Prognostic potential of copper, zinc, copper/zinc ratio, cobalamin, and serum amyloid A in cats with panleukopenia

BACKGROUND

Copper (Cu), zinc (Zn), and the copper/zinc ratio (Cu/Zn), which have been studied in gastrointestinal disorders of humans, may facilitate disease prognosis.

OBJECTIVE

Evaluate the predictive potential of Cu, Zn, cobalamin, and serum amyloid A (SAA) as prognostic indicators in cats with feline panleukopenia (FPV) on admission.

ANIMALS

Client-owned cats diagnosed with FPV and controls.

METHODS

Serum Cu and Zn concentrations were assessed using the spectrophotometric method and serum concentrations of SAA and cobalamin were measured by chemiluminescent immunoassay.

RESULTS

On admission, survivor cats with FPV had significantly higher serum Cu and SAA concentrations and Cu/Zn ratios and significantly lower serum Zn and cobalamin concentrations than controls. Furthermore, non-survivor cats with FPV had significantly higher serum Cu and SAA concentrations and Cu/Zn ratios and significantly lower cobalamin concentrations than survivors and controls. Prognostic thresholds were calculated, with positive predictive value (PPV) for survival of 90% for Cu (≥120.3 μg/dL), 90% for Cu/Zn (≥1.34), 90% for cobalamin (≤430.4 pg/mL), and 90% for SAA (≥0.85 mg/L).

CONCLUSIONS AND CLINICAL IMPORTANCE

Cu (0.93 area under curve [AUC]), Cu/Zn (0.95 AUC), cobalamin (0.98 AUC), and SAA (0.98 AUC) were excellent biomarkers for predicting prognosis in cats with FPV. Their effectiveness, as assessed by sensitivity (100%), specificity (80%), AUC (0.98), and PPV (90%) from receiver operating characteristic analysis, emphasizes the performance of cobalamin and SAA.

Predictor factors of 1-rooted mandibular second molars on complicated root and canal anatomies of other mandibular teeth

Objectives

This study aimed to determine the effects of 1-rooted mandibular second molar (MnSM) teeth on root canal anatomy complexities of the mandibular central incisor (MnCI), mandibular lateral incisor (MnLI), mandibular canine (MnCn), mandibular first premolar (MnFP), mandibular second premolar (MnSP), and mandibular first molar (MnFM) teeth.

Materials and Methods

Cone-beam computed tomography images of 600 patients with full lower dentition were examined. Individuals with 1-rooted MnSMs were determined, and the complexity of root canal anatomy of other teeth was compared with individuals without 1-rooted MnSMs (Group-1; subjects with at least one 1-rooted MnSM, Group-2; subjects with more than a single root in both MnSMs). A second canal in MnCIs, MnLIs, MnCns, MnFPs, and MnSPs indicated a complicated root canal. The presence of a third root in MnFMs was recorded as complicated.

Results

The prevalence of 1-rooted MnSMs was 12.2%, with the C-shaped root type being the most prevalent (9%). There were fewer complicated root canals in MnCIs (p = 0.02), MnLIs (p < 0.001), and MnFPs (p < 0.001) in Group 1. The other teeth showed no difference between the groups (p > 0.05). According to logistic regression analysis, 1-rooted right MnSMs had a negative effect on having complex canal systems of MnLIs and MnFPs. Left MnSMs were explanatory variables on left MnLIs and both MnFPs.

Conclusions

In individuals with single-rooted MnSMs, a less complicated root canal system was observed in all teeth except the MnFMs.

Predictor Mandibular Dentoalveolar Features on the Occurrence of 1-Rooted/C-Shaped Mandibular Second Molar Teeth

OBJECTIVE

This study aimed to examine the mandible form features of the mandible, such as inter-second molar width, anteroposterior length, arch perimeter length, arch breadth, corpus height/width in the mandibular second molars (MnSM) region, and arch form, and the relation for the occasion of the 1-rooted/C-shaped.

METHODS

The study analyzed cone-beam computed tomography images of 215 male and 215 female Turkish patients to determine the prevalence of 1-rooted and C-shaped MnSM. Mandibular dentoalveolar characteristics of individuals with bilateral (1R-1R group) and unilateral (1R-2R group) 1-rooted MnSM were examined and compared with those with bilateral 2-roots (2R-2R group) MnSM. Statistical tests were performed using Chi-square, one-way ANOVA, Tukey, and binary logistic regression analysis at the 5% significance level.

