Forensic medical assessment of subendocardial hemorrhage in acute blood loss

A retrospective analysis of forensic autopsy protocols for 240 victims who died of acute blood loss aged 17-55 years (186 male and 56 female corpses--76.8 and 23.2%, respectively) has shown that appearance of Minakov's spots (MS) depends on duration of the terminal period. Subendocardial hemorrhages occurred most frequently (61.5%) in the terminal period up to one hour. The terminal period for several minutes was associated with MS appearance in 27.5% cases, for several hours--in 6.6%, for 24 hours and more--in 4.4%. MS incidence rate did not correlate with the group of the study, blood loss volume, severity of alcohol intoxication.     

Forensic medical diagnostics of acute and chronic alcohol intoxication

The principal characteristics and results of experimental studies on the problem of acute and chronic alcohol intoxication are presented. The mechanisms of toxic action of ethanol and acetaldehyde are considered with special reference to the comprehensive qualitative estimation of these toxicants and their pathomorphological effects in the target organs. The influence of ethanol-oxidizing enzyme systems in the brain on the development of alcohol tolerance is illustrated. The mechanisms of hormonal regulation via the hypothalamic-pituitary-adrenal axis in the case of exogenous alcoholemia are considered. The dependence of pathological morphological changes in the brain, hypophysis, and adrenal glands on the stage and severity of alcoholic intoxication has been elucidated. Criteria for the morphological and histochemical evaluation of the degree of alcohol-induced lesions and the severity of abstinence syndrome have been developed. The role of alcohol effects in tanatogenesis associated with alcohol-induced diseases is discussed.     

Forensic medical differential diagnosis of craniocerebral trauma in children

It is emphasized that history, complaints, a comprehensive neurological examination, craniography are not often sufficient for differentiation between brain concussion and mild brain contusion in children because of specific characteristics of craniocerebral trauma (CCT) in such patients. To make an adequate forensic medical diagnosis of CCT in children, it is necessary to take into consideration anatomophysiological peculiarities of a child, biomechanical conditions of the brain injury, to apply modern methods of neurovisualization (ultrasonography, computed and MR imaging), to follow up brain function with quantitative electroencephalography. Improvement of differential forensic-medical assessment of CCT severity in childhood should be made according to the principles of evidence-based medicine.     

Forensic medical estimation of acute blood loss based on morphologic and functional changes in the internal organs

The objective of the present work was to obtain histological and morphometric characteristics of internal organs available for forensic medical examination from 236 corpses of subjects aged between 23 to 48 years whose death was caused by acute blood loss following a mechanical injury and concomitant alcohol or drug intoxication. Diagnostic signs of acute blood loss have been identified that can be used by forensic medical experts to estimate the length of the terminal period and reveal characteristic features of blood loss associated with alcohol and drug intoxication.     

Forensic medical diagnostics of nitrate and nitrite intoxication

Nitrates and nitrites, accumulating in toxic concentrations in soil, plants, water and foodstuffs, can cause lethal intoxication. The method of isolation, identification and quantitation has been elaborated for their diagnosis. It is based on the isolation of water and subsequent chromogenic test plus photoelectrocolorimetry.     

The forensic medical assessment of the micromorphology of brain stem hemorrhages in craniocerebral trauma

Microscopic features of primary and secondary hemorrhages in the stem portion of the brain in craniocerebral injuries are described. Criteria of differential diagnosis between primary and secondary hemorrhages in the stem in subjects dead during 24 h after isolated and combined craniocerebral injuries are defined. The forensic medical significance of differential diagnosis of hemorrhages in the stem for the solution of many expert problems is evaluated.     

外伤与流产关系的法医学鉴定

外伤后流产的案例在法医鉴定工作中屡见不鲜，而外伤与流产之间的关系及外伤的参与度问题常常是案件争论的焦点。一方面流产受较多因素影响，尤其是早孕期发生率高，另一方面案情具有复杂性和待推定的特点如外力未直接作用于腹部，外伤轻微通常不至于引起流产、流产儿出现畸形，案情不确定或资料不完整等情况给外伤后流产鉴定带来一定难度。通过对证实已孕、外力作用方式作用机制、伤后症状体征出现的时间特点、孕妇自身流产史及病理基础、流产物病理检查相互佐证分析流产与外伤的关系，得出合理结论。     

外伤与流产关系的法医学鉴定

外伤后流产的案例在法医鉴定工作中屡见不鲜,而外伤与流产之间的关系及外伤的参与度问题常常是案件争论的焦点。一方面流产受较多因素影响,尤其是早孕期发生率高,另一方面案情具有复杂性和待推定的特点如外力未直接作用于腹部,外伤轻微通常不至于引起流产、流产儿出现畸形,案情不确定或资料不完整等情况给外伤后流产鉴定带来一定难度。通过对证实已孕、外力作用方式作用机制、伤后症状体征出现的时间特点、孕妇自身流产史及病理基础、流产物病理检查相互佐证分析流产与外伤的关系,得出合理结论。     

Diagnosis of acute intoxication with ethyl alcohol in expert practice

Significant chemical and biochemical signs of acute alcoholic intoxication are considered tanatologically. A complex approach to diagnosis of acute poisoning with ethyl alcohol is proposed.     

