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.     

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.     

Peculiarities of the forensic medical expertise of the head trauma in children

One hundred and forty (140) medicolegal reports were analyzed in cases of non-lethal trauma of the head in children and teenagers. The specificity of the clinical pattern related with the anatomic-and-physiological peculiarities of child's body was defined. The forensic-medical expertise in such damages needs an elaboration of diagnostic criteria (e.g. an interim stage in craniocerebral trauma) that would be valuable both for medico-legal experts and for neurologists; besides, there is also a need in using the modern methods of neuro-visualization.     

Development of forensic medical expertise of sexual conditions in men

The necessity of new methodological approaches in forensic medical examination of sexual male conditions are discussed basing on the analysis of questionnaire surveys of isolated groups of men and forensic medical examinations of male victims accused of sexual crimes. How to update expertise of sexual male conditions including investigations of anorectal and erectile dysfunctions in shown.     

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.     

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.