Fatal pulmonary thromboembolism following physical torture

Although perpetrators of torture usually use common methods to torture their victim, occasionally they devise novel techniques. Doctors are often called upon to examine victims of torture. This case report is intended to highlight 'the helicopter technique' (also called the, 'parrots perch' in Latin America in 1970s and 1980s) and 'chicken kebab' in Iran (more recently) and the complication of venous thromboembolism. This is a report of a victim who was arrested by the police and subsequently tortured. He died 2 weeks later from pulmonary embolism. The history, physical examination, treatment and autopsy findings of this case are discussed.     

Radiology of torture

PURPOSE: Although there are different definitions of torture, there is no contradiction that torture exists. Changes resulting from torture are shown to demonstrate which findings can be visualized with X-rays. MATERIAL: The findings come from rehabilitation centers for victims of torture, collections of others and from personal observations. They are documented with plain films, scintigraphy, computed tomography, and MRI. RESULTS: On fingers, hand, and arm, and on toes, foot and leg, imaging can visualize changes and pathologies which are characteristic for preceding torture. On head, neck, and trunk, this is only rarely the case; this is understandable, when one considers that force having been directed against these regions of the body will more often be deadly than that applied on limbs only. Special forms of torture with the use of water and electricity are also described. It is pointed out that multiple forms of torture do not leave traces, which might be made visible by diagnostic imaging. The cases are part of a selection: the victims have survived (which means that these types of torture permitted survival; injuries of hand and foot do not endanger the survival as opposed to stab wounds to the head, chest, and abdomen, into the anus and the genitals, which are often mortal. Mutilation by torture motivates the torturer to eliminate any proof of his actions and to kill the victim. Public interest induces a selection of methods, which leave no traces. Possibly (and hopefully) some special forms of torture, which use chemical substances that act on the psyche and the central nervous system, might become visible by functional MRI in the near future. CONCLUSION: Torture is likely to occur when findings are seen to be typical or characteristic forms of torture, when age of fractures and pattern of beatings and other injuries corroborate the indications of the victim, and when these findings correspond to the procedures known from the region of application the organization/group/militia, which is said to have executed the torture.     

Female victims of torture

Torture is common today and is practised in over 100 countries according to Amnesty International. A substantial number of refugees coming to Europe have been tortured including females. Documentation of physical injuries due to torture is done by forensic pathologists often in collaboration with psychiatrists. In Sweden, the majority of torture documentations is done by an organization (KTC) which have specialized in documenting torture, and in short-term therapy of refugees and other crime victims suffering from post-traumatic stress. From the KTC archives of 500 documented alleged torture victims, the records of 63 females were studied separately. Age, nationality, asylum motive, social situation, torture methods, number of injuries, and sequels to torture were among the variables studied. Female torture victims differed from their male counterparts studied previously in the following: (i) The most common reason for seeking asylum was persecution because of the political activity of their husbands or some other close relative. (ii) Rape often both anal and vaginal, several times, and by different persons, was reported by 76% of the women. Physical abuse by use of blunt force was alleged by 95% but (iii) other types of force and specific torture methods was reported infrequently. (iv) A high frequency of PTSD -- 87% was diagnosed.     

Depression and torture.

Torture represents an exceptionally traumatic experience in which horror, helplessness, and hopelessness are extreme. Therefore, it can be expected that depression, along with other trauma-related disorders is present in torture victims at higher rates than in other psychotraumatized individuals. To demonstrate this, we examined two groups of refugees, all suffering the post-traumatic stress disorder. The first group (N = 50) had combat experience but were imprisoned and tortured as well. Members of the second group (N = 29) had combat experience. A third group (N = 30) consisted of local people with no traumatic experience. Using the Hamilton scale, the Beck Depression Inventory and structured dedicated interviews, we tried to determine whether those groups differed in level of depression based on their different levels of traumatic experience. The results of our study indicate that torture victims showed a significantly higher level of depression that is clinically relevant.     

Postinflammatory ossicular fixation: CT analysis with surgical correlation

Postinflammatory ossicular fixation is a common problem encountered by the otologic surgeon upon exploration because of conductive hearing loss in patients with chronic otitis media. These nonotosclerotic noncongenital lesions take three pathologic forms: fibrous tissue fixation (chronic adhesive otitis media), hyalinization of collagen (tympanosclerosis), and new bone formation (fibro-osseous sclerosis). Fibrous tissue fixation appears on CT as nonbony, noncalcific soft-tissue debris encasing some or all of the ossicular chain. Tympanosclerosis appears as unifocal or multifocal punctate or weblike calcifications in the middle ear cavity or on the tympanic membrane. This debris may be in direct apposition to the ossicular chain or may replace the suspensory ligaments in symptomatic patients. New bone formation has been identified only in the attic and is the least common manifestation. Thick bony webs or generalized bony encasement may be present at CT. More than 300 patients with the clinical diagnosis of chronic otitis media have been examined. This study encompasses 23 proved cases.     

Fatal rhabdomyolysis after torture by reverse hanging

Purpose

Reverse hanging (also known as Palestinian hanging) is a form of positional torture where the victim is suspended for a prolonged period of time by the wrists, after the wrists are bound at the back. We report the first autopsy case of reverse hanging. We have discovered that fatal myoglobinuric renal failure due to rhabdomyolysis can be a complication of Palestinian hanging.

