Role of Intraoperative Coeliac Plexus Neurolysis on Postoperative Pain Management for Chronic Pancreatitis.

Control of pain in patients with chronic pancreatitis is difficult because 30.0% to 50.0% of patients still experience persistence or recurrence of pain even after surgery. So a combined approach of surgery and coeliac plexus neurolysis was carried out in this study to see the relief of pain and reduce the requirement of analgesics in these patients. This prospective observational comparative study was carried out in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from November 2017 to October 2018. Forty one (41) study participants with the diagnosis of chronic pancreatitis were included consecutively in this study. The participants were divided into two groups. Group I (n=18) underwent pancreatic surgery with coeliac plexus neurolysis by infiltration of 20ml of 100% alcohol in the loose areolar tissue 10ml each into right and left para-aortic space at the level of coeliac trunk and Group II (n=23) underwent pancreatic surgery only. Participants' preoperative data were collected from patient record file. Number, frequency and intensity of pain and requirement of amount of analgesics for the last 3 months were recorded from patients' history. The intensity of pain was categorized by visual analog scale (VAS) preoperatively. The participants of both groups were followed up at 1, 2 and 3 months interval and asked for disappearance or reduction of pain, frequency of attack and requirement of analgesics. Again visual analog scale was used for categorization of pain. Pain free period was recorded after the end of follow up period. Pain reduction occurred after surgery in both groups. But when pain relief was compared on the basis of VAS (Visual Analogue Scale), it was significantly better in Group I after 1 month of surgery than Group II (p=0.05). But 2 and 3 months after surgery this difference became insignificant (p=0.246 and 0.264). No statistical difference was found in terms of analgesic usage, severe acute attack or hospital admission (p=0.511, 0.439 and 0.495) at the end of 3 months follow up. Participants in Group I had significantly longer pain free period than Group II (p=0.025). Regarding complications, postural hypotension developed in 5.6% (1) patients. Diarrhea developed in 11.1% (2) patients in Group I and wound infection developed in 2 patients in each groups respectively. No patients developed any major complications like anastomotic leakage, deep or organ or space infection. Intraoperative coeliac plexus neurolysis reduces pain immediately after surgery and provides longer pain free period in patients with chronic pancreatitis after surgery.

Management of Choledocholithiasis: Should We Remove the Bile Duct?

Retrieval of stone by endoscopic papillotomy, laparoscopic choledochotomy or open choledochotomy is the treatment of choice for choledocholithiasis. Published literature shows that the recurrence rate is 4% to 24% with existing method of treatment. We have treated 8 patients who admitted with recurrent choledocholithiasis in the department of Hepato-Biliary-Pancreatic and Liver Transplant Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh in the period of January 2016 to December 2019. None had intrahepatic duct abnormality or stones. All patients underwent either ERCP stenting, open choledocholithotomy or both 16 to 84 months back. Management policy is designed and outcome is observed on these patients. There were 3 males and 5 females; age ranges 18 to 60 years. The common bile duct (CBD) diameter of all patient ranges from 15 to 24mm. The shape of CBD is different from normal variant; S shaped, saculated, grossly dilated with terminal narrowing. Considering the anatomical abnormality and recurrence of disease we have removed the abnormal part of common bile duct along with stones and the operation was completed by Roux-en-Y hepaticojejunostomy. All patients were completely symptom free for 6 to 48 months after surgery. Removal of abnormal part of common bile duct with reconstruction in the form of Roux-en-Y hepatico-jejunostomy may be considered for treating choledocholithiasis with abnormal CBD (abnormally dilated, abnormally shaped, angulated or sacculated) however, long-term follow up is required for final comment.

Surgical Treatment of Hepatolithiasis: Our Experience in Bangabandhu Sheikh Mujib Medical University.

