Onshore mud volcanoes as a geological source of mercury: Case study from the Kerch Peninsula, Caucasus continental collision zone.

Three mud volcanoes (MVs) in the Kerch Peninsula were studied as a geological source of mercury. The study focused on total mercury (THg) concentrations in MV waters, mud masses and plants colonizing MV areas; gaseous elemental mercury (GEM) in the atmosphere above MVs; and sulfide mercury (HgS) and HgCl2 species in representative samples of mud masses. THg concentrations in the illite-smectite mud masses ranged from 38 to 920 ng/g. They contained up to 70% of total mercury in sulfide form (in pyrite and cinnabar), but lacked HgCl2. THg values in MV waters of HCO3-Cl/Na- and/or Cl-HCO3/Na-types with рН = 7.4-9.5 mostly fell in a range of 79-440 ng/L, but rarely exceeded 600 ng/L, being comparable with those for geothermal systems. Another issue of interest was the distribution of THg in below- and above-ground parts of halophyte plant Limonium caspium. THg was incorporated into the plant roots, leaves and flowers; the roots exhibited higher concentrations of THg relative to the other organs. The Hg bioaccumulation factor ranged from 0.06 to 0.76. GEM concentrations measured over large bubbling MV pools and newly formed cracks showed values (50 to 520 ng·m-3) higher than background values (≤3 ng·m-3) associated with pristine test sites and background values measured within three MV areas of the Kerch peninsula that is slightly higher than background concentration for the Northern Hemisphere. Maximum GEM contents were comparable with the values found in geothermal and magmatic volcanic provinces.

Carbon and Nitrogen Speciation in N-poor C-O-H-N Fluids at 6.3 GPa and 1100-1400 °C.

Deep carbon and nitrogen cycles played a critical role in the evolution of the Earth. Here we report on successful studying of speciation in C-O-H-N systems with low nitrogen contents at 6.3 GPa and 1100 to 1400 °C. At fO2 near Fe-FeO (IW) equilibrium, the synthesised fluids contain more than thirty species. Among them, CH4, C2H6, C3H8 and C4H10 are main carbon species. All carbon species, except for C1-C4 alkanes and alcohols, occur in negligible amounts in the fluids generated in systems with low H2O, but С15-С18 alkanes are slightly higher and oxygenated hydrocarbons are more diverse at higher temperatures and H2O concentrations. At a higher oxygen fugacity of +2.5 Δlog fO2 (IW), the fluids almost lack methane and contain about 1 rel.% C2-C4 alkanes, as well as fractions of percent of C15-18 alkanes and notable contents of alcohols and carboxylic acids. Methanimine (CH3N) is inferred to be the main nitrogen species in N-poor reduced fluids. Therefore, the behaviour of CH3N may control the nitrogen cycle in N-poor peridotitic mantle. Oxidation of fluids strongly reduces the concentration of CH4 and bulk carbon. However, higher alkanes, alcohols, and carboxylic acids can resist oxidation and should remain stable in mantle hydrous magmas.

Infective endocarditis of aortic valve during pregnancy: a case report.

Infective endocarditis during pregnancy is uncommon but very serious. A 31-year-old woman in the 36th week of second pregnancy was admitted to a hospital because of fever, weakness, chest pain, painful skin over her right leg and dyspnea. Transthoracic echocardiography showed aortic valve vegetation and severe aortic regurgitation. Transesophageal echocardiography revealed a 18 mmx6 mm mobile vegetation, attached to the right coronary cusp. Emergency cesarean section followed with a delivery of a healthy baby. Cardiopulmonary bypass with subsequent aortic replacement with bioprosthesis was initiated immediately after cesarean section. Early echocardiographic examination and 6 months after surgery revealed normal function of aortic valve bioprosthesis and normal LV function. Clinical recognition and early echocardiographic diagnosis followed urgent simultaneous cesarean section and aortic valve replacement was lifesaving for both mother and fetus.

Acute myocardial infarction following blunt chest trauma due to sea traffic accident.

Myocardial infarction as a complication of blunt chest trauma has been reported most commonly in victims of car accidents. Other cases have been very rarely reported. To our knowledge, sea traffic accident as the cause of coronary artery injury has not been described. The authors report on a rare case of acute anterior wall myocardial infarction in a 60-year-old woman following blunt chest trauma caused by sea traffic accident.

[Unusual presentation of an right atrial myxoma]. / Neobicna prezentacija miksoma desnog atrija.

We report a case of a right atrial myxoma initially presenting as an acute anteroseptal MI. A 46-year-old man has been admitted to our ICU with chest pain started five hours before. The initial ECG showed sinus rhythm 56/min with normal atrioventricular conduction and ST segment elevation of 3-4 mm in leads V1-V2, T wave inversion pattern in leads I, II, aVL, V3-V6 with loss of R- voltages in leads V2, V3 all suggestive of an anterior wall myocardial infarction. Total serum creatine kinase (CK) and CK-MB isoenzyme were normal, troponine I and T measurement were not available in our laboratory at that time. Patient received thrombolytic therapy (i.v. Streptokinase 1.5 x 106 U) over 60 minutes without succes. During and after thrombolytic therapy, ECG changes or increased values of cardiac enzymes were not detected. Next morning the patient was reffered for echocardiography. Transthoracic echocardiography showed normal left ventricular contractility and normal ejection fraction. Transesophageal echocardiography showed a large right atrial sessil mass (50 mm x 36 mm) arising from the interatrial septum. Coronary angiography confirmed moderate left ventricular enlargement with normal ejection fraction with normal coronary arteries. Patient underwent cardiac surgery. The tumor was adherent to the atrial wall in the region of the fosa ovalis, and completely removed. Histology confirmed that tumor was myxoma. The patient had an uncomplicated recovery.

Rupture of a right sinus of valsalva aneurysm into the right ventricle during vaginal delivery: a case report.

A case is reported of a right sinus of Valsalva aneurysm rupture into the right ventricle during vaginal delivery in a 34-year-old healthy woman in her third pregnancy. Pregnancy was carried to term and a healthy baby was delivered vaginally. On day 7 following vaginal delivery she was admitted to hospital for dyspnea and cough, with clinical signs of severe heart failure. The diagnosis of the right sinus of Valsalva aneurysm rupture into the right ventricle was established by transthoracic and transesophageal echocardiography. Clinical recognition and early echocardiographic diagnosis followed by immediate surgical repair proved lifesaving in our patient.

[Echocardiographic assessment of diagnosis and prognosis of biopsy-proven amyloid cardiomyopathy]. / Ehokardiografska procjena dijagnoze i prognoze biopsijom dokazane amiloidne kardiomiopatije.

Amyloid cardiomyopathy is myocardial infiltrative disorder which mostly has been seen as the consequence of systemic amiloidosis. The diffuse global myocardial infiltration of nonfunctional amyloid displaces the contractile myocites giving rice to relaxation abnormality and diastolic dysfunction of restrictive or congestive type of both ventricles, but more frequently with right-sided congestion, while systolic left ventricular function deteriorates late in disease process. We report a patient with amyloid cardiomyopathy and nephrotic syndrome underlying primary amiloidosis. Our aim is to point out at echocardiographic assessment of diagnosis and prognosis of amyloid cardiomyopathy, which is proven by postmortal endomyocardial biopsy. The hallmark of echocardiographic diagnostics are the findings of the thickened ventricular and septal walls, small ventricular cavities, dilated atria with thickened interatrial septum and atrioventricular valves, and granular-sparkling and hyperrefractile myocardium. Doppler assessment diagnostically gives us the insight in restrictive physiology of both ventricles, and the inverse relation of the left ventricular thickness and voltage on the ECG is high specific. Echocardiographic evaluation of mean left ventricular thickness in amyloid cardiomyopathy is very important prognostic parameter. so that if it is > or =15 mm, median survival is 0.4 years, whereas in our patient with median thickness of 2.76 cm the survival was only three months. The advanced diastolic dysfunction of the left ventricle with an increased transmitral E/A ratio and deceleration time of < or =150 ms is strong predictor of cardiac death. In this case of restrictive transmitral flow E/A was 1.7 and DT 100 ms and they were ominous prognostic signs of survival.

[Significance of transesophageal echocardiography in the diagnosis of atrial tumor]. / Znacenje transezofagusne ehokardiografije u dijagnostici tumora atrija.

