Patients with valvular heart disease are at increased risk of perioperative cardiovascular complications during non-cardiac surgery. The risk is highly variable, according to the type of valvular heart disease and severity of non-cardiac surgery. In the case of elective non-cardiac surgery, the presence of symptoms is crucial for decision. In asymptomatic patients, non-cardiac surgery with small or moderate risk can be performed safely. We presented a case of a 68-yearold patient who had severe aortic stenosis that required surgical treatment, aortic valve replacement, whereas on the other hand he also had a significant inguinal hernia, which also required surgical treatment. The dilemma was what to do first aortic valve replacement or hernioplasty. According to the new guidelines of the European society of cardiology for the treatment of patients who have valvular heart disease and are sent to non-cardiac surgery, the patient was sent to have aortic valve replacement first, and after complete recovery from cardiac surgery, he was submitted for hernioplasty.

The geochemical composition of the soils and underlying sediments in the Kremna Basin was investigated. The aim was to assess whether the observed heavy metal concentrations in the soil samples represent geogenic or anthropogenic contamination.  The second objective was to show that geochem­ical data of underlying sediments should be used as a tool in the determination of  the potential hazard for soil contamination.  For this purpose,  the contents of As, Cr, Cu, Hg, Ni, Pb and Zn of soil samples were compared with standard values, a reference soil sample and local background values of the underlying sediments. The s oil samples were unpolluted regarding the contents of  As, Hg, Pb and Zn . All samples  had higher contents of Cr and Ni, whereas three samples had higher contents of Cu than the limit standard values. Geochemical parameters  showed that the higher concentrations of  Cr, Cu and Ni  in the soils could be attributed to geogenic impact. This conclusion was supported by  the Chemical Proxy of Alteration  and  Chemical Index of Weathering values , which indicated intense weathering of the sediments.  The obtained results show ed that  the Kremna area is under slight to moderate hazard if a land use change would occur, and proved the importance of the geochemical composition of under­lying sediments in the interpretation of heavy metal pollution.