RESULTS

The prevalence of 1-rooted and 1-rooted/C-shaped MnSM was 12.79% and 9.65%, respectively. Root fusion was more commonly present in females (p<0.05). In the 1R-1R group, the anteroposterior length was shorter than in the 2R-2R group (p<0.05). There was no difference between the groups for other features (p>0.05).

CONCLUSION

Although the study found a shorter anteroposterior length in the 1R-1R group, no feature was a predictive variable for 1-rooted/C-shaped MnSM.

Tailoring the phase composition of carbon-coated nickel sulfides to achieve a high specific capacitance

As significant transition metal sulfides, nickel sulfides integrated with carbon were successfully synthesized in the presence of polyethylenimine and glutaraldehyde with a solvothermal route at 180 °C followed by carbonization. Glutaraldehyde prevented complete sulfur loss and allowed the formation of a mixed phase of nickel sulfide. The electrochemical performances of pure NiS2, NiS@C0, NiS2/NiS@C1, and NiS2/NiS@C2 electrodes were tested by a series of measurements. The specific capacitances obtained from GCD analysis were 698, 1160, 1484, and 908 F g-1 at 1 A g-1 for NiS2, NiS@C0, NiS2/NiS@C1, and NiS2/NiS@C2 electrodes, respectively. The results implied that the NiS2/NiS@C1 electrode possessed the highest specific capacitances and this study can be a good reference for the preparation of other hybrid metal sulfides as pseudocapacitive electrode materials.

Comparing the crown and root metric properties of double-rooted and single-rooted mandibular canine teeth

OBJECTIVES

To compare the crown and root metric properties of two- and single-rooted/multi-canal mandibular canines (MnCn) with single-rooted/single-canal MnCn.

METHODS

Cone-beam computed tomography images of 1000 patients (500 women and 500 men) with both right and left MnCn were analyzed. First, the root and canal morphologies of all teeth were examined. Then, the teeth were divided into three groups; (a) 2-rooted, (b) 1-rooted and multi-canals, (c) 1-rooted and single-canal. Crown lengths/sizes and tooth lengths were compared between the three groups. Statistical analyses were performed using Chi-square, one-way ANOVA, Welch, post hoc pairwise comparison, and independent sample t-tests. The significance level was set at 5%.

RESULTS

Of all the teeth, 2.35% were 2-rooted, and 6.3% were 1-rooted/multi-canal. The frequency of double roots was higher in women (p < 0.05). Double-rooted teeth had longer crown lengths but shorter tooth lengths than single-rooted teeth (p < 0.05). In 2-rooted teeth, buccal and lingual root lengths were similar, root bifurcation levels were mostly at the mid-root, and the mean distance of the bifurcation points of the canals to the cemento-enamel junction was 4.09 mm. Double-rooted teeth were mostly observed unilaterally.

CONCLUSIONS

Since 2-rooted MnCn do not differ significantly from other teeth in terms of crown sizes, it is not possible to differentiate between single- vs. double-rooted MnCn based on clinical examination.

COVID-19 outbreak impact on emergency trauma visits and trauma surgery in a level 3 trauma center

Background

This study aims to compare emergency trauma visits’ severity, emergency surgical needs, and characteristics between the pandemic and pre-pandemic periods.

Methods

This retrospective observational study was conducted in a tertiary training and research hospital between 1 and 30 April 2020 (pandemic group) and compared with the previous year’s same dates (pre-pandemic group). Trauma patients aged 18 and over were included in the study. Emergency Severity Index (ESI) levels, trauma surgery needs, and injury characteristics were compared.

Results

A total of 2097 patients (592 pandemic and 1505 pre-pandemic) were included. There was an approximately 60% reduction in total and daily visits. ESI levels 1 (0.2% vs. 1.4%) and 2 (0.8% vs. 1.9%) patients increased during pandemic period. Trauma surgery needs (1.6% vs. 2.2%), intensive care unit (ICU) admission (0.4% vs. 0.2%), and ward admission (6.3% vs. 7.9%) did not change during pandemic period.

Conclusion

Despite the decrease in the visit frequency of adult trauma patients during the pandemic period, the needs for trauma surgery, ICU, and ward admission did not change. Trauma teams should continue their duties during the pandemic period.

