The effect of sodium hydroxide and hydrochloric acid on pig dermis. A light microscopic study.

In order to compare the dermal changes after exposure to direct current (d.c.) with changes after influence of acid and base influence, the skin of fully anaesthetized Danish Landrace pigs were exposed to acid and basic solutions. Biopsies were obtained immediately after and up to day 7 after the injury. Collagen fibres with increased affinity for eosin and irregular cross-striation in polarized light together with shrunken cells with dark stained nuclei were found just beneath the epidermis immediately after application of 1 N HCl. Immediately after exposure to 1 N NaOH dispersed collagen fibres showed increased eosinophilia and a fine densely spaced cross-striation in polarized light and vesicular nuclei were present within dermal cells. During the following days a narrow demarcation zone of neutrophilic granulocytes separated the zone containing abnormal collagen fibres from normal tissue below. Calcified collagen fibres were not observed and no other abnormal histochemical reactions were present. It is concluded that the morphology of acid induced lesions and base induced lesions shows resemblance to the morphology of anode and cathode lesions, respectively, but not to heat lesions. The reason for not finding depositions of calcium salts on collagen fibres in skin exposed to basic solutions could be a non-optimal pH in the tissue or that other electrochemical processes than shift in pH are necessary for the calcification process.

The occurrence of calcium salt deposition on dermal collagen fibres following electrical injury to porcine skin.

Deposition of calcium salts on collagen fibres has been shown to occur in cathode areas from 2 days to 2 months after exposure to direct current (d.c.) via contact knobs measuring 12 mm in diameter using energy level from 0.5 to 96 J and on day 7 after exposure to alternating current (a.c.) via pointed electrodes using energy level from 30 to 50 J. In order to determine the statistical relation of this histological observation to the type of energy applied 1095 biopsies from 49 pigs including biopsies from skin areas exposed to heat, 50 Hz a.c., 100 kHz a.c. and d.c. as well as from unexposed skin were examined. The specificity was 1.0 using calcium deposition as the test criterium. The sensitivity for cathode areas was found to vary from 0.52 to 1.0 depending on the biopsy technique and the number of days after exposure. Calcium salts on collagen fibres seem uniformly to be present in the cathode area from day 4 to 7, the positive test answer being depending on the biopsy technique. For 50 Hz a.c. the sensitivity using a pointed electrode was found to vary from 0.08 to 0.27 dependent on the number of days after exposure. For all other types of energy the sensitivity was 0.

Ultrastructural changes in dermal pig skin after exposure to heat and electric energy and acid and basic solutions.

In order to describe the ultrastructure of the histopathological changes in dermis after exposure to electrical energy, heat energy and acid and basic solutions the skin of fully anaesthetized Danish Landrace pigs were exposed to direct current, heat (80 degrees C and 450 degrees C) and acid and basic solutions. Biopsies were obtained immediately after the exposure from all types of injury. Biopsies from the cathode areas biopsies were also taken on day 1 and day 2.5 in order to describe the initial calcium deposits. Homogeneous collagen fibres without any birefringence from heat exposed areas were ultrastructurally composed of filamentous materials. Collagen fibres with fine densely spaced cross-striation from cathode areas and areas exposed to basic solutions were shown ultrastructurally to consist of parallelly arranged collagen fibrils with regular waves. It is concluded that the cross-striation of the collagen fibres observed in polarized light are due to a periodic change in the orientation of the fibres seen as waves of the fibres. The ultrastructure of dermal cells were similar to that of epidermal cells following the different types of influence. Characteristically the nuclei were condensed following heat and more electron-lucent following direct current (d.c.) and acid and basic solutions. In cathode areas and areas influenced by basic solutions the electron-lucent nuclei contained fine fibrils. The ultrastructural study supports the suggestion from light microscopic studies that the morphology of anode and cathode lesions shows resemblance to acid induced and basic induced lesions, respectively. Apatite crystals were observed on day 2.5 at the periphery of the collagen fibrils and in the matrix of elastic fibres.

The morphogenesis of electrically and heat-induced dermal changes in pig skin.

In order to establish pathological evidence in dermis for distinguishing between sequelae of electrical torture and those of other superficial injuries, the skin of eleven fully anaesthetized Danish Landrace pigs have been exposed to heat and electrical energy from either 50 Hz alternating current (a.c.) or direct current (d.c.) via 12 mm large contact knobs or via a pointed 0.5 mm large electrode (only 50 Hz a.c.). The lesions have been examined from 1 to 126 days after the injury. While heat lesions exposed to energy lower than 60 joule only gave minor changes, heat lesions exposed to more than 60 joule showed changes in both collagen fibres (basophilic or eosinophilic fibres without any birefringence or coarse cross-striation in polarized light, respectively) and dermal cells (granular cytoplasm). Areas exposed to 50 Hz a.c. via 0.5 mm. electrode showed basophilic collagen fibres and in a few biopsies on day 7 calcium salts on collagen fibres. Using 12 mm large electrodes the changes were minor, but basophilic and eosinophilic collagen fibres with no birefringence or with fine/coarse cross-striation respectively were seen. Even cells with 'vesicular nuclei' were seen on day 1 and 2 after the injury. The changes in the anode area showed resemblance to that of heat lesions (basophilic collagen fibres). Eosinophilic collagen fibres with fine densely spaced cross-striation in polarized light and 'vesicular nuclei' as well as collagen fibres with calcium salts were seen in the cathode lesions. It is concluded that the dermal changes in the cathode area are specific for electrical injury from day 1 to 14. However, earlier studies have demonstrated dermal changes specific for electrical injury at day 0 and the presence of calcified collagen fibres up to 2 months after injury. The dermal changes in anode lesions were non specific and could not be differentiated from those found in heat lesions. Alternating current lesions (50 Hz) were specific from day 1 to day 7, when the pointed electrode was used, but only in a few days when the energy was transferred via the 12-mm electrodes.

Electrically-induced collagen calcification in pig skin. A histopathologic and histochemical study.

Deposition of calcium salts on collagen fibres in skin of fully anaesthetized pigs was induced by exposure to direct current (d.c.). In biopsies obtained from cathode areas successively from day 1 to day 7 after exposure the histopathologic and histochemical changes before and after the initial deposition of calcium salts have been examined. For comparison skin sites with intradermal injected calcium hydroxyapatite crystals were studied in addition. Small areas of calcified collagen and elastic fibres were noted in viable tissue 2 days after d.c. exposure. In succeeding days the calcified areas enlarged with new deposits always more superficial and closer to the epidermis than the original calcium deposits. Preconditions for calcification appear to be (1) a pH change in basic direction and/or the electrochemical processes specific to the cathode area and (2) a viable tissue. Elastic fibres appear to have a lower calcification threshold than collagen fibres. A positive staining for glycoproteins (PAS) and glycosaminoglycans (alcian blue pH 2.5) was noted in the calcified collagen fibres simultaneously with the calcification. In succeeding days the intensity of the staining reactions increased. Whether changes in the glycoproteins, collagen and its intimately bound glycosaminoglycans precede the calcification or the staining reactions develop secondarily to this deposition is not known. However, seven days after intradermal injections of Ca-apatite crystals in pig skin small and large crystals were observed ultrastructurally without any relation to collagen fibrils, but the calcified tissue presented a positive PAS and alcian blue reaction from day 2. Thus the PAS and alcian blue stainings in this model develop secondary to the deposition of calcium salts.

Torture and its treatment.

Physical and psychological torture of political detainees and prisoners is currently practiced in more than 90 countries. Types of torture and the diagnosis and treatment of torture victims are described based on the experience of Copenhagen's Rigshospitalet.

Immediate dermal changes in pig skin after exposure to moderate amounts of heat and electrical energy.

Pig skin was exposed to approximately 80 joules of heat and electrical energy [50 Hz alternating current (a.c.) and direct current (d.c.)], respectively, under controlled conditions in order to find methods to document electrical torture. Biopsies were obtained immediately after exposure, and the morphology of the electrical lesions was compared with that of heat lesions and unexposed skin by using normal and polarized light microscopy. In areas exposed to 50 Hz a.c. and in cathode areas after d.c., where calcified collagen fibers have been found 2 days after injury, the collagen fibers showed a regular, densely spaced, cross-striation. This type of cross-striation was not found in heat or anode lesions. It was possible to blindly group all biopsies correctly with regard to influence of heat, 50 a.c. and d.c.

Psychotherapy for victims of torture.

Three groups of torture victims were studied with the aim of establishing a concept of psychotherapy for such victims. Analysis of the first group, consisting of 200 case-reports made by Amnesty International medical groups, resulted in a general outline of the psychological methods of torture and their main impact on the victims. A second group of 24 torture victims was examined by the authors, and a quantitative assessment of long-term neuropsychological complaints and a qualitative insight into these symptoms achieved. In-depth interviews with victims in the third group which, consisted of the victims from the second group and six others, together with the results from the other two groups, formed the basis of a concept of psychotherapy for torture victims.

Tracing the use of electrical torture.

With the aim of being able to trace skin sequelae to electrical torture, an interdisciplinary group of scientists (the "electrical group" of Anti-Torture Research, ATR) has performed controlled morphological studies on skin biopsies from experiments with fully anesthetized pigs. "Vesicular nuclei" in epidermis and a characteristic pattern of collagen calcification in dermis were found to be typical of electrical damage. These alterations were produced by alternating current as well as by direct current.

The effect of direct current, sodium hydroxide and hydrochloric acid on pig epidermis. A light microscopic and electron microscopic study.

