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Introduction

Overview of
Medical Problems

Types of Torture

Torture-Related Physical
Signs and Symptoms

Oral Health Exam

Oral Health Presentation

Oral Health

Torture-Related Physical Signs and Symptoms

Clinical Signs (1-12)

Form of Torture	Affected Organ/System	Acute Sequelae	Chronic Sequelae
Blunt Trauma Crushing Injuries Whipping Beatings	Skin and Appendages	Edema Lacerations Ecchymosis	Scars
	Musculo-skeletal	Dislocations Fractures Rhabdomyolysis Closed Compartment Syndrome	Ankylosis Limb Deformity Chronic Myalgias Chronic Fascilitis
	Neurological	Brain Concussion: loss of consciousness Intracranial Bleeding Skull Fracture	Organic Brain Syndrome Chronic Headaches Post Concussion Syndrome Reflex Sympathetic Dystrophy
	Genitourinary/Renal	Acute Renal Failure Hematuria Hematocele
	Respiratory	Aspiration Pneumonia
	Ears, Nose, Throat, Eyes	Conjunctivitis Iritis Decreased Visual Acuity Anterior Chamber Bleeding and Collapse Dislocation of the Lens Retinal Detachment and Hemorrhages Strabismus Tympanic Rupture and Erythema Hearing Loss Otitis Media and Externa Vocal Cord Palsy Cricoid Bone Fracture	Tympanic Rupture Blindness or Decreased Visual Acuity Permanent Hearing Loss Vocal Cord Palsy
	Oral and Dental	Bleeding Tooth Avulsion and/or Fracture Mandibular Fracture and/or Dislocation	Edentulous Temporomandibular Joint Syndrome
Penetrating Injuries Gunshot Wounds Stab Wounds Slash Cuts	Skin and Appendages	Edema Lacerations Ecchymosis Infections: cellulitis, abscesses, sepsis	Scars
	Musculo-skeletal	Fractures	Limb Deformity
	Neurological	Peripheral Nerve Damage: palsy or anesthesia Spinal Cord Injury: paraplegia or quadriplegia Brain Damage Seizures Intracranial bleeding	Peripheral Nerve Damage: palsy or anesthesia Spinal Cord Injury: paraplegia or quadriplegia Brain Damage Seizures
	Vascular	Massive bleeding - Death Limb Necrosis	Amputation from Necrosis
	Gastrointestinal	Peritonitis	Fistulas Malnutrition
	Genitourinary/Renal	Hematuria Acute Renal Failure
	Respiratory	Pneumothorax and Tension Pneumothorax Hemothorax Empyema	Broncho-pleural fistulas
	Ears, Nose, Throat, Eyes	Anterior Chamber Collapse Endophthalmitis	Blindness
Electric Shocks	Skin	1 st, 2 nd, or 3 rd Degree Burns	Scars
	Musculo-skeletal	Muscle Sprains Intramuscular Hematomas Fractures Rhabdomyolysis
	Neurological	Seizures	Seizures
	Cardiovascular	Arrhythmias
	Genitourinary/Renal	Acute Renal Failure - Rhabdo
	Respiratory	Apnea
Suspension	Skin and Appendages	Edema Ecchymosis Lacerations Loosening of the Galea	Scars Alopecia Disfigurement
	Musculo-skeletal		Fibrositis, particularly of the shoulders and neck
	Neurological	Peripheral Nerve Damage: palsy or loss of sensation	Peripheral Nerve Damage: palsy or loss of sensation
	Vascular	Necrosis	Amputations
	Genitourinary	Penile Fracture Hematocele Ecchymosis	Erectile Dysfunction Testicular Atrophy
Burns Thermal Chemical	Skin and Appendages	Blisters Infections: cellulitis, sepsis	Scars Contracture over Joint Areas Disfigurement
	Metabolic	Dehydration Electrolyte Imbalance Malnutrition
	Genitourinary/Renal	Acute Renal Failure
	Ears, Nose, Throat, Eyes	Conjuctivitis Iritis Corneal Burns	Blindness
Asphyxiation Dry Submarino Wet Submarino Chemical	Neurological	Seizures Anoxia/Hypoxia	Organic Brain Damage
Asphyxiation Dry Submarino Wet Submarino Chemical	Respiratory	Aspiration Pneumonia Angioedema Burn of the Upper Airway Tract
Sexual Torture	Genitourinary	Sexual Transmitted Diseases Unwanted Pregnancy Mutilation of External Genitalia Hematocele Genital Lacerations and/or Abrasions Hematuria Ecchymosis	Erectile Dysfunction Sexual Transmitted Diseases Dyspareunia

