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DERMOID CYST MIMICKING COLD THYROID NODULE
421 DERMOID CYST MIMICKING COLD THYROID NODULE
SIR,-Masses in the neck, near the thyroid gland, may mimic thyroid disease as pointed out by Leonidas.’ A 34-yearold man, evaluated by us in 1974, presented with a firm nodule at the left inferior side of the neck, that moved on swallowing. Serum triiodothyronine and thyroxine were normal, as was radioiodine uptake at two and twenty-four hours. However, thyroid scanning revealed a normal right thyroid lobe and a cold area in the superior portion of the left lobe, that persisted after TSH stimulation. A surgical opinion was sought, and at operation a dermoid cyst was found over a normal thyroid gland. The scanning was repeated after surgery and the thyroid gland appeared normal. The cyst, by compression, must have produced a false image of a cold thyroid nodule. ’
Department of Medical Genetics and Pediatric Endocrinology Section, Mayaguez Medical Center, Mayaguez, Puerto Rico 00708
ADOLFO PÉREZ COMAS
TREATMENT OF KIDNEY-ALLOGRAFT WITH CYCLOSPORIN A
Changes
in
treatment
lymphocyte responses to PHA stimulation after with cimetidine for 2 weeks.
after taking 800 mg cimetidine daily for 2 weeks. None of the patients showed changes in numbers of circulating lymphocytes during this time. Lymphocytes were separated over ’Ficoll/]?aque’ from heparinised venous blood and tested for stimulation by PHA (Wellcome Reagents) after culture for 1 day in microtitre plates by analysis of changes in cell volume
distribution in an iterative stochastic model.’ The recorded percentages of growing cells and their averaged incremental growth-rates had coefficients of variation of less than 5%. Six patients showed an increase both in the percentage of lymphocytes responding to PHA and in their averaged incremental growth-rate. One patient showed an increase in. the percentage of responding cells, with little change in their growth-rate, and another patient showed an increase in the averaged incremental growth-rate with little change in the number of cells responding. Both of these latter patients therefore showed an increased response to PHA stimulation. In one patient, both the percentage of cells responding to PHA and their averaged growth-rate were substantially reduced. This patient had had cimetidine 6 months previously and he was the only one whose ulcer healed during the period of study. We conclude that treatment with the dose of cimetidine used in this study significantly increased the responsiveness of lymphocytes to PHA (p<0-025 for both percentage of responding cells and their averaged growth-rate), perhaps by blocking the histamine H2 receptors present in the plasma membrane of these cells.2 A. J. ROBERTSON N. R. PEDEN J. H. B. SAUNDERS
J. H. GIBBS Departments of Pathology, Pharmacology and Therapeutics, and Mathematics, University of Dundee, and Ninewells Hospital, Dundee
R. C. POTTS R. A. BROWN K. G. WORMSLEY J. SWANSON BECK
JH, Brown RA, Robertson AJ, Potts RC, Beck JS. A new method of testing for mitogen-induced lymphocyte stimulation: measurement of the percentage of growing cells and some aspects of their cell kinetics with an electronic particle counter. J Immunol Methods 1979; 25: 147-58. 2. Avella J, Madsen JE, Binder HJ, Askenase PW. Effect of histamine H2-receptor antagonists on delayed hypersensitivity. Lancet 1978; i: 624-26. 1. Gibbs
REJECTION
SIR,-As part of our continuing interest in the immunosuppressive drug cyclosporin A, we have tested the potency of . the new commercially prepared "drinking solution" in mongrel dogs receiving renal allografts. This new preparation, supplied by the Sandoz Corporation, was compared on a dose basis with cyclosporin A dissolved in olive oil. The results (table) indicate that the commercially prepared
drinking solution might be more potent than the olive oil soluI
I
I
at 10 days in the drinking solution group the only dog in a series of more than 30 given therapeutic doses of cyclosporin A which showed no prolongation of graft survival. If this dog is omitted, the difference in the two groups is statistically significant (p=0.04, Fischer’s exact test), with the group given the drinking solution showing better graft survival. Because most dose data have been obtained in animal studies with the olive oil solution it is our concern that extrapolation of doses from the olive oil solution to the commercially prepared drinking solution might be potentially dangerous. If the drinking solution is indeed more potent, it might prove to be unexpectedly toxic, or give rise to infectious complications because of over-immunosuppression when used in clinical trials. In general, because cyclosporin A is markedly hydrophobic and the characteristics of its absorption from the gastrointestinal tract are entirely unknown, we feel it is important not to extrapolate dosages from one preparation to another without careful studies to establish relative potencies.
tion. The dog is atypical; it
dying was
Nuffield Department of Surgery, John Radcliffe Hospital, Oxford OX3 9DU
1. Leonidas J-R. 1195.
WILLIAM P. HOMAN JOHN W. FABRE MICHAEL E. FRENCH PETER R. MILLARD PETER J. MORRIS
Lipoma of neck mimicking thyroid nodule.
