Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of “high risk” patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.
The Late Cretaceous–Early Paleogene is the most recent period in Earth history that experienced sustained global greenhouse warmth on multimillion year timescales. Yet, knowledge of ambient climate conditions and the complex interplay between various forcing mechanisms are still poorly constrained. Here we present a 14.75 million‐year‐long, high‐resolution, orbitally tuned record of paired climate change and carbon‐cycling for this enigmatic period (~67–52 Ma), which we compare to an up‐to‐date compilation of atmospheric pCO2 records. Our climate and carbon‐cycling records, which are the highest resolution stratigraphically complete records to be constructed from a single marine site in the Atlantic Ocean, feature all major transient warming events (termed “hyperthermals”) known from this time period. We identify eccentricity as the dominant pacemaker of climate and the carbon cycle throughout the Late Maastrichtian to Early Eocene, through the modulation of precession. On average, changes in the carbon cycle lagged changes in climate by ~23,000 years at the long eccentricity (405,000‐year) band, and by ~3,000–4,500 years at the short eccentricity (100,000‐year) band, suggesting that light carbon was released as a positive feedback to warming induced by orbital forcing. Our new record places all known hyperthermals of the Late Maastrichtian–Early Eocene into temporal context with regards to evolving ambient climate of the time. We constrain potential carbon cycle influences of Large Igneous Province volcanism associated with the Deccan Traps and North Atlantic Igneous Province, as well as the sensitivity of climate and the carbon‐cycle to the 2.4 million‐year‐long eccentricity cycle.
tumour size, larger cancers are compared with smaller ones and screen detected cancers may appear less aggressive simply because of their shorter biological age. However, our results indicate that screen detected breast carcinomas are significantly associated with several features associated with low malignant potential even after adjustment for their smaller size.
Erosion, sediment production, and routing on a tectonically active continental margin reflect both tectonic and climatic processes; partitioning the relative importance of these processes remains controversial. Gulf of Alaska contains a preserved sedimentary record of the Yakutat Terrane collision with North America. Because tectonic convergence in the coastal St. Elias orogen has been roughly constant for 6 My, variations in its eroded sediments preserved in the offshore Surveyor Fan constrain a budget of tectonic material influx, erosion, and sediment output. Seismically imaged sediment volumes calibrated with chronologies derived from Integrated Ocean Drilling Program boreholes show that erosion accelerated in response to Northern Hemisphere glacial intensification (∼2.7 Ma) and that the 900-km-long Surveyor Channel inception appears to correlate with this event. However, tectonic influx exceeded integrated sediment efflux over the interval 2.8-1.2 Ma. Volumetric erosion accelerated following the onset of quasi-periodic (∼100-ky) glacial cycles in the mid-Pleistocene climate transition (1.2-0.7 Ma). Since then, erosion and transport of material out of the orogen has outpaced tectonic influx by 50-80%. Such a rapid net mass loss explains apparent increases in exhumation rates inferred onshore from exposure dates and mapped out-of-sequence fault patterns. The 1.2-My mass budget imbalance must relax back toward equilibrium in balance with tectonic influx over the timescale of orogenic wedge response (millions of years). The St. Elias Range provides a key example of how active orogenic systems respond to transient mass fluxes, and of the possible influence of climate-driven erosive processes that diverge from equilibrium on the million-year scale. O rogenesis reflects the balance of crustal material entering a mountain belt to undergo shortening and uplift versus material leaving the orogen through exhumation, erosion, and sediment transport (1-5). Perturbations in the influx/efflux from the orogen are expected to result in predictable changes in deformation within the orogen as it attempts to reestablish equilibrium (3). The long-term sink for sediment transported out of mountain belts is often in the deep sea, particularly in large submarine fans where sediments accumulate at anomalously high rates (>10 cm/ky) compared with deep-sea pelagic sedimentation (6-8). Even higher sedimentation rates (>100 cm/ky) proximal to glacially eroded regions (9-14) imply that wet-based glaciers are extremely efficient agents of erosion. Observations and modeling have argued that erosion rates can influence tectonic processes (15)(16)(17)(18)(19), but the timescales of adjustment, and the role of landscape disequilibrium, remain unclear. For example, exceptionally high local sedimentation rates (100-1000 cm/ky) recorded on the century timescale (13) SignificanceIn coastal Alaska and the St. Elias orogen, over the past 1.2 million years, mass flux leaving the mountains due to glacial erosion exceeds the plate tectonic input. This...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.