RESUMEN
Heatwaves (HWs) are expected to increase both in duration and intensity in the next decades, but little is known about their synoptic and mesoscalar behavior, which is especially important in mid-latitude regions. Most climate research has focused on temperature analysis to characterize HWs. We propose that a combination of temperature and synoptic patterns is a better way to define and understand HWs because including atmospheric circulation patterns provides information about different HW structures that can irregularly affect the territory, and illustrate this approach at the regional and urban scales using the Iberian Peninsula and the Metropolitan Area of Barcelona as case studies. We first select HW events from 1950 to 2020 and apply a multivariate analysis to identify synoptic patterns based on mean sea level pressure, geopotential height at 500 hPa, and maximum daily 2 m temperature. The results indicate that four synoptic patterns reproduce at least 50% of the variance in HWs, namely, "stationary and stable", "dynamic and advective", "stationary and advective", and "dynamic, advective and undulated". Next, we apply the analysis to the Representative Concentration Pathway future scenarios (RCPs) 4.5 and 8.5 from the Coordinated Regional Climate Downscaling Experiment (CORDEX) to determine how these synoptic trends can change in the future. The analysis shows that the four synoptic patterns continue to explain 55 to 60% of the variance in HWs. Future HW events will be characterized by an increase in geopotential height at 500 hPa due to the northward shift of the anticyclonic ridge. This is especially true for RCP8.5, which simulates business as usual incrementing fossil fuel use and additionally shows an increase in atmospheric dynamism in north advections from all directions in comparison with RCP4.5. These findings point to the importance of considering the geopotential height in HW prediction, as well as the direction of advections. Supplementary Information: The online version contains supplementary material available at 10.1007/s00382-023-06828-1.
RESUMEN
PURPOSE: Biliary ductal injuries are challenging to treat, and often lead to severe morbidity and mortality. The first-line approach involves endoscopic retrograde cholangiopancreatography with sphincterotomy and, in case of refractory leakage, long-lasting percutaneous transhepatic biliary drainage, endoscopic or percutaneous injection of sclerosing agents and/or coiling can be used. We describe a treatment procedure using microcatheter-mediated percutaneous or endoscopic argon plasma coagulation (APC). MATERIALS AND METHODS: Three patients (7-year-old male, 14-year-old male, 81-year-old female) with refractory postsurgical and/or post-traumatic bile leaks underwent percutaneous (n = 2) or endoscopic (n = 1) APC through a detachable microcatheter. RESULTS: The procedure was technically feasible in all patients. Postoperative imaging showed complete occlusion of biliary leakage. The technique was uneventful intraoperatively with no adverse events occurring during recovery or follow-up. CONCLUSION: Our initial experience demonstrates that refractory bile duct leaks may be successfully treated with microcatheter-mediated APC endoscopically or percutaneously. Further research is needed to confirm the safety, efficacy, and clinical indications for this innovative technique.
Asunto(s)
Coagulación con Plasma de Argón , Enfermedades de las Vías Biliares , Adolescente , Anciano de 80 o más Años , Conductos Biliares/cirugía , Enfermedades de las Vías Biliares/etiología , Niño , Colangiopancreatografia Retrógrada Endoscópica , Drenaje , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Background. Drain inclusion inside the gastric pouch is rare and can represent an important source of morbidity and mortality associated with laparocopic Roux-en-Y gastric bypass (LRYGBP). These leaks can become chronic and challenging. Surgical options are often unsuccessful. We present the endoscopic management of four patients with drain inclusion. Patients. All four obese morbidly patients underwent LRYGBP and presented a gastro-jejunal fistula after acute anastomotic leakage. During follow-up endoscopy the drain was found inside the gastric pouch. It was moved into the abdominal cavity. Fistula debit reduced significantly and closed. Results. Gastric leak closure in less than 24 hours was achieved in all, with complete resolution of symptoms. These patients benefited exclusively from endoscopic treatment. Conclusions. Endoscopy is useful and technically feasible in chronic fistulas. This procedure is a less invasive alternative to traditional surgical revision. Other therapeutic strategies can be used such as clips and fibrin glue. Drains should not be placed in contact with the anastomosis or stapled lines. Drain inclusion must be suspected when fistula debit suddenly arises. If so, endoscopy is indicated for diagnostic accuracy. Under endoscopy vision, the drain is gently removed from the gastric reservoir leading to sudden and complete resolution of the fistula.