1195 toxic plant material, and only 37 of these had ingested seeds. As poisonous plant material accounts for such a small percentage of A. & E. attendances for poisoning, I think it unlikely that laburnum seeds account for 3800 out of 4140 admissions of children aged 0-14 years, with non-medicinal poisonings. One. fact that emerges from this analysis of home-accident statistics is that the average age for poisoning with seeds was 5.3years, much higher than the average age for all types of accidental poisoning, which is 2-3 years. Quite a few children of school age are being treated after eating poisonous seeds. While health education directed towards these children might be counterproductive, stimulating interest in laburnum seeds, there would seem to be scope for educating parents. Forrester’s idea of avoiding admission by using a sheet of instructions on the lines of those used for head-injury patients seems a good one, worthy of general application.
Time (min)
Change of apparent blood-glucose concentration with time. 4.5 mmol/l (81 mg/dl). The Boehringer meter should be reserved for the special circumstance of home monitoring of diabetes. The coloured strips are stable and may be transported for subsequent measurement in the outpatient clinic.’1 The instrument cannot be recommended for normal hospital
J. M. MORFITT
LIPOMA OF NECK MIMICKING THYROID NODULE
use.
Department of Clinical Chemistry, East Birmingham Hospital, Birmingham B9 5ST
E. F. LEGG H. G. SAMMONS
KARELA AND TESTS FOR GLYCOSURIA
SiR,—Dr Gaskin’sletter (May 5, p. 986) postulated that Mr Aslam and Dr Stockley’s report (March 17, p. 607) of a fooddrug interaction between Momordica charantia (karela) and chlorpropamide was the result of false negatives recorded by ’Clinistix’, an extract of the karela keeping "the indicator dye in the glucose-oxidase strips and the alkaline copper salts in a reduced state". My studies at the Birmingham General Hospital in late February on a wide range of urine testing strips containing the glucose-oxidase test have shown that glucose added to the urine of volunteers who had eaten karela was detected down to a concentration of 5 mmol/1 (90 mg/dl) of glucose. ’Clinitest’ tablets also detected the presence of glucose. My preliminary investigations do not support Gaskin’s hypothesis. Physicians treating Asian patients should be aware of this possible food-drug interaction; further investigations are being carried out to clarify the role of karela in the treatment of diabetes. Pharmacy Department, General Hospital, Birmingham B4 6NH
RAKESH K. PANESAR
LABURNUM POISONING
StR,—Isuspect that Dr Forrester’s projection of about 3800
being admitted to hospital after eating laburnum England and Wales in one year may be an overestimate (May 19, p. 1074). The Hospital In-patient Enquiry figures for 1974 listed only 4140 admissions of children aged 0-14 years, from home accident poisonings with "toxic effects of substances chiefly non-medical as to source". It is likely that most children who are admitted after eating laburnum are first seen at an accident-and-emergency departchildren seeds in
ment. The Department of Prices and Consumer Protection has been collecting data about home accident cases treated at twenty large A. & E. departments in England and Wales, and I have had a print-out of their statistics on poisoning episodes involving children aged 0-14 years. Out of 1169 A. & E. attendances for poisoning in 1977, only 73 (6-2%) had ingested 1.
Community Health Services, Wolverhampton Area Health Authority, Wolverhampton WV1 4QT
Howe-Davies, S., Holmes, 1979, ii, 596.
R. R.,
Phillips, M., Turner,
R. C. Br.
med. J.
SIR,-A small mass in a patient’s neck was thought by twelve clinicians (thyroid specialists and cancer surgeons) to represent a thyroid nodule. Surgical exploration revealed a lipoma of the neck independent of the thyroid. A 38-year-old man was referred to the thyroid clinic because of a small growth noted 12months previously in the anterior aspect of the neck. The growth had been increasing in size but was not painful. There was no history of childhood neck irradiation and no family history of thyroid disease. The patient was clinically euthyroid. He had a 2x1-5cm, soft, non-tender, nodule in the lower aspect of the right thyroid lobe. The rest of the gland was palpable but not enlarged. The mass moved on swallowing but not on moving the tongue anteriorly. Serum thyroxine was 7.6 ug/dl (normal 4-12). Triiodothyronine resin uptake was 29% (normal 25-35). The iodine-131 uptake was 24% and a scan showed a normal configuration of the gland with a mass projecting over the lower aspect of the right lobe. A true lateral view was not possible with a scanner. A sonographic examination of the gland demonstrated the right and left lobe to be normal in size and echo pattern. Sitting on the right lobe, and depressing it, was a 2 x 1 -5 cm solid mass which appeared to be separated from the thyroid. The patient was examined by twelve clinicians, all thyroid specialists or cancer surgeons; all were convinced that the mass belonged to the thyroid. Despite the sonographic finding, many felt that the mass behaved as being part of, or attached to, the gland. Because of the rapid progression, surgery was advised. A lipoma was found and was confirmed histologically. This is an unusual case of a lipoma behaving clinically as a thyroid nodule. The location of the tumour, its consistency, and its motion with deglutition, all pointed to its thyroidal origin. The normal scan did not completely rule out a thyroidal1 origin since a small thyroid nodule may not be visible on scan.’ The fact that it was separated from the thyroid on sonographic examination was important but did not rule out a possible lateral aberrant mass that "May be attached to, or isolated, from the lobes of the thyroid". Surgical exploration provided a clear answer: a lipoma of the neck which transmits thyroid motion because of close contiguity. A word of caution: all that roid.
moves on
swallowing is
not
thy-
Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, N. Y. 11203, U.S.A.
