Locating an insulinoma by surgical exploration.

The case of a 79-year old man who was suspected to have an insulinoma is presented. Although clinically and biochemically an insulinoma was the most probable diagnosis there was no supportive radiological evidence. Open surgery and exploration revealed a lesion which was confirmed to be an insulinoma. The patient's hypoglycaemia improved immediately following surgery. In the Sri Lankan setting where sophisticated imaging procedures are not freely available, open exploration of the pancreas is a good alternative to locate a suspected insulinoma.

Intermittent oral iron supplementation during pregnancy.

RATIONALE: It has been suggested that in pregnant women weekly iron supplements are as effective as daily supplements in preventing iron deficiency anaemia (IDA). OBJECTIVE: To compare the effectiveness of prophylactic antenatal oral iron supplements given weekly, thrice weekly and daily in preventing IDA in pregnancy. DESIGN: A randomised control trial. SETTING: University antenatal clinic, (UANC) Galle. SUBJECTS AND METHOD: An oral iron supplement containing 100 mg of elemental iron was randomly given weekly (n = 26) thrice weekly (n = 35) and daily (n = 31) to 92 women who were 14 to 24 weeks pregnant. Haemoglobin (Hb), serum ferritin (SF) and haematocrit (Hct) were assessed before and after 12 to 20 weeks of supplementation and a logistic regression analysis carried out. RESULTS: The risk of developing anaemia was significantly higher in the weekly (odds ratio 15, 95% CI 1.4-165.6, p < 0.03) and possibly higher in the thrice weekly (odds ratio 3, 95% CI 0.3-30.3, p = 0.3) groups. The risk of developing iron deficiency (SF < 12 micrograms/l) was also significantly higher in the weekly (odds ratio 18, 95% CI 2.8-115.5, p < 0.003) and thrice weekly (odds ratio 10, 95% CI 1.6-64.8, p < 0.02) groups. CONCLUSION: Prophylactic oral iron supplements when given intermittently were not effective in preventing iron deficiency anaemia in pregnancy.

Iron absorption from a traditional Sri Lankan weaning food and the enhancing effect of ascorbic acid in adult male volunteers.

OBJECTIVE: To study absorption of iron from Centella gruel and the enhancing effect of ascorbic acid in young adult males. DESIGN: An in vivo absorption study. SETTING: Faculty of Medicine, Galle. METHODS: The percentage of iron absorbed from the Centella gruel was measured using a double isotope technique with 55Fe and 59Fe on 10 healthy male volunteers. OUTCOME MEASURE: Percentage of iron absorption from the gruel with and without ascorbic acid. RESULTS: The mean iron absorption from each meal of Centella gruel was 2.2% (SEM 0.8). This increased to 5% (SEM 1.6) by addition of 50 mg ascorbic acid. When ingested with ascorbic acid, the bioavailable nutrient density (BND) of the weaning food was increased from 0.23 to 0.53 mg iron/1,000 kcal. To satisfy the daily physiological requirements of iron in infants and toddlers, it was calculated that apart from ascorbic acid supplementation, the total iron content also needs to be increased from 2.05 mg to 4.0 mg/meal. CONCLUSION: Centella gruel cannot provide the amount of iron to meet the BND for iron required by infants and toddlers, unless supplemented with an enhancer of iron absorption such as ascorbic acid and its total iron content is increased.

Iron stores and its correlation to haemoglobin levels in pregnant women attending an antenatal clinic.

OBJECTIVES: To determine the rate of iron deficiency in women coming for antenatal care and to asses whether the haemoglobin concentration is a good index in its detection. DESIGN: A cross sectional cohort study. SETTING: University antenatal clinic, Teaching Hospital, Galle. SUBJECTS: Haemoglobin (Hb), haematocrit (HC) and serum ferritin (SF) were estimated in 236 women. RESULTS: Only 7(3%) women had satisfactory iron stores as shown by SF of over 60 ng/ml. SF levels of less than 10 ng/ml indicating complete depletion of iron stores were found in 135(57%). An Hb level of 11 g/dl, which is the recommended cut off point for the diagnosis of anaemia, had a sensitivity of 63% and a negative predictive value of 41% in the detection of iron deficiency in the study population. The SF was poorly correlated to the Hb at Hb levels of more than 11 g/dl. (r2 = 0.000342, P > 0.5). CONCLUSION: In women attending for antenatal care the rate of iron deficiency is high (69%). The haemoglobin concentration is not a good index to detect this.