医疗纠纷的法医学鉴定

目的研究医疗纠纷法医学鉴定的特点,并讨论医疗纠纷法医学鉴定的重点及难点。方法将医疗缺陷分为责任性缺陷、技术性缺陷、管理性缺陷、学科性缺陷和其他缺陷,对36件案例分别进行分类并进行统计。其中把18例由医疗事故鉴定委员会鉴定的结论与我室的鉴定结果进行比较分析,其他18例另行统计。结果36例案件中存在医疗缺陷的占86.11%,其中技术性缺陷66.67%,责任性缺陷和管理性缺陷均占25%。18例由医疗事故鉴定委员会鉴定的结论与我室的鉴定结果进行比较,医疗缺陷的认定两者有明显差异(P<0.05),对于医疗缺陷已对患者造成不良影响的认定,两者具有显著性差异(P<0.01)。结论法医进行医疗纠纷的鉴定,对医疗纠纷诉讼案件的处理起着积极的作用。目前,医疗纠纷的法医学鉴定仍存在许多问题需要进一步讨论。     

The forensic medical expertise in trauma of male genitals

A damage inflicted to genitals organs (GO) affects the copulative functions, the sperm fertilizing ability and, as a whole, the reproductive function. Injuries to the external genital organs (EGO) due to immediate trauma are more often the case in the forensic medical practice; they are less often encountered in operative interventions in organs, which are close to the prostate or those having immediate direct links with the testicles or with the cavernous bodies of the penis, i.e. in case of an indirect trauma or an mediated effect on the functions of GO. Even if there is a smallest damage to the EGO region, the man needs to consult the urologist in the out-patient or in-patient medical institution. It is always necessary to asses a degree of severity to the health both by signs of duration to health disorders and by an outcome of injury with regard for trauma severity and possible impact on the reproductive function.     

Drawbacks and new methodological approaches to forensic medical examination of sexual conditions

Drawbacks of forensic-medical examination of sexual conditions are due to problems of management and diagnosis. Updating expertise of sexual conditions means standardization, application of modern examination tools and devices, making more than one examinations, skills in examination of the man in suspected erectile dysfunction, purposeful search for sperma.     

Approaches to the improvement of forensic medical expertise in the cases of sexual crimes and doubtful gender status

The authors analyzed the results of the forensic medical expertise of the cases of sexual assaults and covert sexual abuse. Special attention is given to the peculiarities of forensic-medical expertise in the cases of veneral diseases and HIV-infection, injuries to sexual organs in women and men. The specific approaches to the examination of corpses in the cases of atypical sexual behavior or a murder supposedly committed for sexual motives are considered.     

Topical issues of organisation and implementation of forensic medical expertise

The shaped-up experience of management and implementation of expertise as applicable to civil and criminal cases and with respect to the requirements of new legislative acts was analyzed. Issues connected with composing a commission of experts, with the range of competence of forensic medical expert and of clinical practitioner, as well as with the content and form of the expert conclusions are under discussion.     

Regional forensic medical characteristics of sexual maturity

Published data on sexual maturity of women in the North are reviewed. The authors analyze the findings of their studies and the anthropometric parameters of sexual maturity recorded in Regulations of Forensic Medical Obstetrical and Gynecological Expert Evaluations (1966) and find essential differences in the values of some parameters as regards the population of the Russian European North. The authors propose revision of the current Regulations in order to define regional standards.     

The forensic medical expertise of acute local radiation trauma]

Informative diagnostical criteria of medicolegal evaluation and prognosis of corporal lesion gravity in case of acute local radiation trauma as well as algorithm of medicolegal diagnostical process concerning these lesions with reference to external radiation exposure, kind of injuring factor, differential-diagnostical signs of acute local radiation trauma are suggested. They make it possible to formulate medicolegal diagnosis and can form the basis for developing diagnostical programmes.     

Using electrophoresis for the identification of subjects in forensic medical expertise

It was proven as advisable to apply the electrophoretic method in sophisticated expertise cases for the purpose of defining the nature of objects in examinations of material evidence.