Recurrent cholangitis and sepsis are common complications after surgical treatment for hepatolithiasis as total clearance is not always possible. This retrospective study is designed to see the effect of our treatment for hepatolithiasis on stone clearance and post operative complications. We have treated 60 patients with hepatolithiasis surgically from September 2010 to September 2016 in the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Various operative procedures were applied on the basis of location of stone and status of biliary tree. Choledocoscopic examination was performed during surgery for checking and cleaning of intrahepatic duct. Regular follow up was given and outcome was assessed. The chronological changes of treatment methods for patients with hepatolithiasis were analyzed for appropriate treatments for particular type. There were 22 males and 38 females with age ranges from 15 to 60 years. The stone were located in left duct (56.6%), right duct (10%) and both duct (33.4%). The most commonly performed operation was extended choledocholithotomy and hepatolithotomy and it was performed in 28 patients (46.7%). Segmentectomy and lobectomy was performed in 17 patients (28.3%). Common bile duct (CBD) excision, hepatolithotomy and hepaticojejunostomy with or without segmentectomy, lobectomy and Houston access loop formation was performed in rest of the patients. Stones could be removed completely in all patients who underwent lobectomy or segmentectomy. In contrast stone clearance was possible only in 57.2% and 55.5% who underwent extended choledocholithotomy and hepatolithotomy, and excision of CBD, hepatolithiasis with hepaticojejunostomy for unilateral or bilateral hepatolithiasis respectively. Houston's access loop to stomach was made in 2 patients for future endoscopic removal of stone. There was no mortality in the present series but morbidity occurred in 18 patients; wound infection (n=15, 25%), bile leakage (n=1, 1.7%), and renal dysfunction (n=1, 1.7%), septicemia (n=1, 1.7%). Patients who underwent lobectomy or segmentectomy did not develop cholangitis or sepsis on 1 to 3 years follow up. In contrast who underwent extended choledocholithotomy and hepatolithotomy, 70.8% patients developed cholangitis and sepsis, and the patients who underwent excision of CBD, hepatolithotomy with hepaticojejunostomy 50% developed cholangitis and sepsis within 1 to 3 years of follow up, required re-operations or conservative treatment. The difference of developing postoperative cholangitis and sepsis is significant (p<0.05) between patient who underwent extended choledocolithotomy and hepatolithotomy, and who underwent excision of CBD, hepatolithotomy and Roux-en-Y hepaticojejunostomy. In conclusion, lobectomy or segmentectomy is the best option for hepatolithiasis if the stones are limited to a lobe or segment. Excision of CBD, hepatolithotomy with hepaticojejunostomy is better than extended choledocholithotomy and hepatolithotomy for bilateral hepatolithiasis. Huston's access loop formation associated with other procedures may be considered for bilateral hepatolithiasis for future minimal invasive stone retrieval procedure as residual stones and recurrent stone formation is common.

Morbidity and Mortality after Pancreatoduodenectomy: A Five Year Experience in Bangabandhu Sheikh Mujib Medical University.

Mortality and morbidity was assessed after adoption of a systematic care for patient with pancreatoduodenectomy starting from patient selection and preparation, operative technique, and postoperative care. In this prospective study seventy patients who underwent pancreatoduodenectomy for periampullary carcinoma with curative intent between January 2010 and December 2014 were carefully analyzed prospectively. Patients were selected those who had ampullary carcinoma, lower bile duct carcinoma and small size carcinoma head of pancreas without local invasion and distant metastasis, and the patient who did not have any major disabling comorbid diseases. All patients were assessed uniformly before surgery and deficiency were corrected up to normal level before operation. Pancreatoduodenectomy and standard lymphadenectomy was performed meticulously with minimum blood loss. The pancreatojejunal reconstruction was performed using duct-to-mucosa method mostly. A nasojejunal feeding tube was placed in most patients for starting postoperative early oral feeding. Broad spectrum antibiotics and the epidural analgesia were mostly prescribed for good control infection and pain. Proper nutrition was maintained in calculative way through central venous line and nasojejunal feeding tube in the early postoperative period. General care, early mobilization and chest physiotherapy were given routinely in each patient. Seventy-seven percent (n=54) patients did not have any postoperative complications and they were discharged from hospital within 12-14 postoperative days. The morbidity occurred in 16 patients (23%) and most common complication was wound infection (18%, n=9). The rest complications were pancreatojejunal anastomotic leakage - 2, hepaticojejunal anastomosis leakage - 1, melaena - 1, intra-abdominal abscess - 1, intra-abdominal hemorrhage - 1, and renal dysfunction - 1. The mortality rate was 5.7% (n=4), causes of death were massive myocardial infarction; 1, failure of reversal from anesthesia; 1, massive intraabdominal bleeding; 1 and CV catheter related severe sepsis; 1. Review of recent published literature revealed that mortality and morbidity our series is better than low volume center and almost similar with high volume center of pancreatoduodenectomy surgery. Our systematic management policy of careful patient selection, planned approach in the form of proper work up, meticulous conduction of the procedure, appropriate postoperative care provides an acceptable morbidity and mortality after pancreatoduodenectomy.

