Pathomorphology of the endocardium and myocardium in the heart injury

Light, polarization, luminescent microscopy, phase contrast, special staining methods and scanning electron microscopy were used for studying sections and fragments of the endocardium and myocardium from 123 patients who had died of heart contusion and ischemic heart disease and from 50 rats with experimental heart contusion. The morphological classification of heart contusion and differential-diagnostic table of myocardial alterations due to contusion of the heart and ischemic heart disease are proposed to facilitate pathomorphological diagnosis of heart contusion. The classification of pathomorphological signs in heart contusion is presented.     

Fatal poisoning with blue vitriol

Cases of fatal poisoning with cupric compounds are relatively rare in everyday life and are not covered much in forensic literature. A case was encountered of fatal poisoning with a blue vitriol solution introduced into the uterine cavity in order to interrupt a pregnancy. A 39-year-old woman brought to the hospital by ambulance complained of pain in the lumbar region and profuse bloody genital discharge, which had appeared 3 days earlier. She believed she was 2 months pregnant and denied artificial interruption of the pregnancy. Upon examination, her condition was grave: a weak pulse of 80; blood pressure 100/60. The abdomen was soft, the liver and spleen not enlarged. Pasternak symptom was negative. The uterus was soft, painless and enlarged to 9 weeks of pregnancy. The uterine cervix was clean, the orifice closed. Discharge was profuse and bloody. The diagnosis was that she was 9 weeks pregnant and had a missed criminal abortion. Scraping out the uterus and corresponding therapy to control bleeding were ineffective. An operation was performed--extirpation of the uterus. However, despite the steps taken, the bleeding did not stop, and the patient's condition continued to worsen. 10 hours after being admitted to the hospital, she died. During forensic investigation, diffused, violet-colored cadaverous spots were discovered. Extensive subcutaneous hemorrhage was detected around the areas of injection. The skin covering was edematous; when pressed with a finger, areas of depression remained. There was about 250 ml of watery blood in the abdominal cavity. Internal organs were anemic. There were multiple subpleural, subepicardial, subcapsular, intraorgan and intramuscular micro- and macro-punctate hemorrhages; bleeding into the mucosa of the gastrointestinal tract and urinary tracts; and cerebral and pulmonary edema. Forensic histological examination showed acute circulatory disturbance with perivascular and peridiapedetic hemorrhage; concentrations of aggregated and hemolyzed erythrocytes in the small vessels and capillaries; cerebral, pulmonary and stromatic edema. In the kidneys there was coaugmentation of renal glomeruli; epithelial necrosis of part of the coiled ducts; lower epithelium in places had pigment grains; primarily in openings of straight ducts there were pigment cylinders; extreme plethora of the surrounding area, and infiltration from annular cells and polynuclears. Forensic chemical analysis showed 12.8 mg of copper; 6.6 mg in the uterus and 5.6 mg in the kidneys. From data obtained it can be concluded that the patient died from cupric compound poisoning, complicated by interruption of the pregnancy and uterine hemolytic hemorrhage. It was later established that during the month before being admitted to the hospital the patient introduced a solution of blue vitriol into the uterine cavity to interrupt the pregnancy.     

Forensic-medical assessment of pathomorphological changes in the myocardium in blunt chest trauma with an isolated heart contusion

A total of 37 autopsy cases were divided into two groups. Group 1 consisted of 17 victims who had died of closed blunt trauma of the chest with isolated heart contusion made by fists, feet in shoes. Group 2 (control) consisted of 20 cases of sudden death of ischemic heart disease because of atherosclerotic cardiosclerosis. Fragments of the heart containing endocardium were studied on the microscope JEIL-SM200 (Japan). Endocardium pathomorphology was represented by relief changes of the endocardium, structural arrangement of separate groups of muscular fibers above the endocardium surface, hemorrhages and blood clots, endotheliocyte desquamation, prelacerations, lacerations and destruction of the endocardium.     

Unfavorable outcome of medical service: study of the problem in forensic medicine

The main tendencies in the development and study of the problem of unfavorable outcome and expert assessment of quality of medical aid were examined. Russian and foreign forensic medicine and juristic practice were compared. A combined approach to improve of forensic medical expertise and to prevent delinquencies of medical stuff was proposed.     

Morphofunctional interaction of adrenal zones in acute lethal carbon monoxide poisoning in people with alcoholic intoxication

Morphological examination of human epinephroses at acute lethal poisoning with carbon monoxide against a background of alcoholic intoxication was done. Acute lethal poisoning with carbon monoxide decreases effect of alcoholic intoxication upon morphofunctional state of epinephroses and disorders characteristics of interzonal interaction. Interaction between zones of one epinephros recedes but interaction between both glands increases.