Statistical analysis of the effluent quality of 231 on-site sanitation facilities in France monitored during a 6-year period.

On-site wastewater treatment systems are approved by the French regulation based on the results of platform tests following the European standard NF EN 12566-3. In addition to this approval for the treatment system, at least 90% of outlet concentrations have to be below 30 mg L-1 for total suspended solids (TSS) and 35 mg L-1 for biochemical oxygen demand. The aim of this study is to evaluate the effluent quality of these treatment systems on site, i.e. under real operating conditions, and to assess their performances. Between 2011 and 2016, 1,286 treated wastewater samples were taken from 231 on-site sanitation facilities in France. Data collected are heterogeneous and a robust statistical methodology (using a generalized log-linear model) was used to study the effects of four explanatory variables (treatment systems, loading rate, aging and sampling methods) on the distribution of treated wastewater concentrations. The model calculates median outlet concentrations depending on the effects identified. Its application allowed studying and comparing the outlet median concentrations of 21 on-site sanitation systems classified into nine categories and three groups. Four treatment systems out of the 21 monitored showed TSS median outlet concentrations below 10 mg L-1 and four treatment systems have TSS medians higher than the regulatory threshold of 30 mg L-1.

Macrophytes are highly sensitive to the herbicide diquat dibromide in test systems of varying complexity.

The herbicide diquat dibromide is used in North America to manage nuisance macrophytes. However, its effect on native macrophytes is less clear and it could cause indirect effects on other aquatic biota. This study determined the sensitivity of both native and non-native macrophytes grown in test systems with varying complexity to diquat dibromide applied directly to water following label directions. In an outdoor mesocosm experiment and single species greenhouse concentration-response tests, Elodea canadensis Michx., Myriophyllum spicatum L., Ceratophyllum demersum L. and Hydrocharis morsus-ranae L. were exposed to a range of diquat dibromide concentrations (4.7 - 1153 µg/L), corresponding to 0.4 - 100% of the recommended label rate of the formulated product. The mesocosm experiment contained all four plant taxa in the same system along with caged amphipods (Hyalella azteca Saus.), tadpoles (Lithobates pipiens Schreber), phytoplankton and periphyton; however, this study focuses on the macrophytes only. In both test systems, severe direct effects of diquat dibromide on macrophytes were detected, with almost 100% mortality of all macrophytes in both test systems at 74 µg/L. The most sensitive species in the single species tests, E. canadensis, showed almost 100% mortality at concentrations below the HPLC-based method detection limit of 5 µg/L. Effects occurred very rapidly and showed no difference in severity between native and non-native macrophytes or complexity of test systems. These results suggest that diquat dibromide could be applied at a considerably lower label rate, depending on the characteristics of the waterbody, while still achieving effective control of nuisance macrophytes.

Lymphogranuloma venereum in Quebec: Re-emergence among men who have sex with men.

BACKGROUND: Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis genotypes L1, L2 and L3. This LGV is associated with significant morbidity and increased risk of HIV transmission. While fewer than two cases per year were reported in Quebec before 2005, LGV emerged in 2005-2006 with 69 cases, followed by a period of low incidence (2007-2012), and subsequent re-emergence since 2013. OBJECTIVES: To describe the incidence of LGV in Quebec and the characteristics of the affected population, including demographics and risk factors, clinical manifestations, laboratory tests, treatments and reinfection rates. METHODS: Descriptive data were collected from the notifiable diseases records through the Institut national de santé publique du Québec (INSPQ) infocentre portal. Questionnaires were obtained through the enhanced surveillance system and transmitted anonymously to the Quebec Ministry of Health. In-depth analysis was performed on cases from 2013 to 2016. RESULTS: There were 338 cases of LGV over the four-year period in Quebec. All cases were male, excluding one transsexual. Mean age was 41 years. Most lived in Montréal (81%) and were men who have sex with men (MSM; 99%). The majority (83%) reported four sexual partners or more in the last year, met mostly through the Internet (77%) and in saunas (73%). Frequency of sexual intercourse with out-of-province residents decreased in 2013-2016 (27%) compared with 2005-2012 (38%). History of STIs was frequent: 83% were HIV-infected, 81% reported previous syphilis and 78% previous gonorrhea. Recreational drug use was frequent (57%), reaching 71% in 2016. Most cases were symptomatic, a proportion which decreased in 2016 (68%) compared with 2013-2015 (82%; p=0.006). Clinical presentations included proctitis (86%), lymphadenopathy (13%) and ulcer/papule (12%). Reinfections, mostly within two years of first infection, occurred in 35 individuals (10%).Conclusion: The re-emergence of LGV in Quebec involves an urban subpopulation composed almost exclusively of MSM with STIs, who have a high number of partners and often use drugs.