Biosynthesis of natural and novel C-glycosylflavones utilising recombinant Oryza sativa C-glycosyltransferase (OsCGT) and Desmodium incanum root proteins.

The rice C-glycosyltransferase (OsCGT) is one of only a small number of characterised plant C-glycosyltransferases (CGT) known. The enzyme C-glucosylates a 2-hydroxyflavanone substrate with UDP-glucose as the sugar donor to produce C-glucosyl-2-hydroxyflavanones. We tested substrate specificity of the enzyme, using synthetic 2-hydroxyflavanones, and showed it has the potential to generate known natural CGFs that have been isolated from rice and also other plants. In addition, we synthesised novel, unnatural 2-hydroxyflavanone substrates to test the B-ring chemical space of substrate accepted by the OsCGT and demonstrated the OsCGT capacity as a synthetic reagent to generate significant quantities of known and novel CGFs. Many B-ring analogues are tolerated within a confined steric limit. Finally the OsCGT was used to generate novel mono-C-glucosyl-2-hydroxyflavanones as putative biosynthetic intermediates to examine the potential of Desmodium incanum biosynthetic CGTs to produce novel di-C-glycosylflavones, compounds implicated in the allelopathic biological activity of Desmodium against parasitic weeds from the Striga genus.

Isolation and identification of Desmodium root exudates from drought tolerant species used as intercrops against Striga hermonthica.

Plants from the genus Desmodium, in particular D. uncinatum, are used on sub-Saharan small-holder farms as intercrops to inhibit parasitism of cereal crops by Striga hermonthica and Striga asiatica via an allelopathic mechanism. The search for Desmodium species which are adapted to more arid conditions, and which show resilience to increased drought stress, previously identified D. intortum, D. incanum and D. ramosissimum as potential drought tolerant intercrops. Their potential as intercrops was assessed for resource poor areas of rain-fed cereal production where drought conditions can persist through normal meteorological activity, or where drought may have increasing impact through climate change. The chemical composition of the root exudates were characterised and the whole exudate biological activity was shown to be active in pot experiments for inhibition of Striga parasitism on maize. Furthermore, rain fed plot experiments showed the drought tolerant Desmodium intercrops to be effective for Striga inhibition. This work demonstrates the allelopathic nature of the new drought tolerant intercrops through activity of root exudates and the major compounds seen in the exudates are characterised as being C-glycosylflavonoid. In young plants, the exudates show large qualitative differences but as the plants mature, there is a high degree of convergence of the C-glycosylflavonoid exudate chemical profile amongst active Desmodium intercrops that confers biological activity. This defines the material for examining the mechanism for Striga inhibition.

Pylorus Preserving Pancreaticoduodenectomy vs. Standard Whipple's Procedure in Case of Carcinoma head of the Pancreas and Periampullary Carcinoma.

