[Lower leg compartment syndrome after prolonged gynecologic surgeries in lithotomy position]. / Unterschenkel-Kompartmentsyndrom nach langdauernden gynäkologischen Operationen in Steinschnittlage.

OBJECTIVE: How to prevent severe complications of lower leg compartment syndrome following gynecologic operations in the lithotomy position? MATERIAL AND METHODS: Two cases of lower leg compartment syndrome following long lasting gynecologic operations are presented. RESULTS: Early diagnosis by clinical signs, measurement of compartment pressure and creatine kinase activity and undelayed surgical intervention can avoid acute renal failure due to rhabdomyolysis and damage of neuromuscular function. CONCLUSIONS: Early diagnosis and undelayed surgical intervention can prevent severe complications of lower leg compartment syndrome following gynecologic operations in the lithotomy position.

[A paradoxical air embolism in a closed foramen ovale]. / Paradoxe Luftembolie bei geschlossenem Foramen ovale.

This case report deals with a patient who was being operated on for a tumor of the colon and who died from a paradoxical venous air embolism. Accompanying massive blood loss impedes differentiation of hemodynamic disturbances either due to venous air embolism or to hemorrhage, respectively. Air was aspirated from the radial artery catheter that was used for blood-pressure monitoring and for taking blood samples for laboratory analysis. At autopsy, no probe-patent foramen ovale could be demonstrated. The mechanism of air passing from the venous to the systemic circulation in our patient remains speculative; however, mechanical cardiopulmonary reanimation itself with its underlying thoracic pump mechanism has to be considered as contributing to the transport of air from the venous to the arterial side of the circulation.