Fructanogenic traits in halotolerant Bacillus licheniformis OK12 and their predicted functional significance

AIMS

Isolating a novel bacterial source of fructan from a saltern and analysis of its genome to better understand the possible roles of fructans in hypersaline environments.

METHODS AND RESULTS

Bacteria were isolated from crude salt samples originating from Çamaltı Saltern in Western Turkey and screened for fructanogenic traits in high-salt and sucrose-rich selective medium. Exopolysaccharide accumulated in the presence of sucrose by isolate OK12 was purified and chemically characterized via HPLC, FT-IR and NMR, which revealed that it was a levan-type fructan (β-2,6 linked homopolymer of fructose). The isolate was taxonomically classified as Bacillus licheniformis OK12 through 16S rRNA gene and whole-genome sequencing methods. Strain OK12 harbours one levansucrase and two different levanase genes, which altogether were predicted to significantly contribute to intracellular glucose and fructose pools. The isolate could withstand 15% NaCl, and thus classified as a halotolerant.

CONCLUSIONS

Fructanogenic traits in halotolerant B. licheniformis OK12 are significant due to predicted influx of glucose and fructose as a result of levan biosynthesis and levan hydrolysis, respectively.

SIGNIFICANCE AND IMPACT OF THE STUDY

Fructans from the residents of hypersaline habitats are underexplored compounds and are expected to demonstrate physicochemical properties different from their non-halophilic counterparts. Revealing fructanogenic traits in the genome of a halotolerant bacterium brings up a new perspective in physiological roles of fructans.

Antibacterial activity of silver nanoparticles activated by photodynamic therapy in infected root canals

BACKGROUND

Root canal disinfection includes mechanical, chemical and biological struggle against microorganisms (MOs). Photodynamic therapy (PDT) and nanoparticle (NP) agents may be proposed as an alternative for use against intracanal infections due to their ability to disrupt biofilm and prevent bacterial adhesion to dentin. The use of NP agents in combination with light/photosensitizer (PS) agents increases the efficiency of PDT in root canal disinfection.

OBJECTIVES

The aim of the study was to evaluate the effect of light application - PDT - on the antibacterial activity of the combination of a PS agent (toluidine blue O -TBO) and an NP agent (silver nanoparticles - AgNPs) for the disinfection of the root canals inoculated with Enterococcus faecalis (E. faecalis).

MATERIAL AND METHODS

In this study, concentrations of 20 ppm of TBO and 10 ppm of AgNPs, which showed the highest antibacterial activity against E. faecalis in the TBO/AgNPs combination, were used according to the preliminary studies. After instrumentation, 120 human, single-rooted, straight-canal mandibular premolars of a standard length of 13 mm were contaminated with bacteria, and experimental procedures were conducted against 21-day-old mature biofilm. The teeth were randomly divided into 5 main experimental groups: TBO/light; AgNPs; TBO/AgNPs; AgNPs/light; and TBO/AgNPs/light. Then, these main groups were divided into 2 subgroups each, according to the 2 application time periods (30 s and 60 s) (n = 10). The remaining 20 teeth constituted positive and negative control groups. The data was analyzed with the Kolmogorov-Smirnov test, one-way analysis of variance (ANOVA), Tukey's honestly significant difference (HSD) test, and the Bonferroni correction.

RESULTS

The NaOCl group provided a bacterial reduction that was higher than in all other groups in a statistically significant manner. Light application on the TBO/AgNPs combination was the group that provided the highest bacterial reduction after NaOCl.

CONCLUSIONS

The photoactivation of the TBO/AgNPs combination led to an increase in the effect of PDT, and it has the potential to be used as an adjunct for disinfection of the root canal system.

Relationship between crown and root canal anatomy of four-rooted maxillary molar teeth

This study aimed to determine the prevalence of four-rooted teeth and the corresponding crown, root and canal morphology in maxillary molars. Cone-beam computed tomographic images for 1200 patients were examined, and 1799 maxillary first molar (MFM) and 2123 maxillary second molar (MSM) teeth were evaluated. Statistical analyses were performed at a 5% significance level. Only three MFMs (0.17%) and 30 maxillary MSMs (1.41%) were four-rooted. The most common four-root type was the double palatal root. A higher proportion of four-rooted teeth were observed in men (P < 0.05), and a high percentage of root fusion was seen in these teeth. The palatal half of the crown was wider in teeth with double palatal roots. Although rarely encountered, the diagnosis and proper treatment of these teeth are very important for endodontic success.

Viral prevalence, clinical profiles and comparison of severity scores for predicting the mortality of adults with severe acute respiratory infections

Background/aim

The aim of this study was to determine the accuracy of severity scores for predicting the 28-day mortality among adults with severe acute respiratory infection (SARI) admitted to the emergency department.

Materials and methods

This study included 159 consecutive adult patients with SARI admitted to the emergency department of a tertiary hospital. A standard form was filled out in order to record demographic information, clinical parameters, laboratory tests, and radiographic findings of the patients. CURB-65, PSI, SIRS, qSOFA, SOFA and APACHE II scores were compared between the survivor and nonsurvivor groups.

Results

Of 159 patients included in the study, 38.4% were positive for respiratory viruses and 28.3% were positive for influenza viruses. 35.8% of the patients were admitted to an intensive care unit (ICU) and the mortality rate was 36.5%. The area under the receiver operating characteristic curve of CURB-65, PSI, SIRS criteria, qSOFA, SOFA and APACHE II scores were 0.717, 0.712, 0.607, 0.683, 0.755, and 0.748, respectively in predicting mortality and 0.759, 0.744, 0.583, 0.728, 0.741, and 0.731, respectively in predicting ICU admission.

Conclusion

SOFA and APACHE II were more accurate than SIRS in predicting the 28-day mortality among adults with SARI. There was no significant difference among these scores in terms of other multivariate comparisons.

Increased genetic diversity of BVDV strains circulating in Eastern Anatolia, Turkey: first detection of BVDV-3 in Turkey

Bovine viral diarrhea virus (BVDV) is a pathogen associated with loss of meat, milk, and reproductive performance in cattle across the world. There have been two types of BVDV identified worldwide: BVDV-1 and BVDV-2. However, a new type of BVDV, named HoBi-like pestivirus (BVDV-3), has been identified recently. BVDV presence in Turkey has been reported since the 1990s, but a mandatory vaccination program has not been implemented in Turkey so far. In serological studies conducted in Turkey for BVDV, reported seropositivity has been 50% on average. The aim of this study is to determine the genetic diversity of BVDV in blood and abortion materials from bovine in eastern Turkey. The presence of the virus was determined by antigen ELISA test. As a result of the phylogenetic analysis of 5'UTR, Npro and E2 genomic regions of the BVDV (n = 28), BVDV-1 (n = 25) was identified as the dominant type. In addition, BVDV-2 (n = 2) and BVDV-3 (n = 1) were determined which is the first report of HoBi-like pestivirus in Turkey. Although BVDV-1l (n = 19) was detected as the predominant sub-type of BVDV-1, 1a (n = 2), 1b (n = 1), 1c (n = 1), and 1d (n = 2) were also identified. In 2 samples, the BVDV-2 type detected was the 2a sub-type. In this study, it is emphasized that BVDV can be present in the abort materials as an agent and that it should be examined in the herd screening. In addition, it is understood that molecular epidemiological studies should continue for determining the genetic diversity of the viruses and that such studies should be carried out on the country basis. Necessary diagnostic programs should be developed for animals, which are imported or buying from other barns, and protection and control measures should be taken. The increase of reports on BVDV heterogeneity in Turkey and worldwide gets up related to the occurrence and spread of new BVDV types or variants, with potential implications for animal health and disease control.

Prevalence and predictors of gestational diabetes mellitus: a nationwide multicentre prospective study

AIM

Prevalence rates of gestational diabetes mellitus (GDM) show considerable variation among different countries and regions of the world. The primary aim of this study was to determine the nationwide prevalence and predictors of GDM in Turkey.

METHODS

We conducted prospective nationwide screening among pregnant women. Between August 2016 and November 2017, a total of 2643 pregnant women from 51 centres in 12 different regions were enrolled. A two-step screening method and Carpenter and Coustan criteria were used in the diagnosis of GDM. Clinical and biochemical data were obtained using electronic database software.