Lancet
1979;
i:
SIR,-Masses in the neck, near the thyroid gland, may mimic thyroid disease as pointed out by Leonidas.’ A 34-yearold man, evaluated by us in 1974, presented with a firm nodule at the left inferior side of the neck, that moved on swallowing. Serum triiodothyronine and thyroxine were normal, as was radioiodine uptake at two and twenty-four hours. However, thyroid scanning revealed a normal right thyroid lobe and a cold area in the superior portion of the left lobe, that persisted after TSH stimulation. A surgical opinion was sought, and at operation a dermoid cyst was found over a normal thyroid gland. The scanning was repeated after surgery and the thyroid gland appeared normal. The cyst, by compression, must have produced a false image of a cold thyroid nodule. ’
Department of Medical Genetics and Pediatric Endocrinology Section, Mayaguez Medical Center, Mayaguez, Puerto Rico 00708
ADOLFO PÉREZ COMAS
TREATMENT OF KIDNEY-ALLOGRAFT WITH CYCLOSPORIN A
Changes
in
treatment
lymphocyte responses to PHA stimulation after with cimetidine for 2 weeks.
after taking 800 mg cimetidine daily for 2 weeks. None of the patients showed changes in numbers of circulating lymphocytes during this time. Lymphocytes were separated over ’Ficoll/]?aque’ from heparinised venous blood and tested for stimulation by PHA (Wellcome Reagents) after culture for 1 day in microtitre plates by analysis of changes in cell volume
distribution in an iterative stochastic model.’ The recorded percentages of growing cells and their averaged incremental growth-rates had coefficients of variation of less than 5%. Six patients showed an increase both in the percentage of lymphocytes responding to PHA and in their averaged incremental growth-rate. One patient showed an increase in. the percentage of responding cells, with little change in their growth-rate, and another patient showed an increase in the averaged incremental growth-rate with little change in the number of cells responding. Both of these latter patients therefore showed an increased response to PHA stimulation. In one patient, both the percentage of cells responding to PHA and their averaged growth-rate were substantially reduced. This patient had had cimetidine 6 months previously and he was the only one whose ulcer healed during the period of study. We conclude that treatment with the dose of cimetidine used in this study significantly increased the responsiveness of lymphocytes to PHA (p<0-025 for both percentage of responding cells and their averaged growth-rate), perhaps by blocking the histamine H2 receptors present in the plasma membrane of these cells.2 A. J. ROBERTSON N. R. PEDEN J. H. B. SAUNDERS
J. H. GIBBS Departments of Pathology, Pharmacology and Therapeutics, and Mathematics, University of Dundee, and Ninewells Hospital, Dundee
R. C. POTTS R. A. BROWN K. G. WORMSLEY J. SWANSON BECK
JH, Brown RA, Robertson AJ, Potts RC, Beck JS. A new method of testing for mitogen-induced lymphocyte stimulation: measurement of the percentage of growing cells and some aspects of their cell kinetics with an electronic particle counter. J Immunol Methods 1979; 25: 147-58. 2. Avella J, Madsen JE, Binder HJ, Askenase PW. Effect of histamine H2-receptor antagonists on delayed hypersensitivity. Lancet 1978; i: 624-26. 1. Gibbs
REJECTION
SIR,-As part of our continuing interest in the immunosuppressive drug cyclosporin A, we have tested the potency of . the new commercially prepared "drinking solution" in mongrel dogs receiving renal allografts. This new preparation, supplied by the Sandoz Corporation, was compared on a dose basis with cyclosporin A dissolved in olive oil. The results (table) indicate that the commercially prepared
drinking solution might be more potent than the olive oil soluI
I
I
at 10 days in the drinking solution group the only dog in a series of more than 30 given therapeutic doses of cyclosporin A which showed no prolongation of graft survival. If this dog is omitted, the difference in the two groups is statistically significant (p=0.04, Fischer’s exact test), with the group given the drinking solution showing better graft survival. Because most dose data have been obtained in animal studies with the olive oil solution it is our concern that extrapolation of doses from the olive oil solution to the commercially prepared drinking solution might be potentially dangerous. If the drinking solution is indeed more potent, it might prove to be unexpectedly toxic, or give rise to infectious complications because of over-immunosuppression when used in clinical trials. In general, because cyclosporin A is markedly hydrophobic and the characteristics of its absorption from the gastrointestinal tract are entirely unknown, we feel it is important not to extrapolate dosages from one preparation to another without careful studies to establish relative potencies.
tion. The dog is atypical; it
dying was
Nuffield Department of Surgery, John Radcliffe Hospital, Oxford OX3 9DU
1. Leonidas J-R. 1195.
WILLIAM P. HOMAN JOHN W. FABRE MICHAEL E. FRENCH PETER R. MILLARD PETER J. MORRIS
Lipoma of neck mimicking thyroid nodule.
Lancet
1979;
i: