Progressive veining during peridotite carbonation: insights from listvenites in Hole BT1B, Samail ophiolite (Oman)

The reaction of serpentinized peridotites with CO2-bearing fluids to listvenite (quartz-carbonate rocks) requires massive fluid flux and significant permeability despite increase in solid volume. Listvenite and serpentinite samples from Hole BT1B of the Oman Drilling Project help to understand mechanisms and feedbacks during vein formation in this process. Samples analyzed in this study contain abundant magnesite veins in closely spaced, parallel sets and younger quartz-rich veins. Cross-cutting relationships suggest that antitaxial, zoned carbonate veins with elongated grains growing from a median zone towards the wall rock are among the earliest structures to form during carbonation of serpentinite. Their bisymmetric chemical zoning of variable Ca and Fe contents, a systematic distribution of SiO2 and Fe-oxide inclusions in these zones, and cross-cutting relations with Fe-oxides and Cr-spinel indicate that they record progress of reaction fronts during replacement of serpentine by carbonate in addition to dilatant vein growth. Euhedral terminations and growth textures of carbonate vein fill together with local dolomite precipitation and voids along the vein – wall rock interface suggest that these antitaxial veins acted as preferred fluid pathways allowing infiltration of CO2-rich fluids necessary for carbonation to progress. Fluid flow was probably further enabled by external tectonic stress, as indicated by closely spaced sets of subparallel carbonate veins. Despite widespread subsequent quartz mineralization in the rock matrix and veins, which most likely caused a reduction in the permeability network, carbonation proceeded to completion in listvenite horizons.

Ralstonia mannitolilytica sepsis after elective cesarean delivery: a case report

Background Ralstonia mannitolilytica, a newly emerging opportunistic pathogen worldwide, has been reported to be responsible for human pneumonia, septicemia and meningitis. This is the first report of a case of Ralstonia mannitolilytica sepsis after elective cesarean delivery. Case presentation A 25-year-old woman, gravida 1 para 0, was scheduled for an elective cesarean delivery at 39+ 1 weeks of gestation. Sudden high fever and decreased blood pressure occurred a short time after the operation. Ralstonia mannitolilytica was identified in her blood culture 5 days after the operation. Based on the presence of sepsis and septic shock, massive fluid replacement, blood transfusion, vasoactive agents, imipenem/cilastatin and cefoperazone sulbactam sodium were applied. She was discharged after intensive care without complications. Conclusions Although the incidence of sepsis due to Ralstonia mannitolilytica is relatively low, once infection occurs in a puerpera, severe symptoms develop abruptly. Thus, prompt diagnosis and appropriate treatment are key to the cure.

Challenging diagnostic work-up of a massive fluid-filled structure in the cranial abdomen of a cat

A 9-year-old female, neutered European shorthair cat was presented with acute vomiting, obvious jaundice and painful enlargement of the abdomen. Icteric skin and mucous membranes in addition to severe bilirubinaemia (mainly direct bilirubin) and a large increase in liver enzyme activities were the main findings at the initial examination. Radio- and ultrasonographic evaluation revealed a massive fluid-filled structure caudal to the liver displacing abdominal organs, in particular the stomach. As this structure with a diameter of 8–10 cm occupied considerable space in the cranioventral abdomen, a detailed ultrasonographic examination of the liver and the gallbladder, and determination of the structure’s association with a particular abdominal organ was initially impossible. Via ultrasound-assisted puncture under general anaesthesia 300 ml of an almost clear fluid could be aspirated. Cytological examination revealed a cyst content-like fluid with cell detritus.Further ultrasonographic and computed tomographic diagnostics followed by abdominal laparotomy finally enabled diagnosis of a cystic dilatation of the entire common bile duct and accumulation of white bile. Histopathological examination after euthanasia (requested by the owner) identified lymphoplasmacytic cholangitis and necrosis of the duodenal papilla. The massive dilatation of the common bile duct complicated its definite diagnosis by diagnostic imaging methods. It was most likely caused by a longer-standing obstruction of the bile flow by lymphoplasmacytic cholangitis with necrosis and granulation tissue formation in the area of the duodenal papilla. An interesting but initially misleading feature was the presence of white bile. The etiology of this extremely rare condition remains obscure but in the described case a manifestation of impaired hepatocyte function secondary to biliary stasis is suspected to be the cause.

Endovascular Treatment in a Case of Phelgmasia Cerulean Doleans

Background: Phlegmasia cerulean dolens (PCD) is an uncommon and severe manifestation of massive proximal venous thrombosis of the lower extremities associated with a high degree of morbidity and mortality. Case: We describe a case of a 67-year-old gentleman with metastatic gastric neuroendocrine tumour, who developed PCD of his left lower limb. He underwent endovascular thrombectomy with thrombolysis and stent placement with good effect. Discussion: Characterised by severe venous outflow obstruction, marked limb swelling, pain and discolouration, PCD can lead to venous gangrene, congestion with massive fluid sequestration and circulatory collapse if left untreated. Various treatment modalities were reported with varying outcomes, morbidity and mortality. Conclusion: A multifaceted approach to PCD may be required for successful limb salvage, taking into account the risks and benefits of each treatment modality.

Case report: Physiological changes due to a rapid ascent from 55 metres underwater

We present the case of a diver who experienced an uncontrolled ascent from 55 m and presented with a severe decompression illness. She was clinically shocked and in multi organ failure due to massive fluid shifts. She demonstrated bilateral lower limb loss of power and sensation and required multiple hyperbaric therapy sessions. With joint critical care, hyperbaric and physical therapy involvement, she was discharged some five weeks after her presentation with an independent level of function.