Comparison of the design criteria of 141 onsite wastewater treatment systems available on the French market.

New EC standards published in 2009 led to a surge in onsite wastewater treatment systems reaching the European market. Here we summarize their technical aspects and compare them to known values used in centralized wastewater treatment. The paper deals with two types of processes: attached-growth systems (AGS) on fine media and suspended-growth systems (SGS). Covering 141 technical approvals and 36 manufacturers, we compare onsite design criteria against the centralized wastewater design criteria for each process. The systems use a wide range of materials for bacterial growth, from soil, sand or gravel to zeolite, coconut shavings or rockwool cubes, with a huge range of variation in useful surface, from 0.26 m2/PE for one rockwool cube filter to 5 m2/PE for a (traditional system) vertical sand filter. Some rockwool can handle applied daily surface load of 160 g BOD5/m2. SGS design parameters range from 0.025 to 0.34 kg BOD5 per kg MLVSS/d with hydraulic retention times of 0.28-3.7 d. For clarifier design, water velocity ranges from 0.15 to 1.47 m/h. In the sludge line, sludge storage volume ranges from 0.125 down to just 0.56 m3/PE.

Neural progenitor fate decision defects, cortical hypoplasia and behavioral impairment in Celsr1-deficient mice.

The development of the cerebral cortex is a tightly regulated process that relies on exquisitely coordinated actions of intrinsic and extrinsic cues. Here, we show that the communication between forebrain meninges and apical neural progenitor cells (aNPC) is essential to cortical development, and that the basal compartment of aNPC is key to this communication process. We found that Celsr1, a cadherin of the adhesion G protein coupled receptor family, controls branching of aNPC basal processes abutting the meninges and thereby regulates retinoic acid (RA)-dependent neurogenesis. Loss-of-function of Celsr1 results in a decreased number of endfeet, modifies RA-dependent transcriptional activity and biases aNPC commitment toward self-renewal at the expense of basal progenitor and neuron production. The mutant cortex has a reduced number of neurons, and Celsr1 mutant mice exhibit microcephaly and behavioral abnormalities. Our results uncover an important role for Celsr1 protein and for the basal compartment of neural progenitor cells in fate decision during the development of the cerebral cortex.

Prenatal diagnosis and prognosis of accelerated idioventricular rhythm.

OBJECTIVES: As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on specific electrocardiographic patterns, prenatal diagnosis of this condition is challenging and its true incidence is unknown. The objectives of this study were to evaluate the performance of prenatal ultrasonography in identifying intrauterine cardiocirculatory events linked to specific electrocardiographic signs of postnatal AIVR, including left or right ventricular origin, and to assess the prenatal prognosis of this arrhythmia. METHODS: We reviewed Doppler tracings from the superior vena cava/ascending aorta (SVC/Ao), ductus venosus (DV), ductus arteriosus (DA) and aortic isthmus (AoI), as well as simultaneous M-mode recordings of septal and left ventricular wall motions of fetuses diagnosed with AIVR from January 2004 to December 2014. RESULTS: Three cases of AIVR were identified among 27 912 fetuses. SVC/Ao Doppler flow recordings revealed atrioventricular dissociation (ventricular rates within 20% of atrial rates) in all three fetuses and episodes of isorhythmic atrioventricular dissociation in one, while M-mode confirmed normal left ventricular shortening fraction in all cases. Fusion beats were observed on AoI tracing in one fetus, while simultaneous recordings of AoI and DA revealed signs of right bundle branch block in one case and left bundle branch block in the other two. On DV Doppler recordings, retrograde a-waves in the presence of simultaneous atrial and ventricular contractions were observed in all three fetuses, leading to an increase in central venous pressure in all and hydrops fetalis in two cases without evidence of ventricular dysfunction. CONCLUSIONS: Echocardiographic criteria required for postnatal diagnosis of AIVR can be documented in utero using specific ultrasonographic approaches. During fetal life, AIVR may not be a benign entity. Hydrops fetalis is frequently associated with AIVR because of increase in central venous pressure related to simultaneous atrioventricular contractions; thus, the ultrasonographic investigation protocol of fetuses with unexplained hydrops fetalis should aim at ruling out AIVR and include Doppler flow recordings in SVC/Ao, DV, AoI, DA and umbilical vein. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Assessment of wetland/upland vegetation communities and evaluation of soil-plant contamination by polycyclic aromatic hydrocarbons and trace metals in regions near oil sands mining in Alberta.