1. 2.
JEAN-ROBERT LEONIDAS
Werner, S. C., Ingbar, S. H. (editors) The Thyroid, p. 306. 1978.
ibid. p. 418.
Time (min)
Change of apparent blood-glucose concentration with time. 4.5 mmol/l (81 mg/dl). The Boehringer meter should be reserved for the special circumstance of home monitoring of diabetes. The coloured strips are stable and may be transported for subsequent measurement in the outpatient clinic.’1 The instrument cannot be recommended for normal hospital
J. M. MORFITT
LIPOMA OF NECK MIMICKING THYROID NODULE
use.
Department of Clinical Chemistry, East Birmingham Hospital, Birmingham B9 5ST
E. F. LEGG H. G. SAMMONS
KARELA AND TESTS FOR GLYCOSURIA
SiR,—Dr Gaskin’sletter (May 5, p. 986) postulated that Mr Aslam and Dr Stockley’s report (March 17, p. 607) of a fooddrug interaction between Momordica charantia (karela) and chlorpropamide was the result of false negatives recorded by ’Clinistix’, an extract of the karela keeping "the indicator dye in the glucose-oxidase strips and the alkaline copper salts in a reduced state". My studies at the Birmingham General Hospital in late February on a wide range of urine testing strips containing the glucose-oxidase test have shown that glucose added to the urine of volunteers who had eaten karela was detected down to a concentration of 5 mmol/1 (90 mg/dl) of glucose. ’Clinitest’ tablets also detected the presence of glucose. My preliminary investigations do not support Gaskin’s hypothesis. Physicians treating Asian patients should be aware of this possible food-drug interaction; further investigations are being carried out to clarify the role of karela in the treatment of diabetes. Pharmacy Department, General Hospital, Birmingham B4 6NH
RAKESH K. PANESAR
LABURNUM POISONING
StR,—Isuspect that Dr Forrester’s projection of about 3800
being admitted to hospital after eating laburnum England and Wales in one year may be an overestimate (May 19, p. 1074). The Hospital In-patient Enquiry figures for 1974 listed only 4140 admissions of children aged 0-14 years, from home accident poisonings with "toxic effects of substances chiefly non-medical as to source". It is likely that most children who are admitted after eating laburnum are first seen at an accident-and-emergency departchildren seeds in
ment. The Department of Prices and Consumer Protection has been collecting data about home accident cases treated at twenty large A. & E. departments in England and Wales, and I have had a print-out of their statistics on poisoning episodes involving children aged 0-14 years. Out of 1169 A. & E. attendances for poisoning in 1977, only 73 (6-2%) had ingested 1.
Community Health Services, Wolverhampton Area Health Authority, Wolverhampton WV1 4QT
Howe-Davies, S., Holmes, 1979, ii, 596.
R. R.,
Phillips, M., Turner,
R. C. Br.
med. J.
SIR,-A small mass in a patient’s neck was thought by twelve clinicians (thyroid specialists and cancer surgeons) to represent a thyroid nodule. Surgical exploration revealed a lipoma of the neck independent of the thyroid. A 38-year-old man was referred to the thyroid clinic because of a small growth noted 12months previously in the anterior aspect of the neck. The growth had been increasing in size but was not painful. There was no history of childhood neck irradiation and no family history of thyroid disease. The patient was clinically euthyroid. He had a 2x1-5cm, soft, non-tender, nodule in the lower aspect of the right thyroid lobe. The rest of the gland was palpable but not enlarged. The mass moved on swallowing but not on moving the tongue anteriorly. Serum thyroxine was 7.6 ug/dl (normal 4-12). Triiodothyronine resin uptake was 29% (normal 25-35). The iodine-131 uptake was 24% and a scan showed a normal configuration of the gland with a mass projecting over the lower aspect of the right lobe. A true lateral view was not possible with a scanner. A sonographic examination of the gland demonstrated the right and left lobe to be normal in size and echo pattern. Sitting on the right lobe, and depressing it, was a 2 x 1 -5 cm solid mass which appeared to be separated from the thyroid. The patient was examined by twelve clinicians, all thyroid specialists or cancer surgeons; all were convinced that the mass belonged to the thyroid. Despite the sonographic finding, many felt that the mass behaved as being part of, or attached to, the gland. Because of the rapid progression, surgery was advised. A lipoma was found and was confirmed histologically. This is an unusual case of a lipoma behaving clinically as a thyroid nodule. The location of the tumour, its consistency, and its motion with deglutition, all pointed to its thyroidal origin. The normal scan did not completely rule out a thyroidal1 origin since a small thyroid nodule may not be visible on scan.’ The fact that it was separated from the thyroid on sonographic examination was important but did not rule out a possible lateral aberrant mass that "May be attached to, or isolated, from the lobes of the thyroid". Surgical exploration provided a clear answer: a lipoma of the neck which transmits thyroid motion because of close contiguity. A word of caution: all that roid.
moves on
swallowing is
not
thy-
Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, N. Y. 11203, U.S.A.
1. 2.
JEAN-ROBERT LEONIDAS
Werner, S. C., Ingbar, S. H. (editors) The Thyroid, p. 306. 1978.
ibid. p. 418.
