Posttraumatic neurosensory hypoacusis in forensic medical practice

Literature data and results of epidemiological examination show that traumas play a significant role in emergence of neurosensory hypoacusis (NSHA) in young healthy population. The diagnosis of NSHA is often missed in forensic-medical examination and this may cause a social problem. Audiometric signs of NSHA were studied in subjects with trauma of the labyrinth. Pure tone audiometry results can be used for differential diagnosis of mechanical and barotraumas and as additional criteria in determination of the harm to health.     

Combined trauma and sepsis in forensic medical practice

The relationship between combined injury and sepsis is an important problem of forensic medicine. A total of 227 cases with combined injuries have been investigated postmortem at Bureau of Forensic Medical Expert Evaluations of Moscow in 1997. Sepsis developed in 9.7% cases. The studies revealed a direct cause-and-effect relationship between mechanical injuries and development of sepsis in the overwhelming majority of cases. Sepsis may develop at any period of the traumatic disease, except the first one, and the infection is prone to generalization in the remote postoperative period.     

Ascertainment of the cause and tempo of death in forensic medical practice

In order to develop a method of ascertaining a cause of death and of evaluating its tempo the authors undertook a histological study and a study of a dehydration degree in 76 cases of death due to the below reasons: mechanical trauma, mechanical asphyxia, burn shock, and carbon monoxide intoxication. Acute emphysema of lungs, lack of edemas in lungs and brain, desquamation of pulmonary macrophages, hyperemia of renal capillaries, primary urine in some glomerules, prevalence of ischemic changes with karyopyknosis in medulla and hypohydration of brain were typical of fast death. Prevalence of dystelectasis in lungs, emptying of pulmonary capillaries, evident edema of lungs and brain, desquamation of pulmonary macrophages, lack of primary urine in glomerular capsules, acute circulatory disorders of renal hemodynamics with sweating of fibrin and erythrocyte glomerules into cavities, necrotic nephrosis, pigment cylinders in renal tubules, thrombi in vessels, prevalence of chromatolysis, karyolysis and cytolysis in medulla, pronounced glial reaction as well as pronounced edema of brain and its hyperhydration were typical of slow death.     

The significance of developmental anomalies of the thyroid cartilage for the practice of forensic medical expertise]

The authors discuss developmental abnormalities of the thyroid cartilage and its injuries in blunt injuries of the neck. Basing on two cases, they describe developmental abnormalities (no joining between the superior horn and the lamina or complete absence of one of the superior horns) that during autopsies were considered, to be resultant from injuries.     

Algorhythm of making forensic medical expert examinations by medical documents in obstetric-gynecological practice

Most of the suits brought against medical professionals concern obstetricians-gynecologists. The experienced clinicians take part in commissions of experts to certify validity of diagnosis, treatment, operations, manipulations. Current state of obstetric-gynecological expertise is characterized. Algorithm of making obstetric-gynecological examinations is proposed. Criteria on forensic-medical assessment of medical care conducted in comparison with current standards of this care are formulated.     

The epidemiological characteristics of fatal subdural hematomas in forensic medical practice

A retrospective analysis of subdural hematomas is carried out: 493 in subjects dead from mechanical injuries (from files of forensic medical morgues in Tver', 1992-1994), and 37 cases with chronic subdural hematomas (from files of forensic medical morgues No. 2 and 6 in Moscow, 1995-1997). Age and sex of victims, time and circumstances of injuries, topographic and morphological features of subdural hemorrhages and their relation to concomitant injuries, and presence of ethyl alcohol in the organism are studied. The data on chronic subdural hematomas are presented. The authors emphasize the need in forensic medical studies of this condition.     

Iatrogenic conditions as an object of forensic medical studies

The author proposes an original definition of iatrogenic states and their forensic medical model based on the analysis of the causes underlying the development of these conditions. A rationale for the application of this model in the forensic medical practice is formulated.     

The forensic medical expertise of the victims of large-scale fires]

The difficulties of present-day forensic medical expert evaluation of poisonings in fires are explained by exposure of man to highly toxic compounds that form during burning of polymers. Analyzing forensic medical expert evaluations of a large number of victims dead in a large-scale fire, the authors emphasize the necessity of measuring not only dead people's blood levels of HbCO, but of some other toxic combustion products that may exert combined effects on human body. The authors think it desirable that criteria of forensic medical evaluation of combined poisoning in fire be defined.     

