ABSTRACT
Sulfolane is a widely used polar, aprotic solvent that has been detected by chemical analysis in groundwater and creeks around the world including Alberta, Canada (800 µg/mL), Louisiana, USA (2900 µg/mL) and Brisbane, Australia (4344 µg/mL). Previous research provided information on adverse effects of sulfolane on mammals, but relatively little information is available on aquatic organisms. This study tested the effects of sulfolane (0-5000 µg/mL) on early development of zebrafish larvae, using various morphometric (survival, hatching, yolk sac and pericardial oedema, haemorrhaging, spinal malformations, swim bladder inflation), growth (larval length, eye volume, yolk sac utilisation), behavioural (touch response, locomotor activity and transcript abundance parameters (ahr1a, cyp1a, thraa, dio1, dio2, dio3, 11ßhsd2, gr, aqp3a, cyp19a1b, ddc, gria2b and hsp70) for 120 h. Embryos were chronically exposed to sulfolane throughout the experimental period. For locomotor activity, however, we also investigated acute response to 2-h sulfolane treatment. Sulfolane sensitivity causing significant impairment in the observed parameters were different depending on parameters measured, including survival (concentrations greater than 800 µg/mL), morphometric and growth (800-1000 µg/mL), behaviour (500-800 µg/mL) and transcript abundance (10 µg/mL). The overall results provide novel information on the adverse health impacts of sulfolane on an aquatic vertebrate species, and an insight into developmental impairments following exposure to environmental levels of sulfolane in fish embryos.
ABSTRACT
BACKGROUND: Pancreatic fistula remains a major complication after pancreaticoduodenectomy (PD). Re-operation is generally considered only after exhaustion of non-surgical options. A variety of pancreas-preserving operations have been proposed, but completion pancreatectomy (CP) stands out in locally complicated cases as a universal approach. This study aims to provide a qualitative synthesis of the peer-reviewed literature regarding emergency CP for post-PD pancreatic fistula. METHODS: A systematic search of PubMed and EMBASE for all studies reporting clinical outcomes for CP in the acute treatment of pancreatic fistula following PD from January 1975 until May 2016. RESULTS: Eleven patient-series with a total of 5566 PD and 151 (3%) emergency CP were included. Median time from PD to CP ranged from 6 to 17 days (7 studies), and mean operative time and blood loss - reported in only two studies - were 197 min and 2173 mL respectively. Re-laparotomy following CP was required in 35% of patients. Median hospital length-of-stay varied from 21 to 64 days, and postoperative mortality was 42%. CONCLUSIONS: Emergency surgery for postoperative pancreatic fistula should only be considered after expert consultation. CP carries a high risk of mortality, and it is most commonly recommended for a selected subgroup of patients with locally complicated fistula.
