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It is very unusual to forget a surgical sponge in an operative wound, but the consequences are severe. Traditionally, textiloma produces a reticulated, textiform mass of mixed pattern, the appearance of which is highly suggestive on both plain abdomen radiograph and computerized tomography (CT) scan. [1][2][3] We report an atypical case of giant abdominal cystic textiloma mimicking a hydatid cyst arising from the spleen with spontaneous rupture into the stomach. Case ReportA 40-year-old male patient was referred to the surgical clinic of King Khalid Military City Hospital with complaints of epigastric swelling and pain of three years' duration, without fever. On inquiry, no other symptoms were noted, but the patient reported a past history of surgical operation for a road traffic accident 9 years previously. Clinical examination revealed a large firm abdominal mass extending from the left to the right hypochondrium. Its lower margin was well-circumscribed, but its upper margin could not be felt. A right upper abdominal paramedian laparotomy scar was noted. Biological tests were unremarkable. Plain abdominal radiographs showed an opacity in the epigastrium and left hypochondrium, displacing the gastric bubble and bowel gas. Ultrasound of the abdomen revealed a huge cyst in the left upper quadrant, measuring 25 cm in its long axis. The cyst was in close contact with the inner surface of the spleen, which showed multiple large calcifications with marked posterior acoustic shadowing (Figure 1). The cyst demonstrated multiple tiny mobile low-level echoes, with the presence of dependent hyperechoic serpiginous structures. These features were suggestive of hydatid cyst of the abdomen complicated by membrane detachment (type 2 of Gharbi). 4 Ultrasound could not confirm the organ of origin of the cyst. Abdominal CT scan with oral and intravenous contrast enhancement disclosed a well-defined encapsulated, non-enhancing cystic mass in the left upper quadrant. The liver, pancreas, stomach and great vessels had been pushed to the right. Inside the cyst, dependent hyperattenuated serpiginous structures were noted (Figure 2). CT scan could not determine whether the mass arose from the spleen, the left lobe of the liver or the peritoneum. Magnetic resonance imaging (MRI) of the abdomen was done in transverse, sagittal and coronal planes by using SE T 1 -weighted sequences in order to detail the location and extent of this mass. On MRI, the lesion appeared isointense to the spleen, suggesting a thick content. Coronal and transverse cuts demonstrated that the cyst was independent of the liver. On sagittal cuts, the mass showed a close relation to the anterior surface of the spleen that was displaced downwards (Figure 3). No intracystic formation was identified on MRI. Although the serological agglutination test for ecchinococcosis was negative, the radiological picture was suggestive of a huge abdominal hydatid cyst with detached membrane, probably arising from the spleen.

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The modulation of the immune response by interaction of prolactin and cyclosporin has been investigated in a total of 181 subjects, 121 males and 60 females. This study demonstrates a significant difference in the magnitude and fluctuation in prolactin and cyclosporin concentrations between males and females receiving cyclosporin as the single immunosuppressant. Levels of both analytes are lower in the male and show markedly less fluctuation than in the female. It is proposed that prolactin levels should be taken into account when determining the appropriate dosage regimen of cyclosporin in those patients receiving cyclosporin alone as immunosuppressant therapy. Cyclosporin A (Cy A), the immunosuppressive agent, has been used successfully to prevent graft rejection in renal transplantation for more than a decade [1]. Circulating levels of this drug must be frequently monitored in order to differentiate between acute rejection due to inadequate immunosuppression and nephrotoxicity because of high circulating concentrations of the parent compound and its metabolites. Levels of the drug have to be maintained within a narrow therapeutic window to prevent loss of the transplanted organ while minimizing the toxic side effects of Cy A. Frequent assessment of renal function and trough levels [2] of Cy A are essential during the immediate postoperative period to establish optimum therapy. Despite careful clinical and biochemical assessment of a recently transplanted organ, it is still difficult to maintain Cy A levels within the therapeutic window. Indeed, many patients have exaggerated fluctuations in Cy A levels without significant changes in renal and liver functions or in dosage regimen [3].The pituitary peptide hormone prolactin has been shown to restore the immunocompetence of hypophysectomized animals in mounting humoral and cell mediated immune responses [4]. A role for prolactin in modulating the immune response through its modulation of lymphocyte function has been proposed by recent evidence from Russel et al [5]. These workers have demonstrated that prolactin affects the immunosuppressive function of Cy A in organ transplantation by restoring the immune competence of the host. Hiestand et al [6] have proposed a mechanism of action of Cy A through binding to receptors on the B lymphocyte. Russel et al [7] have shown that Cy A and prolactin bind to these receptors and displacement of Cy A by prolactin from these receptors occurs on a dose dependent basis. Hiestand et al [8] have demonstrated that, in rats, bromocriptine induced inhibition of prolactin synthesis promotes graft and host survival when the animals were given sub-therapeutic doses of Cy A.It is well known that prolactin concentrations are higher in normal human females than in males [9] and that fluctuations in reproductively competent females are greater than in mature males. This study was established to determine whether, in transplant patients, these sex-mediated variations in prolactin concentrations were modulated by the concentration of cycl...