Clinical Symptoms (1-12)

Form of Torture	Affected Organ/System	Acute	Chronic
Blunt Trauma Crushing Injuries Whipping Beatings Penetrating Injuries Gunshot Wounds Stab Wounds Slash Cuts Electric Shocks Suspension Burns Thermal Chemical Asphyxiation Dry Submarino Wet Submarino Chemical Sexual Torture	Skin and Appendages	Bleeding Purulent Drainage of Wounds Pain Swelling Loss of hair	Nail atrophy or thickening Permanent hair loss
	Musculo-skeletal	Pain Swelling Muscle Spasm Decrease Range of Motion Crepitation Deformity	Chronic Pain Decrease Range of Motion Deformity
	Neurological	Palsy Anesthesia, Paresthesia, and Dysesthesia Memory Deficit Loss of Consciousness Changes in Mental Status Incontinence Seizures Shivers/Tremors	Palsy Anesthesia Chronic Headaches Memory Deficit Vertigo/Dizziness Chronic Seizures
	Cardiovascular	Palpitations Chest Pain Bleeding	Palpitations
	Gastrointestinal	Nausea and Vomiting Hematemesis Bright Red per Rectum Melenas Abdominal Pain Changes in Bowel Habits: diarrhea and constipation Tenesmus Fecal Incontinence	Changes in Bowel Habits: diarrhea and constipation Soiling
	Genitourinary/Renal	Urinary Frequency Urinary Hesitancy Dysuria Decrease Urine Flow Urinary Retention Hematuria Vaginal Bleed and Discharge Tenesmus	Dysuria Urinary Hesitancy
	Respiratory	Shortness of Breath Cough Pleuritic Pain	Shortness of Breath Cough
	Ears, Nose, Throat, Eyes	Decrease Hearing Earache Ear discharge Tinitus Epixtasis Anosmia Dysphagia Hoarseness	Permanent Hearing Loss Anosmia Tinitus Permanent Hoarseness Chronic Dysphagia
	Oral and Dental	Pain Swelling Bleeding Decrease Range of Motion and Crepitation of the Temporomandibular Joints	Chronic Temporomandibular Joint Pain

References:
1. Shrestha NM and Sharma B. Torture and Torture Victims – A Manual for Medical Professionals. Center for Victims of Torture, Katmandu, Nepal, 1995.

2. Mcivor RJ and Turner SW. Assessment and Treatment Approaches for Survivors of Torture. British J. Psychiatry 1995;166: 705 – 711.

3. Forrest D. The Physical After-Effects of Torture. Forensic Science International 1995; 76: 77 – 84.

4. Petersen HD and Rasmussen OV. Medical Appraisal of Allegations of Torture and the Involvement of Doctors in Torture. Forensic Science International 1992; 53: 97 – 116.

5. Rasmussen OV. Medical Aspects of Torture. Danish Medical Bulletin 1990; 37(Supplement 1): 1 – 88.

6. Goldfeld AE, Mollica RF, Pesavento BH, Stephen VF. The Physical and Psychological Sequelae of Torture – Symptomatology and Diagnosis. JAMA 1988; 259(18): 2725 – 2729).

7. Skylv G. Physical Sequelae of Torture. In: Basoglu M (Ed.). Torture and Its Consequences – Current Treatment Approaches. Cambridge University Press: Cambridge, UK, 1992. p 39 – 53.

8. Sommier F, Vesti P, Kastup M and Genefke IK. Psychosocial Consequences of Torture: Current Knowledge and Evidence. In: Basoglu M (Ed.). Torture and Its Consequences – Current Treatment Approaches. Cambridge University Press: Cambridge, UK, 1992. p 56 – 68.

9. Weinstein HM, Dansky L, and Iacopino V. Torture and War Trauma Survivors in Primary Care Practice. West J Med 1996; 165: 112 – 118.
10. Iacopino V, Ozkalipci O, Schlar C. Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (The Istanbul Protocol). Available at: http://www.phrusa.org/research/torture/index.html [Accessed 05/11/01].

11. American College of Physicians. The Role of the Physician and the Medical Profession in the Prevention of International Torture and in the Treatment of its Survivors. Ann Int Med 1995;122: 607 – 613.

12. Annas GJ and Grodin MA. The Nazi Doctors and the Nuremberg Code - Human Rights and Human Experimentation. Oxford University Press, New York, NY; 1992.

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