excluded, the incidence of carcinoma was 28 per cent. In summary, in spite of the decline in radiation associated cases, the incidence of carcinoma in nodular thyroid disease in the population under 21 years, remains at the relatively high figure of 28 per cent.

Adenocarcinoma↗
PubMed1988

Carcinoma of the thyroid in patients with autonomous nodules.

Over a period of 25 years (1961-1986), 30 consecutive patients were operated upon for solitary "HOT" nodules. The autonomy of these nodules was substantiated by cytomel nonsuppressibility on 131I or 123I scanning, or TSH stimulated enhancement of the remaining suppressed thyroid tissue (n = 24); or as a solitary toxic hot nodule with suppression of the remaining thyroid tissue (n = 6). Seventeen of these patients were euthyroid and 13 were thyrotoxic and required preoperative preparation with antithyroid medication. Five patients had a history of head and neck irradiation. The population consisted of 24 women and six men. Their ages ranged from 14 to 68 years. The tumors ranged in size from 1.5 to 7 cm. The pathologic findings consisted of "colloid" adenoma in nine patients, follicular adenoma in 19 patients, and a follicular carcinoma in two patients, for an incidence of 6 per cent. It is of interest that neither of the patients with thyroid carcinoma were toxic or had a history of radiation exposure. These findings support the concept that the incidence of carcinoma in truly autonomous "HOT" thyroid nodules is not negligible.

Adenocarcinoma↗
PubMed1987

Thyroid neoplasia following radiation therapy for Hodgkin's lymphoma.

The question of thyroid neoplasia following high-dose radiation treatment to the neck and mediastinum for malignant neoplasms such as Hodgkin's lymphoma in children and young adults has been raised recently. Five patients, 19 to 39 years old, were operated on for thyroid neoplasms that developed following cervical and mediastinal radiation therapy for Hodgkin's lymphoma. Three patients had papillary carcinomas and two had follicular adenomas. The latency period between radiation exposure and the diagnosis of thyroid neoplasm ranged from eight to 16 years. This limited series provided strong support for the recommendation that children and young adults who are to receive high-dose radiation therapy to the head, neck, and mediastinum should receive suppressive doses of thyroxine prior to radiation therapy in order to suppress thyrotropin (thyroid-stimulating hormone) and then be maintained on a regimen of suppression permanently.

Adenoma↗
PubMed1987

Routine use of the thallium-technetium scan prior to parathyroidectomy.

The merit of the preoperative localization of parathyroid tumors with thallium-technetium subtraction imaging is a subject of current debate in the treatment of primary hyperparathyroidism. Eighty patients with hyperparathyroidism underwent preoperative subtraction scintigraphy with 201Tl Cl and 99mTcO4; scan results were correlated with the operative identification and histopathology of the resected parathyroid tissue. The true-positive, false-positive and false-negative rates of these scans were compared between patients with tumors in normal and ectopic anatomic locations and between patients undergoing an initial and reoperative neck exploration. The scan was clearly valuable in patients with one or more prior neck explorations. True-positive scans were obtained in seven (77%) of nine such patients. The scan was also valuable in patients who had ectopic tumors (six mediastinal, seven intrathyroid, and two in the carotid sheath). Twelve (80%) of these 15 ectopic tumors were correctly localized either prior to their first operation or before subsequent explorations. In contrast, only 33 (50%) of 65 patients had a true-positive scan prior to their first operation and when the tumor was not in an ectopic location. In summary, in this series, the thallium-technetium scan was correct in only 50 per cent of patients undergoing an initial operation. However, it was positive in 77 per cent of patients who had at least one prior neck exploration and in 80 per cent of patients with an ectopic parathyroid tumor. These results support the selective use of this valuable imaging and localization tool.

Adenoma↗
PubMed1987

Improvement of vocal cord paresis after thyroidectomy.

Iatrogenic vocal cord paralysis is a well-publicized complication of thyroid and parathyroid operations. Less appreciated is the improvement of vocal cord function after resection of a thyroid or parathyroid tumor. Over the last 22 years, 14 patients presented with vocal cord paresis in the presence of thyroid or parathyroid tumors. Of these 14 patients, nine had complete resolution of paresis following resection of the thyroid or parathyroid tumors: three had a thyroid carcinoma impinging upon the nerve, three had large colloid goiters, two had a follicular adenoma and one had a parathyroid adenoma displacing the nerve. In five of the 14 patients the vocal cord paralysis persisted after operation. In three, the pathology accounted for the vocal cord paralysis and was not amenable to operative improvement: one patient had an unresectable anaplastic thyroid carcinoma, one patient had long-standing idiopathic unilateral vocal cord paralysis, and one patient had laryngeal adenoid cystic carcinoma with thyroid invasion. The fourth patient had an extensive thyroid hemangioma. The paralysis persisted after resection. The fifth patient had long-standing idiopathic vocal cord palsy. A preoperative vocal cord paresis in a patient with thyroid or parathyroid disease does not indicate permanent loss of recurrent nerve function, even in the presence of carcinoma. In this series, vocal cord function was restored in 9 of 10 patients with resectable thyroid or parathyroid tumors.

