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Purpose: Suspension syndrome describes a potentially life-threatening event during passive suspension on a rope. The pathophysiological mechanism is not fully understood and optimal treatment unknown. We aimed to elucidate the pathophysiology and to give treatment recommendations., Methods: In this experimental, randomized crossover trial, 20 healthy volunteers were suspended in a sit harness for a maximum of 60 min, with and without prior climbing. Venous pooling was assessed by measuring the diameter of the superficial femoral vein (SFV), lower leg tissue oxygenation (StO 2 ) and by determining localized bioelectrical impedance. Hemodynamic response was assessed by measuring heart rate, blood pressure, stroke volume, and left ventricular diameters. Signs and symptoms of pre-syncope were recorded., Results: Twelve (30%) out of 40 tests were prematurely terminated due to pre-syncopal symptoms (mean 44.7 min, minimum 13.4, maximum 59.7). SFV diameter increased, StO 2 and the capacitive resistance of the cells decreased indicating venous pooling. Heart rate and blood pressure did not change in participants without pre-syncope. In contrast, in participants experiencing pre-syncope, heart rate and blood pressure dropped immediately before the event. All symptoms dissolved and values returned to normal within 5 min with participants in a supine position., Conclusions: Sudden pre-syncope during passive suspension in a harness was observed in 30% of the tests. Blood pools in the veins of the lower legs; however, a vagal mechanism finally leads to loss of consciousness. Time to pre-syncope is unpredictable and persons suspended on a rope should be rescued and put into a supine position as soon as possible.

The original version of this article unfortunately contained a mistake. Information was missing in the acknowledgements section. The correct information is given below.

Purpose: The aim of this pilot study was to evaluate surface contamination by platinum drugs in the environment of patients in ICUs and wards treated by hyperthermic intraperitoneal chemotherapy (HIPEC)., Methods: The monitoring included 12 HIPEC treatments from four hospitals during the following 3 days after perfusion. A total of 33 urine and 33 drainage fluids from HIPEC patients and 160 wipe samples from several surfaces (urine/drainage bags, floors, gloves) were taken during the study period., Results: In urine, the highest platinum concentrations were measured on the first day after perfusion. Median platinum concentrations were 1260 ng/ml for patients after cisplatin perfusion and 11,000 ng/ml for oxaliplatin treatment. Concentrations decreased until day three to 413 ng/ml cisplatin and 529 ng/ml oxaliplatin, respectively. In drainage liquids, platinum concentrations were generally lower. Platinum concentrations from surfaces of bags and floors ranged from 0.01 to 439 pg/cm(2) (median: urine bag 2.77 pg/cm(2), drainage bag 0.22 pg/cm(2), floor left 0.14 pg/cm(2), floor right 0.24 pg/cm(2)), with the highest contamination found on the outer surface of the urine bags. Samples from nurses' protective gloves ranged between 0.03 and 12 pg/cm(2) (median: 0.2 pg/cm(2))., Conclusions: High platinum-drug concentrations in urine and drainage liquids are the main source of contamination. Therefore, safe handling of these liquids is the best way to avoid cross-contamination on surfaces in wards and ICUs. Our results show that it is possible to take care of HIPEC patients without high contaminations during the first 3 days.

Background: Guidelines for ovarian shielding are to place a lead shield in the midline of the abdomen at the level of the umbilicus. However, the ovaries are routinely seen at other locations on all types of imaging examinations., Objective: To determine the position of the ovaries in girls, newborn to 18 years of age, in order to assess efficacy of ovarian shield placement., Materials and Methods: We identified 336 girls who underwent lumbar spine and pelvic MRI. Images were reviewed noting the position of the ovaries relative to anatomic landmarks: symphysis pubis, iliac crest and anterior superior iliac spine (ASIS). In 174 girls a total of 307 ovaries were visualized. The girls were divided into three age groups and analyzed together. Right and left ovaries were analyzed together. The mean, 95% confidence interval (CI), standard deviations and range were calculated., Results: The ovaries lay at or below the iliac crest (the level of the umbilicus), most often just medial to the ASIS and above the pubic symphysis in girls of all ages., Conclusion: Current methods of shielding only the midline of the pelvis for the purpose of reducing radiation dose to the ovaries during radiographic imaging are ineffective given that the ovaries are almost always positioned laterally in the pelvis. Therefore current shielding techniques should be changed; lead ovarian shields should be placed in a lateral position or even abandoned if relevant anatomy will be obscured.

Background: Instabilities and dislocations after elbow arthroplasty, in particular in surface or unlinked prostheses, may cause functional impairments occasionally with the need for surgical revision. We provide a review of the literature about the frequency and causes of these complications and present some of our results obtained with the GSB III prosthesis., Patients and Methods: We examined the trigger mechanisms and frequency of joint instabilities as well as treatment strategies by studying five internationally used types of prostheses on the basis of published results. We evaluated 160 GSB III prostheses regarding the above complications and determined the causes for uncoupling., Results: Unlinked prostheses dislocate in 0-15% of cases, accounting for about 25% of the total complication rate described. All surface prosthesis models, including GSB III, were affected with variable frequency. For 160 GSB III prostheses, the dislocation rate was 7.4%. Frequent causes were errors of rotation of parts of the prostheses and displacements of the centre of rotation., Conclusion: Elbow arthroplasty requires demanding surgery, which is still associated with a comparatively high rate of complications. With correct indication, adequate choice of the type of prosthesis used and sufficient experience gained in surgery techniques, it is possible to considerably lower the rate of disassembling.