RESUMEN
Dry aerosol size distributions and scattering coefficients were measured on 10 flights in 32 clear-air regions adjacent to tropical storm anvils over the eastern Atlantic Ocean. Aerosol properties in these regions were compared with those from background air in the upper troposphere at least 40 km from clouds. Median values for aerosol scattering coefficient and particle number concentration >0.3 µm diameter were higher at the anvil edges than in background air, showing that convective clouds loft particles from the lower troposphere to the upper troposphere. These differences are statistically significant. The aerosol enhancement zones extended ~10-15 km horizontally and ~0.25 km vertically below anvil cloud edges but were not due to hygroscopic growth since particles were measured under dry conditions. Number concentrations of particles >0.3 µm diameter were enhanced more for the cases where Saharan dust layers were identified below the clouds with airborne lidar. Median number concentrations in this size range increased from ~100 l-1 in background air to ~400 l-1 adjacent to cloud edges with dust below, with larger enhancements for stronger storm systems. Integration with satellite cloud frequency data indicates that this transfer of large particles from low to high altitudes by convection has little impact on dust concentrations within the Saharan Air Layer itself. However, it can lead to substantial enhancement in large dust particles and, therefore, heterogeneous ice nuclei in the upper troposphere over the Atlantic. This may induce a cloud/aerosol feedback effect that could impact cloud properties in the region and downwind.
RESUMEN
The development of chylous ascites after an abdominal surgical procedure is potentially grave. It frequently leads to malnutrition and significant mortality. Chylous ascites developed after emergency repair of a ruptured abdominal aneurysm. In spite of treatments with low-fat diet (medium-chain triglycerides), hyperalimentation, and abdominal paracentesis, hypoproteinemia and peripheral edema developed and symptomatic ascites continued. Though some success has been reported following ligation of leaking lymphatics, we avoided laparotomy because the patient was recovering from formidable complications. A peritoneovenous shunt was placed. No complications occurred and permanent recovery promptly resulted. We believe this is a reasonable alternative to laparotomy.
Asunto(s)
Rotura de la Aorta/cirugía , Ascitis Quilosa/etiología , Aorta Abdominal/cirugía , Ascitis Quilosa/cirugía , Humanos , Masculino , Persona de Mediana Edad , Derivación Peritoneovenosa , Complicaciones PosoperatoriasRESUMEN
The experience with the surgical treatment of adenocarcinoma of the stomach in a community hospital from 1970 to 1979 is presented. The single most important prognostic factor for survival is the extent of disease at the time of operation. Positive regional nodes or distant metastases are associated with a dismal survival regardless of treatment. Other variables such as histologic findings, tumor morphologic features or location did not affect survival in our series. Although fewer and somewhat less radical operations were performed by a large number of community surgeons, the results were comparable to those reported elsewhere. The results depended most strongly on the extent of disease at operation. Aside from a fortunate and unexplained decrease in the incidence of adenocarcinoma of the stomach in this country, the best hope for decreased mortality in the future lies with earlier detection at a surgically curable stage.