RESULTS

The national prevalence of GDM was found to be 16.2% [95% confidence intervals (CI) 15.0% to 17.4%] without a significant difference between urban and rural regions. Women with GDM were older (mean age: 32 ± 5 vs. 28 ± 5 years, P < 0.001) and heavier (mean BMI: 27.2 ± 5.1 vs. 24.7 ± 4.7 kg/m² , P < 0.001) than their counterparts without GDM. The prevalence of GDM tended to increase with age (< 25 years, 6.9%; 26-35 years, 15.6%; and 36-45 years, 32.7%; P < 0.001). Maternal age, maternal BMI, history of previous GDM and family history of diabetes mellitus were independent predictors of developing GDM (P < 0.05 for all). Low-risk women (age < 25 years, BMI < 25 kg/m² , no family history of diabetes) comprised 10.7% of the total population and the prevalence of GDM in these women was 4.5% (95% CI 2.4% to 7.8%).

CONCLUSION

The results of this nationwide study indicate that GDM is very common, affecting one in seven pregnancies in Turkey. Implementation of international guidelines on screening and management of this public health problem is required.

P3HT-graphene bilayer electrode for Schottky junction photodetectors

We have investigated the effect of a poly (3-hexylthiophene-2.5-diyl)(P3HT)-graphene bilayer electrode on the photoresponsivity characteristics of Si-based Schottky photodetectors. P3HT, which is known to be an electron donor and absorb light in the visible spectrum, was placed on CVD grown graphene by dip-coating method. The results of the UV-vis and Raman spectroscopy measurements have been evaluated to confirm the optical and electronic modification of graphene by the P3HT thin film. Current-voltage measurements of graphene/Si and P3HT-graphene/Si revealed rectification behavior confirming a Schottky junction formation at the graphene/Si interface. Time-resolved photocurrent spectroscopy measurements showed the devices had excellent durability and a fast response speed. We found that the maximum spectral photoresponsivity of the P3HT-graphene/Si photodetector increased more than three orders of magnitude compared to that of the bare graphene/Si photodetector. The observed increment in the photoresponsivity of the P3HT-graphene/Si samples was attributed to the charge transfer doping from P3HT to graphene within the spectral range between near-ultraviolet and near-infrared. Furthermore, the P3HT-graphene electrode was found to improve the specific detectivity and noise equivalent power of graphene/Si photodetectors. The obtained results showed that the P3HT-graphene bilayer electrodes significantly improved the photoresponsivity characteristics of our samples and thus can be used as a functional component in Si-based optoelectronic device applications.

The combination of acute pancreatitis and toxic hepatitis developing secondary to exposure to malathion : a case report

Organophosphate(OPH) compounds are cholinesteraseinhibiting chemicals used as pesticide. Pancreatitis secondary to malathion toxicity is rare and toxic hepatitis has been reported in only one case. In this paper, we report the case of the combination of acute pancreatitis and toxic hepatitis, which developed in a 30-year old farm worker and the mechanism is discussed in this first report of its kind. Awareness of this complication should prompt earlier investigation because early diagnosis coupled with timely therapeutic measures may improve patient prognosis.

MUSCULAR HYPERTROPHY AS ATYPICAL INITIAL PRESENTATION OF HYPOTHYROIDISM

Hypothyroidism is a common endocrine disease with characteristic symptoms and signs such as fatigue, weight gain, intolerance of cold, constipation, depression, mental slowdown and muscle cramps. Myopathic changes are observed in 30-80% of patients with hypothyroidism, but muscular hypertrophy with muscle stiffness has been reported in less than 10% of patients. Hoffmann's syndrome is a specific form of the hypothyroid-associated myopathy, rarely seen. Symptoms of this syndrome include proximal muscle weakness, hypertrophies in extremities, stiffness, muscle cramps, spontaneous muscle pain; and are associated with increased muscle enzymes. These findings can be seen at any time during hypothyroidism. Hofmann's syndrome has a very good prognosis. Its response to hormone replacement therapy is very good. Therefore, in patients with myopathy-like symptoms, considering in the differential diagnosis that the myopathy may be a reflection of hypothyroidism will facilitate the diagnosis and treatment. In this case, we aimed to present together Hashimoto thyroiditis and muscular hypertrophy, which is an atypical presentation of hypothyroidism and rarely seen in the literature, namely Hoffmann's syndrome.

SERUM IRISIN LEVEL INCREASES THROUGHOUT THE GESTATIONAL PERIOD AND IT DOES NOT PLAY A ROLE IN DEVELOPMENT OF GESTATIONAL DIABETES MELLITUS

INTRODUCTION

Irisin is a recently discovered novel adipomyokine that induces an increase in total body energy expenditure, improves insulin sensitivity and glucose tolerance. It has been shown that circulating levels of irisin are low in patients with obesity, diabetes mellitus and impaired glucose tolerance. However, the information about the level of circulating irisin in gestational diabetes mellitus (GDM) is controversial.

