title: Vascular response to ischemia in the feet of falanga torture victims and normal controls--color and spectral Doppler findings.
abstract: OBJECTIVE
  To investigate whether signs of chronic compartment syndrome could be found in plantar muscles of falanga torture victims with painful feet and impaired gait. The hypothesis was that the muscular vascular response to two minutes ischemia would be decreased in torture victims compared to controls. On color Doppler this would be seen as less color after ischemia and on spectral Doppler as elevated resistive index (RI).
  
  
  METHODS
  Ten male torture victims from the Middle East and nine age, sex and ethnically matched controls underwent Doppler examination of the abductor hallucis and flexor digitorum brevis muscles before and after two minutes ischemia induced with a pressure cuff over the malleoli. The color Doppler findings were quantified with the color fraction (CF) before and after ischemia. On spectral Doppler the resistive index was measured once before and three consecutive times after ischemia.
  
  
  RESULTS
  Both torture victims and controls responded to ischemia with an increased CF. There was no difference between torture victims and controls. With spectral Doppler all subjects had an RI of 1.0 before ischemia. After ischemia, in nearly all subjects and all muscles the first RI was lowest, the second was higher and the third was highest indicating that the response to ischemia was disappearing as measurements were made. There was a trend that the first RI was higher in torture victims than in controls.
  
  
  CONCLUSIONS
  The study was not able to confirm the presence of chronic compartment syndrome. However, the trend in RI still supports the hypothesis. The negative findings may be due to inadequate design where the CF and RI were measured in one setting, perhaps resulting in both methods being applied imperfectly. The response to ischemia seems short-lived and we suggest that the Doppler methods may be re-evaluated with separate ischemic phases for CF and RI.
authors.affiliation: The Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark. stp@frh.regionh.dk
authors.forename: Søren
authors.initials: S
authors.lastname: Torp-Pedersen
authors.forename: Kirstine
authors.initials: K
authors.lastname: Amris
authors.forename: Christian Cato
authors.initials: CC
authors.lastname: Holm
authors.forename: Merete
authors.initials: M
authors.lastname: Kønig
authors.forename: Karen
authors.initials: K
authors.lastname: Prip
authors.forename: Bente
authors.initials: B
authors.lastname: Danneskiold-Samsøe
mesh_terms: D016022:Case-Control Studies; D005528:Foot / Q000098:blood supply*; D018409:Foot Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008297:Male; D018482:Muscle, Skeletal / Q000098:blood supply / Q000000981:diagnostic imaging; D012016:Reference Values; D012680:Sensitivity and Specificity; D014104:Torture; D015599:Trauma Severity Indices; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000209:etiology