Pancreatic carcinoma is a life threatening condition. Surgical resection is the only hope of cure. Advances in surgical technique have reduced the mortality rate. Nevertheless, operative complications related with morbidity still remains high. Two operation techniques in the treatment of periampullary and pancreatic head cancer: the Standard Whipple operation (SW) and Pylorus Preserving Pancreaticoduodenectomy (PPPD) are performed predominantly. This study was performed to compare the results of Pylorus Preserving Pancreaticoduodenectomy (PPPD) with that of the Standard Whipple's (SW) procedure. This prospective study was carried out in the Department of General Surgery, BSMMU in two years duration. All admitted patient's with periampullary carcinoma and carcinoma of the head of the pancreas were included and randomized for a SW or a PPPD resection. Data regarding patients demographics, preoperative assessment, intraoperative and postoperative findings were collected and analyzed. Less blood loss (2.67±0.65 units in Group I and 2.88±0.64 units in Group II), fewer need of blood transfusions and shorter hospital stay in the PPPD group were observed. Gastrointestinal leakage was similar in both groups of patients (1:1). One pancreatic fistula (8.3% in Group I) was observed in PPPD group and one intra-abdominal abscess developed in Standard Whipple's procedure (00.0% in Group I and 12.5% in Group II). Bile leakage was higher in standard Whipple procedure (8.3% in Group I and 37.5% in Group II). Morbidity was more or less similar in both groups (58.0% in Group I and 50.0% in Group II) but one patient (12.5% in Group II) died in standard Whipple's resection. PPPD procedure is more effective treatment for periampullary carcinoma and cancer of the pancreatic head region than the standard Whipple's operation.

Chronic calcific pancreatitis and pancreatic cancer.

An observational cross-sectional study of 50 cases of chronic calcific pancreatitis patients was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) and some other tertiary level hospitals of Dhaka city from August 2008 to July 2010. Patients required laparotomy for different modalities of surgical treatment to manage chronic calcific pancreatitis were included in the study. Biopsy was taken from panceatic duct containing stone during laparotomy to determine the histopathological changes. Among 50 cases female predominance was observed. Male, female ratio was 2:3. Majority (62%) patients were in 20 to 40 years age group. Female presented earlier than male (20-30 years and 30-40 years respectively). All patients complained recurrent attack of epigastric pain. Other presentations were diabetes (74%), malnutrition and weight loss (56%), steatorrhoea (24%) and jaundice (12%). Adenocarcinoma was found in 3(6%) patients (2 male and 1 female) and rests were chronic pancreatitis. Several studies showed the association between chronic calcific pancreatitis and pancreatic cancer. Further large scale study is required to find out the national incidence level.

Delayed primary suture prevents wound infection in patients with obstructive jaundice and septic abdomen.

This study was undertaken to assess the efficacy of delayed primary closure in prevention of postoperative wound infection in patients with obstructive jaundice and septic abdomen. Here analyzed 93 patients retrospectively who underwent surgery in hepato-biliary-pancreatic unit of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2011 to June 2011. Primary closure of the abdominal wound was applied in all patients. There was no mortality, but 21 patients had postoperative morbidity (wound infection in 17, intra-abdominal abscess in 1, melaena in 1, biliary leakage in 1, burst abdomen in 1). Seventy-two patients had uneventful postoperative recovery were included in Group 1. Patients who developed postoperative wound infection (n=17) were included in Group 2. Rest 4 patients who developed other complications were excluded from the study. Pre-, per and postoperative parameters were compared between two groups for identifying the risk factors for SSI. Delayed primary closure of the wound was applied prospectively in 21 patients (Group 3) on the basis of retrospective results and the outcome was assessed. Retrospective analysis revealed that the patient who developed wound infections (Group 2) after primary closure; significantly greater number of patients had obstructive jaundice or intra-abdominal septic condition preoperatively. Prospective results revealed that there was no wound infection in 21 patients with in obstructive jaundice or intra-abdominal sepsis in which delayed primary closure was applied. Hospital stay was significantly reduced in Group 3 in compare to Group 2. In subsequent follow up, it has been found that 2 patients developed incisional hernia in Group 2 patients but none in Group 3 patients. Delayed primary closure of the wound is a good option in patient with obstructive jaundice and intra-abdominal septic condition for preventing postoperative wound infection.