THE AIM OF WORK: To assess the diagnostic accuracy and clinical significance of transesophageal echocardiography (TEE) in the diagnosis of atrial tumors. The authors own experiences with use of TEE images in the assessment of atrial tumors are reported. PATIENTS AND METHODS: The study group consisted of 18 consecutive patients (9 women and 9 men), age range 40-72 years (mean age 60.5+/-10.1) years. Authors prospectively analyzed the results of 615 TEE in nine-years period (between May 1996 - March 2005). RESULTS: We detected 16 atrial myxomas in 15 patients, one fibroelastoma, one leiomyosarcoma, and one metastatic adenocarcinoma. The fibroelastoma, leiomyosarcoma, and metastatic carcinoma were found in right atrium. There was no false negative TEE diagnosis, was one false positive diagnosis, yielding a 95% sensitivity and specifity of TEE in detection atrial tumor. Seventeen patients referred for cardiac surgery, and TEE diagnosis was confirmed by pathohistology. Patient with right atrial metastatatic adenocarcinoma is not surgically treated. This patient treated with chemotherapy and radiotherapy because pulmonary adenocarcinoma. TTE detected atrial tumor in 15 (83%) patients. CONCLUSION: Results of this work suggested that TEE is a safe procedure, high sensitive and specific, and accurate in the diagnosis of atrial tumors. The ability of TEE to visualize both atria with great diagnostic accuracy makes it a very valuable procedure in the detection of atrial tumors.

Echocardiographic features of adult tetralogy of Fallot with natural palliative correction by patent ductus arteriosus.

A thirty-year-old man with the diagnosis of the tetralogy of Fallot and patent ductus arteriosus was admitted to our hospital because of a syncope. He reported no previous symptoms. We diagnosed adult tetralogy of Fallot, which included all four characteristic anomalies: ventricular septal defect, overriding aorta, pulmonary artery stenosis, and right ventricular hypertrophy. The associated persistent ductus arteriosus and the presence of compensatory arteriovenous communications produced a continuous flow load on the left ventricle, which resulted in moderate left ventricular hypertrophy, but without symptoms of pulmonary congestion or cardiac decompensation. Anatomic diagnosis and hemodynamic assessment were established by transthoracic and transesophageal echocardiography, with incidental finding of a quadricuspid aortic valve. To the best of our knowledge, our case of the adult form of Fallot's tetralogy associated with both patent ductus arteriosus and quadricuspid aortic valve is the first one ever described. It is well known that patients with tetralogy of Fallot who do not undergo operation in childhood have short survival, which depends predominantly on the degree of pulmonary artery stenosis and early development of collateral circulation to the lungs. Long-term persistence of natural aortopulmonary anastomosis with systemic collateral circulation to the lungs and remodeling of the heart, with better hemodynamic balance as well as the presence of mild pulmonary artery stenosis probably enhanced the survival of our patient.

Prevalence and clinical significance of left atrial spontaneous echo contrast detected by transesophageal echocardiography.

The prevalence and clinical significance of left atrial spontaneous echo contrast (SEC) were studied in patients undergoing transesophageal echocardiography (TEE). The study group included 290 consecutive patients (186 male and 104 female, aged 17-86 years, mean age 56.1 +/- 12.8 years). Left atrial SEC was found in 50 (17.2%) patients, and was significantly associated with atrial fibrillation, mitral stenosis, absence of mitral regurgitation, and left atrial dimension. Atrial fibrillation was recorded in 44 (88%) patients, mitral stenosis or mitral valve replacement in 21 (42%) patients, and left atrial thrombus or previous embolism in 23 (46%) patients with SEC. Univariate analysis showed a significant association between the presence of SEC and atrial fibrillation, mitral stenosis or mitral valve replacement, and left atrial size. Multivariate analysis showed the presence of left atrial SEC and atrial fibrillation to be independent factors for thrombus formation and/or thromboembolism. Since left atrial SEC associated with atrial fibrillation, left atrial enlargement, mitral stenosis, or mitral valve prosthesis was found in 17.2% of patients undergoing TEE, it might be considered a marker of left atrial thrombus or previous thromboembolism.