Sudebno-Meditsinskaya Ekspertisa最新文献

General accidental hypothermia, which leads to death, is a complex problem, the scale of which is significantly underestimated. Statistics on mortality from general deep hypothermia are underreported because the diagnosis is often established after the fact, especially if death occurs in conditions complicating the body discovery or the cause of death determination. Many cases of death, erroneously classified as cardiovascular diseases or other causes, may actually be the result of long-term exposure to cold. In such situations, especially in remote areas or in the absence of proper forensic examination, the true cause of death may remain unknown.

Objective: To describe the local signs of human death from hypothermia.

Material and methods: In order to establish additional local signs of death from hypothermia, the findings of forensic experts and personal observations on the corpses of people who died from hypothermia on land (150 observations) were analyzed, as well as the personal photo archives of A.Yu. Chudakov.

Results: The article describes uncharacteristic but very common soft tissue injuries for death from general hypothermia, including bite wounds of the fingers, abrasions, minor wounds on the back of the hands and fingers, detached nails from terminal self-digging, linear stripe-like abrasions on the face, wounds and bruises on the face and head, areas of the elbow and knee joints, which may indicate events that occurred in the terminal phase and some other data.

Conclusion: Diagnosis of death from hypothermia requires a comprehensive approach, including inspection of the accident site (place of the corpse's discovery), analysis of history, external examination, forensic investigation, histological examination, as well as toxicological and other laboratory tests. Only a comprehensive analysis of all the data allows to establish the exact cause of death and exclude other factors. The mechanisms of human behavior in cooling are complex and require further research, including the study of neurochemical processes occurring in the brain under critical hypothermia.

The article presents the study results of publications on the history of forensic medicine in the Forensic Medical Expertise journal for the 1958-2023. The data on the number of publications for the entire specified period are presented, the author's composition and their publication activities have been analyzed. The analysis of publications with classification by the same type of directionality was carried out, the most common thematic units are highlighted. The analysis of scientific texts was done in three directions: historical personality and her contribution to the development of forensic medicine, the history of the departments of forensic medicine and scientific schools, historical discoveries and events, the history of the formation of forensic medical services in Russia at various stages.

A case from expert practice, namely the death of a young man on the third day of hospitalization after heatstroke at the running competition, is presented. A clinical picture of edema and ischemia of the extremities has been revealed in the patient at admission in coma; myoglobin up to 136 803 μg /l, lactic acidosis, hepatorenal insufficiency according to laboratory test data. In hospitals, hemodiafiltration, extracorporeal membrane oxygenation and fasciotomy with striped incisions of the extremities were performed. The patient's condition progressively worsened despite the therapy and he died on the third day. Signs of cerebral edema, foci of myocyte necrosis in the muscles of the extremities, excretory nephrosis, and signs of hemorheological disorder have been revealed in forensic medical examination. Thus, the patient with hyperthermia on exertion developed rhabdomyolysis resulting in acute renal failure and cerebral edema. A factor that could influence the development of irreversible complications, namely hypersthenic type of constitution and overweight (BMI=28 kg/m²), has been established in a detailed study. This observation shows that a morphological examination of the muscles, a histological examination of the kidneys and a biochemical determination of myoglobinemia and myoglobinuria are important in case of death during physical exertion. Metabolic status and weather conditions should be considered in athletes' preparation for competition, as well as rational nutrition and hydration should be ensured to reduce the risk of mortality among sport fans.

The article describes a forensic medical examination of combined birth craniocerebral trauma in a full-term newborn, with a double, tight umbilical cord entanglement around the neck. The manifestations of the injuries in this case were: craniocerebral and spinal injuries, a fracture of the left clavicle. The connection between the injury and the use of an obstetric remedy - removal/cutting of the umbilical cord loops from the fetus's neck - has been proven.

Objective: To investigate the features of 1.4-dihydropyridine derivatives' determination in biological material in chemical and toxicological studies.

Material and methods: Liquid-liquid extraction, semi-preparative column chromatography, thin-layer chromatography (TLC) and gas chromatography with mass spectrometric detection (GC-MS) were used as analysis methods.

