Subsequent to the earthquake which occurred in southern Italy in Nov., 1980, 19 patients were admitted to the Univeristy of Naples.sbd.II Medical School with crush syndrome. Clinical and biochemical studies were carried out in 8 of them. There was an inconstant relation between the type of lesion and the clinical course, leading to the assumption of 2 diverse physiopathologic mechanisms: one for crush and the other for compression. Timely recognition of the 2 syndromes is difficult; and elevated creatine-creatinine ratio was found in those patients with an irreversible crush syndrome. Apparently, this is the only element which would permit a prompt distinction between the 2 pathologic states and which would provide an indication for early, life-saving amputation.