The diagnosis of pulmonary tuberculosis in the forensic medical study of cadavers]

Presents analysis of cases when pulmonary tuberculosis was diagnosed during autopsy by forensic medical experts. Before death the patients were not registered at tuberculosis control centres and were administered no treatment for tuberculosis.     

The structure of the conclusions in the forensic medical expertise of material evidence]

A new structure of conclusions including special chapter "Conclusion validity", which ensures their high availability for officials of legal investigation agencies is suggested. The examples of conclusion making on the basis of new form in case of blood, secretion and hair tests performed in two variants (known and unknown criminal) are presented.     

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.     

The determination of buccal epithelial cells in forensic medical cytological research]

The morphology of isolated cells of multi-layer squamous non-horny epithelium (buccal, vaginal, urethral, rectal), stained with 0.05% nigrosine solution, was under study, and the sizes of these cells and their nuclei were measured. Specific markers were detected in the buccal epitheliocytes, that permit their reliable differentiation from other epitheliocytes studied by the size of the cells and nuclei, by a characteristic structure of the cytoplasm, etc. The findings may be used for the diagnosis of the origin of isolated cells of the buccal mucosa.     

Some aspects in preparation and use of wide spectrum antiglobulin sera in forensic medical studies

Wide spectrum (polyspecific) antiglobulin sera were obtained by rabbit immunization with 10% solution of zymosan-charged globulin (product of yeast digestion with trypsin) with complete Freund's adjuvant. The resultant sera meet the international standards and can be used for forensic medical identification of serum G1m(1) group and for detecting incomplete antierythrocytic complement-fixing anti-Daffi, anti-Kell, and other antibodies in blood transfusion service.     

The selective spatial filtration of roentgenograms in the forensic medical expertise of stab-cutting wounds]

Investigation of 14 roentgenograms of skin preparations with cut-stab wounds, treated by spatial filtration method in medium and high spatial frequency modes was performed using material of 13 specific cases. This resulted in detection of disturbances of skin pattern left at the area of former skin cone in 7 cases while in 2 cases indistinct heel traces were seen. Changes in skin pattern were not recorded on roentgenograms of skin preparation of 12 experimental cut-stab wounds obtained on cadaveric skin.     

The possible use of the dielectric indices of human hair in forensic medical expertise]

Method of measuring dielectric parameters of human hair was developed. It was shown that values of relative dielectric permeability of hair may serve as objective criteria in the course of determination of their similarity.     

The modern concepts of placental pathology and its role in perinatal mortality in the context of forensic medical practice

The modern concepts of placental pathology are considered and analysed in the context of forensic medical practice. The most promising approaches to the application of fundamental knowledge of placental pathology (including morphometric methods) for the purpose of forensic medical expertise are discussed.     

Analysis of the structure of forensic chemical studies carried out in the Perm regional bureau of forensic medical expert evaluations in 1997-2000

Analysis of statistical data on forensic chemical studies carried out in the Perm Regional Bureau of Forensic Medical Expert Evaluations in 1997-2000 indicates an increased number of expert evaluations with positive results. The specific share of expert evaluations with positive results for Perm was 66.6% of the total number of evaluations. The absolute number of the detected agents in combinations with other agents increased more than 2-fold over the studied period. The number of detected agents increased 1.8 times, the rate of detection of narcotics increased sharply (6.5 times).     

法医学鉴定实践中的伦理考量

法医学鉴定的对象是人及与人相关材料,因此在法医学检案实践中需要考虑伦理问题。基于法医学鉴定中的公平正义、尊重、真相告知三大基本原则,进一步衍生出法医学检案实践活动的具体伦理要求,即法医学鉴定的称职性、对鉴定涉及案件及其当事人伦理考虑、如何处理案件检材。然而当前法医学鉴定却存在部分法医鉴定人不称职、重技术轻程序、鉴定机构选择出现争议、利益输送与利益冲突等问题。笔者针对以上问题提出相应对策,并重点讨论三大矛盾,保证法医学鉴定称职性。