Method

An adult detainee, who underwent interrogation by authorities, was admitted to hospital from a prison and died in hospital after a few days. Death was due to myoglobinuric renal failure. An autopsy was performed.

Results

At autopsy, the body showed anasarca due to renal failure. There were healing ligature marks on the wrist and forearm, but no blunt impact injury to the shoulders or arms. There was extensive necrosis of the pectoralis major, biceps, and deltoid muscles, organizing hemoarthrosis of the right glenohumeral joint and hemorrhage into the joint capsule of the both glenohumeral joints. The kidneys showed evidence of myoglobin deposition grossly. The overstretching of the major muscles of the shoulder, in response to the prolonged Palestinian hanging, gave rise to the muscle necrosis.

Conclusion

This case underscores the importance of conducting autopsies on people who die in custody, particularly if detained at times of political instability when torture may be practiced by state actors and others. This case also reveals that fatal rhabdomyolysis can occur by positional torture in a stress position, despite the absence of direct trauma due to blunt impacts.

     

1540nm激光分段式光热解治疗炎症后皮肤色素沉着疗效观察

目的探讨1540nm激光分段式光热解治疗炎症后皮肤色素沉着的疗效和安全性。方法面部炎症后皮肤色素沉着患者13例,采用1540nm激光分段式光热解治疗,光斑直径15mm,脉宽10ms,能量8～10mJ/脉冲,扫描5～6次,每4周一次,共治疗5次,术后严格防晒。每次治疗前采用VISIA图象分析系统和前后照片比较色素沉着改善和疗效。结果色素沉着均有不同程度改善,显效率69.2%,有效率23.0%,总有效率92.3%,仅1例发生色素沉着。该疗法还有收缩毛孔、改善皮肤纹理的作用。结论 1540nm激光分段式光热解治疗炎症后皮肤色素沉着疗效确切,安全性高,无明显副作用,为治疗皮肤色素沉着提供新的手段。     

Scars of torture: a Sri Lankan study

Interpretation of scars of torture is not an easy task as our understanding of evolution of scars of different methods of torture is still in its infancy. The objectives of this study were to produce the features of a typical scar of a few selected methods of torture and determine their characteristic distribution. To achieve this, 100 medico-legal records of victims of torture examined at the Judicial Medical Officer's Office, Colombo between 1998 and 2001 were perused. Scars caused by seven selected methods of torture were taken into consideration. They were, assault with both non-pliable and pliable blunt objects, cigarette burns, burns with heated solid objects and molten plastic, ligature application with different forms of suspension and cuts with sharp objects. Total number of scars analyzed in this study was 1846, which included 740 scars of non-pliable blunt weapons, 182 of pliable blunt weapons, 102 of ligature, 59 of molten polythene, 55 of heated objects and 82 of razor blades and knives. Typical scars of each method of torture and their characteristic distribution were determined.     

Examination for the late physical after effects of torture

This paper describes the experience of doctors at the Medical Foundation for the Care of Victims of Torture, London, in documenting torture as recounted by survivors, mostly refugees from one of 63 countries, and in writing medico-legal reports to support their asylum claims. More than 2000 new patients are seen each year and 500 reports written. Few patients are seen in the acute phase; many not until 10 years following their torture. Patterns of torture practised in different countries are described, with the resulting physical signs. Methods of history-taking and examination are discussed, with emphasis on the detection of subtle forms of torture, recognition of deception and encouragement of full disclosure.     

Treatment of persistent pain from torture: review and commentary

Torture and the conditions under which it is inflicted often leave persistent painful disorders. Because there may be no lasting signs, persistent pain is often misconceived as a somatic representation of psychological distress, also common after torture. This serious failure to understand the nature of persistent pain means that pain is largely overlooked and untreated in torture survivors. We carried out a systematic review on treatments for pain from torture, but found few studies and little use of current understanding and evidence. We discuss this in the context of treating pain associated with psychological distress and of the broader problems faced by the refugee and torture survivor that may take priority over pain. We propose clinical and research implications for this neglected field.     

Implementing Istanbul Protocol standards for forensic evidence of torture in Kyrgyzstan

The Kyrgyz government declared a policy of “zero tolerance” for torture and began reforms to stop such practice, a regular occurrence in the country's daily life. This study presents the results of 10 forensic evaluations of individuals alleging torture; they represent 35% of all criminal investigations into torture for the January 2011–July 2012 period. All individuals evaluated were male with an average age of 34 years. Police officers were implicated as perpetrators in all cases. All individuals reported being subjected to threats and blunt force trauma from punches, kicks, and blows with objects such as police batons. The most common conditions documented during the evaluations were traumatic brain injury and chronic seizures. Psychological sequelae included post-traumatic stress disorder and major depressive disorder, which was diagnosed in seven individuals. In all cases, the physical and psychological evidence was highly consistent with individual allegations of abuse. These forensic evaluations, which represent the first ever to be conducted in Kyrgyzstan in accordance with Istanbul Protocol standards, provide critical insight into torture practices in the country. The evaluations indicate a pattern of brutal torture practices and inadequate governmental and nongovernmental forensic evaluations.