Adult↗
PubMed1987

The incidence of thyroid carcinoma in Hashimoto's thyroiditis.

The incidence of thyroid carcinoma in Hashimoto's thyroiditis has been a widely debated issue. Previous authors have reported on this topic by analyzing series of patients with Hashimoto's thyroiditis or patients with thyroid carcinoma, but not both of those populations in the same series. The population consists of a consecutive series of 800 patients operated on for thyroid nodules not associated with a radiation history. Among 161 patients with the diagnosis of thyroid carcinoma, 61 (38%) had coexistent Hashimoto's thyroiditis. In comparison, among 161 sex- and age-matched patients with colloid nodules in the same population, 18 (11%) had Hashimoto's thyroiditis. Furthermore, in the series as a whole, the incidence of Hashimoto's thyroiditis in 423 patients with colloid nodules was 10 per cent. From the perspective of the Hashimoto's thyroiditis population in the same series of 800 thyroidectomies, among 267 patients with Hashimoto's thyroiditis 61 (23%) had coexistent carcinoma. In comparison, among 267 age- and sex-matched patients with colloid nodules there were only ten coexistent carcinomas for an incidence of 4 per cent. The high incidence of carcinoma of the thyroid in Hashimoto's thyroiditis lends credence to the hypothesis that Hashimoto's thyroiditis is a predisposing factor in the development of thyroid carcinoma.

Adolescent↗
PubMed1986

The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters.

The incidence of carcinoma in patients with multinodular goiters has been reported to be considerably lower than in patients with a single cold nodule. However, the definition of a "single cold nodule" is highly subjective and has therefore been modified by qualifiers such as "clinically solitary" or "clinically dominant." In this retrospective study, we find no significant difference in the incidence of carcinoma in patients with multinodular goiters compared with patients with a solitary cold nodule confirmed by operation and histopathologic examination. In a consecutive series of thyroidectomies over a 22-year period, all patients with factors predisposing them to neoplasia, such as a history of radiation exposure and thyroiditis, were eliminated. Furthermore, all patients thought to have additional nodules documented by gross examination at operation or subsequently by histopathologic examination were also eliminated. The remaining 69 patients with clinically evident multinodular goiters were compared with the remaining 96 patients with a solitary cold nodule. The incidence of carcinoma in the 96 patients with a solitary cold nodule was 17%. In the 69 patients with clinically evident multinodular goiters, the incidence of carcinoma was 13%. The difference is not significant. It is of interest that male patients with multinodular goiters had the highest incidence of carcinoma at 29%, whereas, males with a solitary cold nodule had an incidence of only 13%. In conclusion, once known factors that predispose patients to neoplasia are eliminated, there does not seem to be a significant difference in the incidence of thyroid carcinoma between patients with operatively and histopathologically proved solitary cold nodules and those with multinodular goiters.

Carcinoma↗
PubMed1977

Influence of protein content upon the electrolyte composition of lymph and plasma.

The concentration of Na+ and Cl' is higher in renal hilar lymph (HL) than in arterial (P) or renal venous plasma or thoracic duct lymph (TDL). The purpose of the present study was to test the theory that this is the consequence of differences in protein content of lymph and plasma rather than a reflection of renal function. Samples of P, HL and TDL were obtained from dogs and analysed for Na+, Cl', K+ and Ca++. The samples were then centrifuged through an ultrafiltration membrane to remove the protein and reanalysed for electrolyte content. Ca++ concentrations were reduced by 30-40% in the (protein-free) filtrate. This was attributed to protein binding. Na+ and Cl' concentrations were raised minimally (2.0 mEq/L and 5.0 mEq/L respectively) in protein-free filtrate of plasma, but not in protein-free filtrate of lymph. It was concluded that the relative protein concentration in lymph and plasma are not an important influence on Na+ and Cl' concentrations.

Animals↗