Oil sands mining in Alberta, Canada, has been steadily increasing over the last 50years. The extent to which the surrounding vegetation has been altered/contaminated by pollutants released during bitumen extraction has not been a focus of oil sands environmental monitoring efforts. The objectives of this study were to assess plant species richness and composition in wetlands and uplands in the vicinity of oil sands mining areas and to measure levels of contamination of trace metals and polycyclic aromatic hydrocarbons (PAHs) in soils and plants. Twenty-two sites were selected in three locations: near to (OS, n=7), West (n=7), and East (n=8) of oil sands mining operations. Aboveground plant species were inventoried and soil was collected for a seedbank study. Soils and plants were collected for analyses of 28 metals and 40 parent and alkylated PAHs. Plant species richness and composition differed significantly among locations. More species were found in the OS sites, many of them being non-native, than in East and West sites, which contained almost exclusively native perennials. PAH levels were significantly higher in OS sites, and were mostly comprised of alkylated PAHs. Patterns of PAH distribution indicated contamination from bitumen/petroleum in four sites; other combustion types may have affected five additional sites at different levels. Metals were also elevated in OS sites. Metal levels were significantly correlated with distance to upgrader facilities. Ratios of some metals in soil vs. above- and belowground plant parts were significantly higher in West and East than in OS sites, likely due in part to pH as soil was acidic at the East and West locations but alkaline at OS sites. This study showed that sites located near oil sands mining operations were contaminated with PAHs and metals, and that the vegetation composition at these sites greatly differed from less disturbed areas.

Evaluating trivalent chromium toxicity on wild terrestrial and wetland plants.

Elevated chromium levels in soil from mining can impact the environment, including plants. Mining of chromium is concentrated in South Africa, several Asian countries, and potentially in Northern Ontario, Canada, raising concerns since chromium toxicity to wild plants is poorly understood. In the first experiment, concentration-response tests were conducted to evaluate effects of chromium on terrestrial and wetland plants. Following established guidelines using artificial soil, seeds of 32 species were exposed to chromium (Cr(3+)) at concentrations simulating contamination (0-1000 mg kg(-1)). This study found that low levels of chromium (250 mg kg(-1)) adversely affected the germination of 22% of species (33% of all families), while higher levels (500 and 1000 mg kg(-1)) affected 69% and 94% of species, respectively, from 89% of the families. Secondly, effects on seedbanks were studied using soil collected in Northern Ontario and exposed to Cr(3+) at equivalent concentrations (0-1000 mg kg(-1)). Effects were less severe in the seedbank study with significant differences only observed at 1000 mg kg(-1). Seeds exposed to Cr(3+) during stratification were greatly affected. Seed size was a contributing factor as was possibly the seed coat barrier. This study represents an initial step in understanding Cr(3+) toxicity on wild plants and could form the basis for future risk assessments.

Note: Spin-exchange optical pumping in a van.

The advent of spin-hyperpolarization techniques designed to overcome the sensitivity issue of nuclear magnetic resonance owing to polarization transfer from more ordered systems has recently raised great enthusiasm. However, the out-of-equilibrium character of the polarization requires a close proximity between the area of production and the site of use. We present here a mobile spin-exchange optical pumping setup that enables production of laser-polarized noble gases in a standalone mode, in close proximity to hospitals or research laboratories. Only compressed air and mains power need to be supplied by the host laboratory.

Oxygen profile and clogging in vertical flow sand filters for on-site wastewater treatment.