眼球钝挫伤后视网膜脱离的司法鉴定

目的分析眼球钝挫伤后视网膜脱离在法医临床学眼损伤及伤残鉴定中的致伤原因及因果关系。方法研究112例眼球钝挫伤后视网膜脱离案例,对其中视网膜裂孔类型、外伤至视网膜脱离时间、合并其他损伤或疾病进行分析。结果本组案例锯齿缘离断4.28%,黄斑裂孔12.50%,其他部位的裂孔(<90°)56.25%,巨大裂孔(>90°)5.00%,未发现裂孔的增殖性玻璃体视网膜病变(PVR)性视网膜脱离11.6%,其中45眼有不同程度的PVR。外伤至视网膜脱离的时间以1周～2个月为常见(61.60%)。合并中高度近视者83.93%,合并玻璃体混浊者52.68%。外伤与视网膜脱离存在直接因果关系者41.07%,存在间接因果关系者52.68%,外伤与视网膜脱离难以联系者6.25%。结论视网膜脱离与多种危险因素有关,外伤与视网膜脱离之间因果关系的分析是法医学眼损伤及伤残鉴定的重要内容。     

Forensic medical assessment of the validity of medical risk

The notions of an unfavorable outcome as accepted in medical practice as well as those of defected medical care and of iatrogeny are presented in the paper alongside with examples from forensic medical practice. An algorithm is suggested for the thanatogenetic analysis applicable to detection and evaluation of the cause-and-effect relations between the therapeutic-and-diagnostic measures, on the one hand, and the above outcome, on the other hand. Risk criteria are substantiated with reference to medical practice. Finally, a objective assessment scheme is suggested to confirm that the diagnostic and treatment tools, related with a higher risk, were justifiable.     

非法行医的法医学鉴定1例

我国刑法三百三十六条规定的非法行医罪是指未取得医生执业资格的达到刑事责任年龄，具备刑事责任能力的自然人明知自己的行为可能造成危害社会的后果而放任该后果的发生心态而行医且情节严重的行为。边疆侵犯了国家对医疗卫生行业的管理秩序和广大人民生命健康权。现将笔者近期所遇的非法案例报导于后（犯罪嫌疑人已逮捕），借此探索和解决当前的医疗卫生秩序。     

非法行医的法医学鉴定1例

我国刑法三百三十六条规定的非法行医罪是指未取得医生执业资格的达到刑事责任年龄 ,具备刑事责任能力的自然人明知自己的行为可能造成危害社会的后果而放任该后果的发生心态而行医且情节严重的行为。边疆侵犯了国家对医疗卫生行业的管理秩序和广大人民生命健康权。现将笔者近期所遇的非法案例报导于后 (犯罪嫌疑人已逮捕 ) ,借此探索和解决当前的医疗卫生秩序。案　例 :2 0 0 1年 10月 3日晚 ,圈龙乡灯塔村 3级村民杨某某 (女 ,2 2岁 )第一胎足月孕临产 ,村“接生员”左某某 (未经培训也无合格证 )用“丰谷酒”搓手后并未消毒产妇会阴部就…     

头部创伤后精神障碍的司法鉴定(附34例分析)

目的 研究头部创伤和精神障碍的关系及其伤情评定等相关问题。方法 ３４例头部创伤１年后出现精神障碍的鉴定案例，分为车祸组和殴伤组，对两组有关数据进行卡方检验。结果 车祸组出现明显昏迷者及具有明确神经系统体征者显著多于殴伤组，殴伤者出现痴呆样表现者多于车祸组，两组出现精神病性症状、社会功能严重缺陷或丧失的例数没有显著差异。结论 头部创伤严重程度和精神障碍的严重程度及后果不成比例，在伤情评定时对精神功能     

头部创伤后精神障碍的司法鉴定(附34例分析)

目的研究头部创伤和精神障碍的关系及其伤情评定等相关问题。方法34例头部创伤1年后出现精神障碍的鉴定案例，分为车祸组与殴伤组，对两组有关数据进行卡方检验。结果车祸组出现明显昏迷者及具有明确神经系统体征者显著多于殴伤组，殴伤者出现痴呆样表现者多于车祸组，两组出现精神病性症状、社会功能严重缺陷或丧失的例数没有显著差异。结论头部创伤严重程度和精神障碍的严重程度及后果不成比例，在伤情评定时对精神功能缺陷及丧失这一重要因素应充分加以考虑。