Results: It has been established that extraction of 1.4-dihydropyridine derivatives from biomaterial is most appropriate to be carried out by consecutive (by 30 min) infusion with two portions of acetone-acetonitrile (7.5:2.5) mixture at a mass ratio of the extracting liquid and bioactive matrix equal 2:1. The optimum regimen of 1.4-dihydropyridine derivatives chromatography in C-18 «Silasorb» sorbent column using acetonitrile-aqua (7:3) eluant was determined, that was realized in combined purification including the extraction with ethyl acetate from aqua-acetonitrile medium and column chromatography of analytes. Butanol-acetone (5:5) eluant may be used to identify analytes by TLC method («Sorbfil» plates). Additionally, the identification of 1.4-dihydropyridine derivatives can be performed using GC-MS (HP-5 ms Ultra inert (30 000×0.25 mm) column, immobilized phase is 5% phenyl-95% dimethylpolysiloxane, mobile phase is helium by characteristic retention time and ion sets in the analytes' mass-spectra. The same method was used for quantitative determination of studied compounds. Methods for the determination of amlodipine, nifedipine, nimodipine and felodipine were developed by GC-MS method in biomatrix model (liver tissue), that showed suitability to validation requirements by a number of key criteria. The maximum detectable and quantitatively determinable content levels of studied substances in biomatrix did not exceed 0.04-0.14 and 0.08-0.24 mg/g, respectively.

Objective: To determine the shortfalls of medical documents for victims with facial injuries and concussions and the related challenges during forensic medical expert assessment of the injury.

Material and methods: The medical records of the victims and the reports of forensic examination of living persons were examined.

Results and conclusion: Facial injuries with concussion account for about 20% of all examinations of living persons. The morphological essence of the described lesions differs significantly among forensic medical experts and clinical doctors. Clinicians provide an excessive or insufficiently validated diagnosis of concussion, which is not confirmed during forensic medical examination in nearly 40% of cases. Forensic medical experts could determine the nature of trauma based on the study of medical documents only in 68% of cases. The efficacy of in-person expert examinations of victims is low. Some ambiguous provisions of regulations and medical criteria for determining the severity of harm caused to human health allow for arbitrary interpretation.

The article presents the results of experimental study of the features of injuries of clothing imitators (coarse calico) and parts of the human body as a result of shots from smoothbore 12-gauge firearms (12×70) with cartridges, equipped with metal alloy and plastic bullets. The distinctive features of morphology of experimental gunshot injuries caused by bullets of different construction have been given.

Thalamus and basal nuclei are deep structures of the brain which play a crucial role in regulating consciousness level. Traumatic injuries in them occur in craniocerebral injury (CCI), post-traumatic alterations - at the 2nd stage of dislocation syndrome. Non-traumatic hemorrhages are most often located in these structures. The existing methods of the brain autopsy study have not been effective enough for their focused detailed examination.

Objective: To develop the rational and effective method of thalamus and basal nuclei autopsy examination for identification of pathomorphological changes and their characteristics.

Material and methods: The brain of 42 males and 31 females aged 18-65 years who died due to CCI at different times of post-traumatic period, as well as 22 males and 25 females aged 35-68 years who died due to various causes of non-violent death, was examined according to autopsy data. The cases were divided into 2 groups for study of the thalamus and basal nuclei: in the 1st group (69 observations) the brain was examined by traditional methods (Virchow, Pitre, Fisher), in the 2nd group (51 observations) - by own developed method.

Results: In the 1st study group hemorrhages in thalamus were found in 15% of cases, in basal nuclei - in 12%, in the 2nd group -hemorrhages in thalamus were identified in 32%, in basal nuclei - in 21% of observations. The application of newly developed method of thalamus and basal nuclei autopsy examination has shown its advisability and efficacy.

Conclusion: The method of autopsy study of the thalamus and basal nuclei has been developed and proposed for practice that will allow to increase the objectivity and evidence of forensic medical examination of the corpse.

The world literature data characterizing the problem of stillbirth are summarized and systematized in this article. We studied scientific publications of the first half of the 20th century discussing issues that are still relevant today: the feasibility of creating a unified system for consideration of the stillbirth criteria, the importance of managing pregnant women in the antenatal period, the need for comprehensive training of doctors in order to prevent stillbirth. Attention has been focused on the features of performing forensic and coroner's autopsies of fetuses and deceased newborns. The current state of the problem of stillbirth has been considered. The importance of using theoretical knowledge in the field of obstetrics and gynecology, pathological anatomy for the purposes of forensic medical practice has been noted.

Two expert reports of medical malpractice cases, in one of which there was a conclusion about the presence of a direct causal relationship with the natural course of the disease, and the other - with the incorrect actions of the doctor, were analyzed. Methodological approaches to solving such issues are discussed. It is recommended to use the logical method of hypothetical elimination of incorrect actions of medical professionals in order to avoid errors.