13 million people (about 20% of the population) use on-site wastewater treatment in France. Buried vertical sand filters are often built, especially when the soil permeability is not sufficient for septic tank effluent infiltration in undisturbed soil. Clogging is one of the main problems deteriorating the operation of vertical flow filters for wastewater treatment. The extent of clogging is not easily assessed, especially in buried vertical flow sand filters. We suggest examining two possible ways of detecting early clogging: (1) NH4-N/NO3-N outlet concentration ratio, and (2) oxygen measurement within the porous media. Two pilot-scale filters were equipped with probes for oxygen concentration measurements and samples were taken at different depths for pollutant characterization. Influent and effluent grab-samples were taken three times a week. The systems were operated using batch-feeding of septic tank effluent. Qualitative description of oxygen transfer processes under unclogged and clogged conditions is presented. NH4-N outlet concentration appears to be useless for early clogging detection. However, NO3-N outlet concentration and oxygen content allows us to diagnose the early clogging of the system.

Vertical flow constructed wetlands subject to load variations: an improved design methodology connected to outlet quality objectives.

This study surveyed four campsites and four rural villages of major tourist interest, called tourist-interest or ti-villages, that were monitored for several years, generating over 70 performance balances for vertical flow constructed wetlands (VFCWs) that were intentionally scaled down for experimental trials. The wastewater effectively qualifies as domestic sewage, although relatively concentrated, with the campsites presenting particularly high nitrogen concentrations (122 gTKN L(-1)) (TKN: total Kjeldahl nitrogen). The applied daily loads were also particularly high, with some combinations of load parameters (hydraulic load, organic matter, TKN) leading to 400% overloading. Even under those drastic conditions, the quality of effluent remained excellent on the characteristic organic matter parameters, with removal performances always over 85%. Analysis of the dataset points to two major design thresholds: for campsites, in order to maintain a 73% nitrification rate even at the height of the summer season, the load applied onto the first stage filter in operation could achieve up to 600 gCOD m(-2) day(-1) (COD: chemical oxygen demand). For tourist-interest villages, in order to maintain an 85% nitrification rate, the load applied onto the second stage filter in operation could achieve up to 22 gTKN m(-2).day(-1). Here, VFCWs were demonstrated to robustly handle a massive increase in loads applied, providing the construction and operation stringently follow design standards and practices.

A doubly responsive probe for the detection of Cys4-tagged proteins.

Recombinant proteins bearing a tag are crucial tools for assessing protein location or function. Small tags such as Cys4 tag (tetracysteine; Cys-Cys-X-X-Cys-Cys) are less likely disrupt protein function in the living cell than green fluorescent protein. Herein we report the first example of the design and synthesis of a dual fluorescence and hyperpolarized (129)Xe NMR-based sensor of Cys4-tagged proteins. This sensor becomes fluorescent when bound to such Cys4-tagged peptides, and the (129)Xe NMR spectrum exhibits a specific signal, characteristic of the biosensor-peptide association.

3D-printed system optimizing dissolution of hyperpolarized gaseous species for micro-sized NMR.

Dissolution of hyperpolarized species in liquids of interest for NMR is often hampered by the presence of bubbles that degrade the field homogeneity. Here a device composed of a bubble pump and a miniaturized NMR cell both fitted inside the narrow bore of an NMR magnet is built by 3D printing. (129)Xe NMR experiments performed with hyperpolarized xenon reveal high and homogeneous dissolution of the gas in water.

Is exposure to night-time traffic noise a risk factor for purchase of anxiolytic-hypnotic medication? A cohort study.

BACKGROUND: Studies suggest that road traffic noise increases risks of sleep disturbances, anxiety and depressive symptoms, but few have focused on psychotropic drug use. We examined whether exposure to night-time road traffic noise in Marseilles (France) is associated with an increased risk of purchasing anxiolytic or hypnotic medications. METHODS: Cohort of 190,617 inhabitants of Marseilles (aged 18-64 years) covered by the National Health Insurance Fund. We used the CadnaA noise propagation prediction model to calculate a potential road noise exposure indicator at dwellings for the night-period: Ln. Association between the number of purchases of anxiolytics-hypnotics in 2008-9 and the Ln was analysed with a zero-inflated negative binomial (ZINB) model adjusted for characteristics of individuals (sociodemographic, consultations with general practitioners, presence of chronic psychiatric disorder), prescribers (demographic, specialty, workload) and neighbourhoods (medical density, complaints filed for environmental noise). Analyses were stratified by the deprivation level of the census block of residence to control for the confounding effects of neighbourhood socio-economic status. RESULTS: The ZINB model showed a small but significant increase in the risk of purchasing higher numbers of anxiolytics-hypnotics for Ln greater than 55 dB(A) only in the low deprivation stratum. CONCLUSION: We found some evidence that potential exposure to night-time road traffic noise might affect individual use of anxiolytics-hypnotics. Further research based on strictly individual approaches is warranted to assess exposure to road traffic noise more precisely and reliably than allowed by noise propagation prediction models.