Periampullary carcinoma: better prognosis with early pre-stenting referral to surgery.

This study was undertaken to find out reasons of delayed referral for surgical treatment and to assess the effect of delayed referral on management and prognosis of patients with periampullary carcinoma. Patients with histopathologically proved periampullary carcinoma (n=41) during the period January 2010 to December 2010 who had been admitted into the department of surgery, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh (BSMMU) were included in this study. Information of the patient was retrieved from medical records. Patients and relatives were interviewed for reasons of delay in seeking surgical help. Patients were divided into two groups: Group I: those who admitted to surgical unit within one month (6 days to 1 month) of noticing jaundice (n=13), and Group II: those who admitted to surgical unit after one month (1.2 months to 18 months) of noticing jaundice (n=28). Parameters were compared between two groups. Patients in group II were poor liver function and nutritional status needed more supplementary therapy in perioperative period. The incidence of distant metastasis and ascites were more frequent in Group II than Group I patients. Definitive procedure (Whipple's operation) was possible in 53.8% patients in Group I whereas only 7.1% in Group II patients (p <0.05). The reasons for delay referral to surgery were due to patient's ignorance, superstition and fear of receiving operative treatment. Delay in diagnosis of periampullary carcinoma as a cause of jaundice and immediate relief of jaundice with ERCP and stenting is another important cause of delay in seeking definitive operative treatment. Awareness of public as well as general physicians is required for early referral of patients with periampullary carcinoma to surgery. Joint assessment of these patients by Gastroenterologist and Hepatobiliary surgeons before internal biliary drainage will improve prognosis.

Semiochemicals from herbivory induced cotton plants enhance the foraging behavior of the cotton boll weevil, Anthonomus grandis.

The boll weevil, Anthonomus grandis, has been monitored through deployment of traps baited with aggregation pheromone components. However, field studies have shown that the number of insects caught in these traps is significantly reduced during cotton squaring, suggesting that volatiles produced by plants at this phenological stage may be involved in attraction. Here, we evaluated the chemical profile of volatile organic compounds (VOCs) emitted by undamaged or damaged cotton plants at different phenological stages, under different infestation conditions, and determined the attractiveness of these VOCs to adults of A. grandis. In addition, we investigated whether or not VOCs released by cotton plants enhanced the attractiveness of the aggregation pheromone emitted by male boll weevils. Behavioral responses of A. grandis to VOCs from conspecific-damaged, heterospecific-damaged (Spodoptera frugiperda and Euschistus heros) and undamaged cotton plants, at different phenological stages, were assessed in Y-tube olfactometers. The results showed that volatiles emitted from reproductive cotton plants damaged by conspecifics were attractive to adults boll weevils, whereas volatiles induced by heterospecific herbivores were not as attractive. Additionally, addition of boll weevil-induced volatiles from reproductive cotton plants to aggregation pheromone gave increased attraction, relative to the pheromone alone. The VOC profiles of undamaged and mechanically damaged cotton plants, in both phenological stages, were not different. Chemical analysis showed that cotton plants produced qualitatively similar volatile profiles regardless of damage type, but the quantities produced differed according to the plant's phenological stage and the herbivore species. Notably, vegetative cotton plants released higher amounts of VOCs compared to reproductive plants. At both stages, the highest rate of VOC release was observed in A. grandis-damaged plants. Results show that A. grandis uses conspecific herbivore-induced volatiles in host location, and that homoterpene compounds, such as (E)-4,8-dimethylnona-1,3,7-triene and (E,E)-4,8,12-trimethyltrideca-1,3,7,11-tetraene and the monoterpene (E)-ocimene, may be involved in preference for host plants at the reproductive stage.

Von Hippel-Lindau disease in a pregnant lady.

