1195

Time (min)Change of apparent blood-glucose concentration with time.

4.5 mmol/l (81 mg/dl). The Boehringer meter should bereserved for the special circumstance of home monitoring ofdiabetes. The coloured strips are stable and may be trans-ported for subsequent measurement in the outpatient clinic.’ 1The instrument cannot be recommended for normal hospitaluse.

Department of Clinical Chemistry,East Birmingham Hospital,Birmingham B9 5ST

E. F. LEGG

H. G. SAMMONS

KARELA AND TESTS FOR GLYCOSURIA

SiR,—Dr Gaskin’s letter (May 5, p. 986) postulated that MrAslam and Dr Stockley’s report (March 17, p. 607) of a food-drug interaction between Momordica charantia (karela) andchlorpropamide was the result of false negatives recorded by’Clinistix’, an extract of the karela keeping "the indicator dyein the glucose-oxidase strips and the alkaline copper salts in areduced state". My studies at the Birmingham General Hospi-tal in late February on a wide range of urine testing strips con-taining the glucose-oxidase test have shown that glucose addedto the urine of volunteers who had eaten karela was detecteddown 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 awareof this possible food-drug interaction; further investigationsare being carried out to clarify the role of karela in the treat-ment of diabetes.

Pharmacy Department,General Hospital,Birmingham B4 6NH RAKESH K. PANESAR

LABURNUM POISONING

StR,—I suspect that Dr Forrester’s projection of about 3800children being admitted to hospital after eating laburnumseeds in England and Wales in one year may be an overesti-mate (May 19, p. 1074). The Hospital In-patient Enquiryfigures for 1974 listed only 4140 admissions of children aged0-14 years, from home accident poisonings with "toxic effectsof substances chiefly non-medical as to source".

It is likely that most children who are admitted after eatinglaburnum are first seen at an accident-and-emergency depart-ment. The Department of Prices and Consumer Protection hasbeen collecting data about home accident cases treated at

twenty large A. & E. departments in England and Wales, andI have had a print-out of their statistics on poisoning episodesinvolving children aged 0-14 years. Out of 1169 A. & E. atten-

dances for poisoning in 1977, only 73 (6-2%) had ingested

1. Howe-Davies, S., Holmes, R. R., Phillips, M., Turner, R. C. Br. med. J.1979, ii, 596.

toxic plant material, and only 37 of these had ingested seeds.As poisonous plant material accounts for such a small percent-age of A. & E. attendances for poisoning, I think it unlikelythat laburnum seeds account for 3800 out of 4140 admissionsof children aged 0-14 years, with non-medicinal poisonings.

One. fact that emerges from this analysis of home-accidentstatistics is that the average age for poisoning with seeds was5.3 years, much higher than the average age for all types ofaccidental poisoning, which is 2-3 years. Quite a few childrenof school age are being treated after eating poisonous seeds.While health education directed towards these children mightbe 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 in-structions on the lines of those used for head-injury patientsseems a good one, worthy of general application.

Community Health Services,Wolverhampton Area Health Authority,Wolverhampton WV1 4QT J. M. MORFITT

LIPOMA OF NECK MIMICKING THYROID NODULE

SIR,-A small mass in a patient’s neck was thought bytwelve clinicians (thyroid specialists and cancer surgeons) torepresent a thyroid nodule. Surgical exploration revealed alipoma of the neck independent of the thyroid.A 38-year-old man was referred to the thyroid clinic because

of a small growth noted 12 months previously in the anterioraspect of the neck. The growth had been increasing in size butwas not painful. There was no history of childhood neck irradia-tion and no family history of thyroid disease. The patient wasclinically euthyroid. He had a 2x1-5 cm, soft, non-tender,nodule in the lower aspect of the right thyroid lobe. The restof the gland was palpable but not enlarged. The mass movedon swallowing but not on moving the tongue anteriorly. Serumthyroxine was 7.6 ug/dl (normal 4-12). Triiodothyronine resinuptake was 29% (normal 25-35). The iodine-131 uptake was24% and a scan showed a normal configuration of the glandwith a mass projecting over the lower aspect of the right lobe.A true lateral view was not possible with a scanner. A sono-graphic examination of the gland demonstrated the right andleft lobe to be normal in size and echo pattern. Sitting on theright lobe, and depressing it, was a 2 x 1 - 5 cm solid mass whichappeared to be separated from the thyroid.The patient was examined by twelve clinicians, all thyroid

specialists or cancer surgeons; all were convinced that the massbelonged to the thyroid. Despite the sonographic finding, manyfelt that the mass behaved as being part of, or attached to, thegland. 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 asa thyroid nodule. The location of the tumour, its consistency,and its motion with deglutition, all pointed to its thyroidalorigin. The normal scan did not completely rule out a thyroidalorigin since a small thyroid nodule may not be visible on scan.’ 1The fact that it was separated from the thyroid on sonographicexamination was important but did not rule out a possiblelateral aberrant mass that "May be attached to, or isolated,from the lobes of the thyroid". Surgical exploration provideda clear answer: a lipoma of the neck which transmits thyroidmotion because of close contiguity.A word of caution: all that moves on swallowing is not thy-

roid.

Department of Medicine,State University of New York,Downstate Medical Center,Brooklyn, N. Y. 11203, U.S.A. JEAN-ROBERT LEONIDAS

1. Werner, S. C., Ingbar, S. H. (editors) The Thyroid, p. 306. 1978.2. ibid. p. 418.