MATERIAL AND METHODS

Serum irisin was measured by an ELISA in a longitudinal prospective cohort study in 221 women. There were 156 healthy pregnant and 65 women with GDM.

RESULTS

Circulating irisin levels were significantlly higher in the middle pregnancy compared with early pregnancy levels in healthy pregnant women and in women with GDM. Serum irisin levels were found to be lower in GDM compared to healthy pregnant women during first trimester but the difference was not observed throughout the pregnancy and it was comparable in middle pregnancy. There was a significant inverse correlation of BMI with serum irisin (r = -0.193, p = 0.004) and between HbA1c and mean glucose of OGTT with serum irisin (r =-0.377, p =0.0001) and (r = -0.147, p:0.03) in the early pregnancy of pregnant women repectively.

CONCLUSIONS

The present study shows that serum irisin level increases throughout the gestational period from early to middle pregnancy in women with GDM, but there is no effect of irisin on the development of GDM.

Triple pelvic osteotomy for the treatment of symptomatic acetabular dysplasia in adolescents and adults : A review of 42 hips

We treated 42 hips with symptomatic acetabular dysplasia using triple pelvic osteotomy. The mean age of the patients was 20.7 years (12-47). The median follow-up was 50.3 months. The average Harris hip score improved from 74 to 92 points. Significant improvement from the preoperative to the latest follow-up evaluation was seen radiologically with reference to the center-edge angle, the anterior center-edge angle, the acetabular index and the femoral head extrusion index. Shenton's line was intact in 9 hips before the operation and it was intact in 40 hips at the latest follow-up. The cross-over sign was present in 15 hips before the operation and it was present in one hip after the operation. The results of this study demonstrated that triple pelvic osteotomy provides improved radiographic results and good symptomatic relief in acetabular dysplasia.

MDCT Assessment of the Cochlear-Carotid Interval

The close anatomic course between the cochlea and the carotid artery presents a possible surgical risk during increasingly popular cohlear implant surgery. The purpose of this study was to determine the normal range of the this region termed "cohlear- carotid interval" (CCI) by 64-slice multi-detector computed tomography (MDCT) in the population. The study investigated 1105 patients who had undergone temporal MDCT. The CCI measured by two observers from 0.5 mm thick coronal images with confirmation on axial and sagittal planes. Among 1105 patients and 2210 temporal sides CCI measured 0.0 mm unilaterally in eight (0.7%) and bilaterally in two patients (0.1%) with a score of ten in the total population (0.9%). Total scores ranged from 0.0 to 6 mm for right CCI and 0.0 to 5.9 mm for left CCI. The CCI showed no significant relationship with sex (P=.096) and there were no significant differences between readers (P=.457) and sides (P=.879). A positive correlation (r=0.741) was found between right and left CCI. The present study demonstrated that the CCI varies considerably between 0.0 mm and 6 mm independently of sex in the population. Understanding the importance of CCI and preoperative knowledge of thin or absent bone allows the radiologist to play a crucial role in alerting the surgeon to prevent penetration of the carotid canal during cochlear implant surgery.

Management of community-based shotgun injuries of the extremities: impact of emergent vascular repair without angiography

BACKGROUND

Shotgun injuries of the extremities create challenging problems for vascular surgeons. In this study, we retrospectively analyzed surgical results without preoperative angiography.

METHODS

Forty-nine patients with shotgun wounds who underwent vascular reconstruction in the extremities from 1999 to 2004 were retrospectively reviewed.

RESULTS

Vascular reconstruction of the extremities after shotgun injury differs from that following injuries caused by other firearms because of extensive tissue damage. In 19 patients, function of the extremity was unsatisfactory after one year; in 12 of them functional deficit was extreme, which was thought to be the result of nerve injury. After several interventions, 25 of 49 patients are well after one year under a rehabilitation program.

CONCLUSION

Based on these results, we favor immediate operative exploration of the extremities in patients with hard signs of vascular trauma, thereby minimizing the ischemic interval, and we recommend angiography only for elective operations. Early fasciotomy should be done without hesitation in patients with long ischemic periods and in those with combined arterial/venous injury.