Von Hippel-Lindau disease is a rare genetic disorder characterized by various tumours and cysts in the central nervous system and other viscera. Here a case was described in a young female who was pregnant at the time of initial presentation with the complaints of occasional headache, low back pain and pain in the upper abdomen. After the birth of a healthy baby she was admitted to the hospital and the CT scan of upper abdomen suggested a multiloculated pancreatic cyst. MRI of thoracolumbar spine revealed an intracanalicular extradural mass and CT scan of brain revealed a cerebellar cystic mass. The spinal and cerebellar masses both were diagnosed histologically as haemangioblastoma. After a month she underwent laparotomy with near total pancreatectomy. Microscopically it was a microcystic cystadenoma. Based on the clinical presentation, imaging and histopathology of spinal, cerebellar and pancreatic lesions as well as a family history of her father's death due to brain tumour the final diagnosis was Von Hippel-Lindau disease.

Detection of phytoplasma by loop-mediated isothermal amplification of DNA (LAMP).

Napier stunt phytoplasma (16SrXI and 16SrIII) in eastern Africa is a serious threat to the expansion of Napier grass (Pennisetum purpureum) farming in the region, where it is widely cultivated as fodder in zero grazing livestock systems. The grass has high potential for bio-fuel production, and has been adopted by farmers as a countermeasure to cereal stem borer Lepidoptera, since it attracts and traps the insect. Diagnosis of stunt phytoplasma have been largely by nested polymerase chain reaction (nPCR) targeting the 16S rRNA gene. However, the method is laborious, costly and technically demanding. This investigation has developed a simpler but effective phytoplasma diagnostic tool, called; loop-mediated isothermal amplification of DNA (LAMP). The assay was tested on 8 symptomatic and 8 asymptomatic plants, while its detection limit was compared to nested PCR using samples serially diluted from 3 ng/µl to 0.38 pg/µl. Molecular typing of LAMP products was determined by BsrI restriction digestion and Southern blot analysis. The assay sensitivity, positive and negative predictive values were estimated, while the specificity was tested on 11 phytoplasma groups. LAMP was specific to 5 phytoplasma groups: 16SrVI, X, XI and XVI. BsrI restriction digestion produced two predicted fragments, and there was specific binding of probe DNA to the LAMP amplicons in Southern blot analysis. The assay sensitivity was 100%, while the positive and negative predictive values were 63 and 100% respectively. LAMP was 20-fold more sensitive than nested PCR. This study validates LAMP for routine diagnosis of Napier stunt and other closely related phytoplasmas.

Diagnosis and management of solid pseudopapillary tumours of the pancreas.

The finding of a solid or cystic mass in the pancreas is becoming more common secondary to the increasing use of cross-sectional imaging and the improved sensitivity of such studies for the detection of pancreatic abnormalities. Because of the aggressive natural history of pancreatic cancer, this has caused concern that all pancreatic abnormalities may be cancer as well as confusion over proper diagnostic and treatment algorithms. This review provides an overview of the natural history, diagnostic considerations, and treatment recommendations for the less common tumor of the pancreas which can be misinterpreted as pancreatic cancer: solid pseudopapillary tumors (SPT). A Medline search was conducted to identify studies investigating the clinicopath-ologic features, molecular genetics, pathogenesis, diagnosis, and treatment of SPT. It is often possible to obtain an accurate pretreatment diagnosis for this unusual pancreatic tumor and to successfully differentiate them from the more common pancreatic malignancies.

Electrophysiological responses of the lepidopterous stemborers Chilo partellus and Busseola fusca to volatiles from wild and cultivated host plants.