Herbicide impact on non-target plant reproduction: what are the toxicological and ecological implications?

Declining plant diversity and abundance have been widely reported in agro-ecosystems of North America and Europe. Intensive use of herbicides within cropfields and the associated drift in adjacent habitats are partly responsible for this change. The objectives of this work were to quantify the phenological stages of non-target plants in in-situ field situations during herbicide spray and to compare plant susceptibility at different phenological stages. Results demonstrated that a large number of non-target plants had reached reproductive stages during herbicide spray events in woodlots and hedgerows, both in Canada and Denmark where vegetation varies considerably. In addition, delays in flowering and reduced seed production occurred widely on plants sprayed at the seedling stage or at later reproductive periods, with plants sprayed at reproductive stages often exhibiting more sensitivity than those sprayed as seedlings. Ecological risk assessments need to include reproductive endpoints.

[Anaesthetic management of brain-dead for organ donation: impact on delayed graft function after kidney transplantation]. / Pratiques anesthésiques pour prélèvement d'organes chez le sujet en mort encéphalique et pronostic du greffon rénal.

BACKGROUND: The aim of this study was to report current anaesthetic management brain-dead organ donors and to assess its impact on delayed kidney graft function (DGF). METHODS: To achieve this retrospective multicenter study, brain-dead patient records were analysed for the years 2005 to 2007. Expanded donor criteria, length of stay in ICU, duration of brain death, respect of recommended cold ischemia time, preoperative and intraoperative management, type of anaesthesia, hemodynamic and respiratory parameters during organ retrieval, and impact of anaesthesia on DGF were analysed. RESULTS: One hundred and forty-nine out of 165 files were available. Sixty-two percent of donors received anaesthetic drugs. There were no differences in demographic characteristics between the anaesthesia group (group A) and the no-anaesthesia group (group NA). In group NA, the mean arterial pressure (MAP)>65 mm Hg was more frequent (53% vs. 29%, P<0.01), but did not differ for maximal MAP. In group A, maximal heart rate was higher (120 vs. 105b/min, P=0.02) and donors received significantly more colloids (P<0.01). Independent risk factors of DGF included absence of hydroxyethyl starch infusion during the preoperative period and mechanical ventilation without PEEP. CONCLUSION: During organ retrieval, 62% of organ donors received anaesthetic drugs. Use of anaesthesia lead to lower MAP requiring more fluid challenge with colloids but did not influence the DGF.

Phytotoxicity testing for herbicide regulation: shortcomings in relation to biodiversity and ecosystem services in agrarian systems.

The purpose of this paper is to present current knowledge on methods employed to perform phytotoxicity tests and risk assessments and to highlight shortcomings in relation to biodiversity and ecosystem services. Ecosystem services are benefits provided to humankind by a multitude of organisms present in natural ecosystems. Several studies were conducted between 2001 and 2010 aimed at investigating some of the deficiencies in phytotoxicity testing (new and existing data are presented). Herbicide toxicity responses were similar when comparing a suite of crop versus wild species. However, the validity of the evaluation was limited because of the narrow types of species tested. The number of species tested, currently set between six and ten, appears insufficient. The trait-based approach (i.e. the use of plant attributes to predict species sensitivity to toxicants) can be used to improve species selection. This approach puts more emphasis on the shared biological characteristics that affect plant function within ecological communities rather than on plant phylogeny. Results presented showed that further studies are needed. In test guidelines, protocols require that crop species be sprayed as young vegetative plants, which is assumed to be the most sensitive growth stage to herbicides. In contrast, during herbicide spray, herbicides may reach non-target plants that are at various phenological stages. Several studies demonstrated that plants may be at greater risk when contamination occurs at the reproductive stage. No data on long-term effects, plant recovery or on effects on reproductive stages are requested in current guidelines. Preliminary evidence suggests that this may be an important aspect to consider in risk assessment. In addition, herbicide impacts on plant community diversity as well as biodiversity at other trophic levels have been demonstrated in only a limited number of studies and therefore should warrant more attention in risk assessment.