Lesions in pig skin were induced by direct current, hydrochloric acid and sodium hydroxide, and the morphology of the lesions was compared in order to establish the influence of electrolysis in the electrical lesions. Both light microscopically and electron microscopically a pronounced similarity was found between cathode lesions and base-induced lesions including the presence of vesicular nuclei in both kinds of lesions. Some features were also common to anode lesions and acid induced lesions, but dissimilarities were present as well. From the results it is concluded that electrolysis in the tissue with the subsequent shift of pH, especially towards the alkaline side, is responsible for the formation of the vesicular nuclei which we repeatedly have found to be characteristic of electrical skin lesions. The shift of pH also induces the cytoplasmic feature called "white necrosis" which therefore is found more regularly in electrical lesions than in heat lesions.

Epidermal changes in heat and electrically injured pig skin. A light microscopic study of the influence of heat energy intensity and electrical current frequency.

Pigs were exposed to heat of low and high temperature and electricity of various frequences. Comparable amounts of energy were transferred in all experiments. In lesions induced by heat of low temperature granularity and/or fibrillarity of the cytoplasm were present in the epidermal cells. Lesions induced by heat of high temperature had a similar appearance, but occasionally "white necrosis", defects in the epithelium and light yellow material in stratum corneum were present. Lesions induced by 100.000 hz alternating current were segmental but otherwise microscopically often indistinguishable from lesions produced via transfer of heat of low temperature. Lesions induced by 8000 hz and 59 hz alternating current were segmental. Vesicular nuclei, "white necrosis" and yellow, clumped keratin were present in most lesions. Anode areas in direct current induced lesions showed a shrunken epidermis. The cytoplasm of the epidermal cells were often eosinophilic and homogeneous, and the nuclei were small with condensed chromatin. Occasionally, "empty" nuclei were noted. Yellow, clumped keratin was presented in all lesions. In cathode areas epidermis was of varying thickness and "white necrosis" and vesicular nuclei were present. The pathogenesis of the individual morphological features is discussed based upon theoretical concepts and the difference in morphology of the various lesions encountered in the present study as well as in other studies in this series of experiments. It is concluded that except for lesions produced via transfer of high frequency alternating current the morphology of electrical lesions is specific. Further, an alleged torture instrument was able to produce lesions similar to those observed in the experimental studies.

Tracing the use of torture: electrically induced calcification of collagen in pig skin.

Reports of the use of electrical torture are usually denied, so that there is an urgent need of diagnostic methods to distinguish the consequences of electrical torture from other superficial injuries. The 'electrical group' of Anti-Torture Research (ATR) has accordingly studied the possibility of distinguishing between the sequelae of electrical and heat injury. Among the reported differences of the two types of injuries is the occurrence in epidermis, vessel walls and sweat glands of vesicular nuclei exclusively in electrically injured skin. On the basis of experiments with anaesthetized pigs, we now report that the late sequelae of electrical injury appear to include the deposition of calcium salts beneath the area of an electrical cathode.

Epidermal changes in heat and electrically injured pig skin: a light microscopic study of the sequences in morphology.

Biopsies were obtained from heat and electrically exposed pig skin at different at different times after exposure, in order to describe the morphological sequences in heat and electrically injured skin. The work is part of a series of studies in which it is investigated whether morphological methods can be used in disclosing electrical torture. Epidermal changes in heat lesions differed from those of electrical lesions in all experiments. Heat lesions typically showed a detached epidermis with fibrillar or granular cytoplasm. In older lesions the epidermis appeared concrete. Electrical lesions showed an attached epidermis with small defects, a white, homogeneous cytoplasm, vesicular nuclei and curled, clumped keratin. The electrical lesions were rejected at day 4 or 5. The number of characteristic morphological changes in epidermis decreased with the age of the lesions. It is concluded that epidermal electrical lesions differ in morphology from heat lesions and that it is possible to evaluate the age of the lesions.

Early epidermal changes in heat- and electrically injured pig skin. I. A light microscopic study.

In order to find methods applicable for disclosing electrical torture, pig skin was exposed to heat and electricity under controlled circumstances. Biopsies were obtained immediately after exposure and the morphology of the heat lesions was compared to that of electrical lesions. The cytoplasm of epidermal cells in heat lesions appeared granular or fibrillar, while the nuclei were rather unaffected. In electrical lesions the cytoplasm appeared homogeneous often with a peculiar white colour in hematoxylin-eosin stained sections. The nuclei were either dark and shadowy or enlarged and vesicular. The keratin in electrical lesions often showed a bright yellow colour. Small defects in the epidermis were seen in some electrical lesions. Thus the morphology of electrical lesions differed markedly from that of heat lesions. Although some of these differences may be due to differences in distribution and intensity of energy, it is probable that pH shifts in the cells due to electrolysis is the main cause of the specific morphology of electrical lesions.