The stemborers Chilo partellus and Busseola fusca are major pests of subsistence cereal farming in Africa. Volatiles released by two cultivated hosts, sorghum and maize (Sorghum bicolor and Zea mays), and two wild grass hosts, Pennisetum purpureum and Hyparrhenia tamba, were collected by air entrainment. Electrophysiologically active components in these samples were detected by coupled gas chromatography-electroantennography (GC-EAG), and the active peaks identified by gas chromatography-mass spectrometry. A total of 41 compounds were identified from the four plant species, all of which, as well as two unidentified compounds, elicited an electrophysiological response from one or both of the stemborers. The compounds included a number of green leaf volatiles and other aliphatic aldehydes, ketones, and esters, mono- and sesquiterpenoids, and some aromatic compounds. EAG studies with authentic samples, conducted at two discriminating doses for all compounds, and dose-response curves for 14 of the most highly EAG-active compounds, showed significant differences in relative responses between species. The compounds that elicited large responses in both species of moths included linalool, acetophenone, and 4-allylanisole, while a number of compounds such as the aliphatic aldehydes octanal, nonanal, and decanal elicited a large response in B. fusca, but a significantly smaller response in C. partellus. Furthermore, the wild hosts produced higher levels of physiologically active compounds compared with either of the cultivated hosts. These differences are discussed in relation to the differential attraction/oviposition of the two stemborers observed in the field and, particularly for eastern African small-scale farming systems, in the context of using a push-pull strategy for their control.

Diel periodicity in the production of green leaf volatiles by wild and cultivated host plants of stemborer moths, Chilo partellus and Busseola fusca.

The volatile chemicals produced by four poaceous plant species, blue thatching grass, Hyparrhenia tamba, Napier grass, Pennisetum purpureum, sorghum, Sorghum bicolor, and maize, Zea mays, which are host plants for the lepidopterous stemborers, Chilo partellus and Busseola fusca, were collected by air entrainment and analyzed by gas chromatography. The total quantities of volatiles collected hourly, over a 9-hr period, from P. purpureum and H. tamba showed an approximately hundredfold increase in the first hour of the scotophase. Thereafter, the amount decreased rapidly to levels present during photophase. Although onset of scotophase also triggered an increase in quantities of volatiles collected from two cultivars of S. bicolor and two out of three cultivars of Z. mays, these increases were less dramatic than in the two wild grasses, being only up to 10 times as much as in the last hour of photophase. Analysis showed that up to 95% of the increase in volatiles at the onset of the scotophase was due to just four compounds, the green leaf volatiles hexanal, (E)-2-hexenal, (Z)-3-hexen-1-ol, and (Z)-3-hexen-1-yl acetate, with the latter dominating the volatile profile. Volatiles from P. purpureum were also collected at 10-min intervals for 70 min spanning the transition from light to dark. The vast increase in production of the green leaf volatiles in this species occurs in the first 10 min of the scotophase followed by a rapid decline within the next 20 min. The relevance of these results to the control of stemborers in a "push-pull" strategy is discussed.

Pancreatic fistulae--rare complication of cholecystectomy.

Pancreaticocutaneous fistula after cholecystetactimy is a very rare condition. A 40 year male patient presented with a drain tube on the right lateral abdominal wall with drainage of 200 ml turbid fluid daily for about 2 months following cholecystectomy. After through investigation and operation it was diagnosed as external pancreatic fistula. It is treat by fistulojejunal anastomosis with Roux-En-Y loop of Jejurum in Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka.

Biology and management of economically important lepidopteran cereal stem borers in Africa.

Cereals (maize, sorghum, millet, rice) are extremely important crops grown in Africa for human consumption. Of the various insect pests attacking cereal crops in Africa, lepidopteran stem borers are by far the most injurious. All 21 economically important stem borers of cultivated grasses in Africa are indigenous except Chilo partellus, which invaded the continent from India, and C. sacchariphagus, which has recently been found in sugarcane in Mozambique. C. partellus is competitively displacing indigenous stem borers in East and southern Africa. A parasitoid, Cotesia flavipes, was introduced from Pakistan for biological control of C. partellus and caused a 32-55% decrease in stem borer densities. This article is an attempt to summarize the status of knowledge about economically important cereal stem borers in Africa with emphasis on their distribution, pest status and yield losses, diapause, natural enemies, cultural control, host plant resistance, and biological control. Special attention is given to Busseola fusca and C. partellus, the most important pests of maize and grain sorghum.