The value of woody hedgerows for moth diversity on organic and conventional farms.

Habitat destruction and degradation are important drivers of biodiversity loss within agro-ecosystems. However, little is known about the effect of farming practices and the value of woody hedgerows on Lepidoptera in North America. The purpose of this work was to study moth diversity in woody hedgerows and croplands of organic and conventional farms. In addition, the influence of vegetation composition and abiotic variables on species richness, abundance, and composition was examined. Moths were sampled with light traps during six weeks in the summer of 2001. Vegetation data and abiotic variables were obtained for all sites. In total, 26,020 individuals from 12 families and 408 species were captured. Most species were uncommon. Only 35 species included >100 individuals while for 71% of species <10 individuals were found. The Noctuidae represented 221 species and 85% of all individuals captured. Woody hedgerows harbored more species and in greater number than croplands. There was no significant difference in moth diversity between organic and conventional farms, except that the Notodontidae were significantly more species rich in organic than in conventional sites. Results show that species richness, abundance, and composition were greatly influenced by habitat types (hedgerow versus crop field) and abiotic variables (minimum temperature which was correlated to moon illumination, rainfall, and cloud cover). Moth species composition was significantly correlated to vegetation composition. This study broadens our understanding of the factors driving moth diversity and expands our knowledge of their geographic range. The maintenance of noncrop habitats such as woody hedgerows within agro-ecosystems seems paramount to preserving the biodiversity and abundance of many organisms, including moths.

[Impact of Express study on clinical practice in ARDS patients: a single French ICU experience]. / Evolution des pratiques ventilatoires chez les patients en SDRA lors de la participation à un essai clinique randomisé: l'expérience d'une unité de réanimation française.

INTRODUCTION: The French Express study compared two alveolar recruitment managements (maximal versus standard) in Acute Respiratory Distress Syndrome (ARDS) patients ventilated with 6 ml/kg of ideal body weight (IBW). The objective of the present study was to assess in a single intensive care unit, the impact of Express study on the mechanical ventilation settings in non-included ARDS patients. PATIENTS AND METHODS: From 16 October 2002 to 14 January 2005 all consecutive eligible but non-included patients in Express study were studied. The maximal and minimal tidal volumes, and the minimal and maximal respiratory rates were retrospectively recorded. These parameters were compared according to the date of patient's admission and then the patients were separated in four quartiles (14, 15, 15, 15 patients). RESULTS: From the first to the last study period separated by 26 months, the mean maximal tidal volume decreased from 9.0+/-1.3 to 7.4+/-1.0 ml/kg of IBW (p=0.03), the proportion of patients ventilated with a maximal tidal volume greater than 8 ml/kg decreased from 93% to 20% (p<0.01), the median minimal respiratory rate increased from 14 to 18 b/min (p=0.03) and the proportion of patients with a respiratory rate less than 20 b/min decreased from 100% to 73% (p<0.01). There were correlations between the time of patient's admission and the maximal tidal volume (r=-0.43, p<0.01), the minimal tidal volume (r=-0.28, p<0.04) and the minimal respiratory rate (r=0.33, p<0.02). CONCLUSION: The participation in Express study led physicians to modify their mechanical ventilation settings. The maximal tidal volume decreased and the minimal respiratory rate increased in the ARDS eligible but non-included patients.

[Rhabdomyolysis and compartment syndrome of two forearms after robotic assisted prolonged surgery]. / Rhabdomyolyse et syndrome des loges des deux avant-bras lors d'une chirurgie robotique de longue durée.

Robotic assisted laparoscopic surgery allows for a more precise dissection than classical laparoscopic surgery. However, it sometimes imposes specific exaggerated postures and extralong procedure duration. Combining these two factors may increase the risk for postural complications in at-risk patients. We report the case of an obese 30-year-old female patient who underwent a 12-hour duration robotic laparoscopic surgery for severe endometriosis, in Trendelenburg position. This was complicated by a two forearms rhabdomyolysis, with subsequent compartment syndrome with multiple neuropathy. Physicians must be aware of the cumulative risk for postural complications when extreme positions are associated to long duration procedures in predisposed patients.