Vol 5, No 4 (2019)

PROFESSIONAL REVIEW
MODERN CAPABILITIES OF RADIOLOGIC IMAGING IN FORENSIC MEDICINE
Kildyushov E.M., Egorova E.V., Burenchev D.V.
Abstract
This article presents the current state of the issue of diagnostic possibilities of postmortem computed tomography in forensic medicine and clinical disciplines. It was established that in foreign countries and in Russia methods that improve visualization with post-mortem CT were being developed, and correlation between the time since death and postmortem CT artifacts was examined. At present it is advisable to use post-mortem CT as an additional method of research in forensic practice.
Russian Journal of Forensic Medicine. 2019;5(4):4-8
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ORIGINAL INVESTIGATIONS
PURKINJE CELLS OF THE CEREBELLUM IN CLOZAPINE AND CLOZAPINE ETHANOL POISONING (EXPERIMENTAL RESEARCH)
Golubev A.M., Sundukov D.V., Churilov A.A., Ershov A.V., Romanova O.L., Telipov I.N.
Abstract

Objectives. Systematization of cerebellar Purkinje cell injuries to clarify the pathogenesis of combined clozapine-alcohol poisoning and to substantiate the immediate cause of death. 

Material and methods. Experimental studies were performed on 25 white outbreed rats divided into 5 groups: control, group I (clozapine 3 hours), group II (clozapine 24 hours), group III (clozapine + alcohol 3 hours), group IV (clozapine+alcohol 24 hours). Te assessment of Purkinje cell injury was performed using the classifcation of neuronal damage.

Results. In the control group of animals reversible changes in Purkinje cells prevailed: primary irritation and acute swelling (15-20%). Irreversible changes were detected in 2-5%. In case of clozapine poisoning the number of Purkinje cells with irreversible changes (shrinking, karyocytolysis, severe changes, Ghost-like cells) was increased. Te percentage of Purkinje cells with such changes was 30-40%. In case of combined clozapine-alcohol poisoning the percentage of irreversible Purkinje cells injury increased to 40-60% (especially 24 hours afer starting the study). Quantitative diferences in irreversible changes in Purkinje cells in the experimental groups were statistically signifcant if compared to the controls (p<0.05).

 Conclusion. As a result of the study the most commonly detected injuries of Purkinje cells of cerebellum in clozapine poisoning were revealed. Te most prominent damage to Purkinje cells with predominance of irreversible changes were found in cases of combined clozapine-alcohol poisoning. 24-hour duration of the experiment led to the more severe Purkinje cell injuries if compared to the 3-hour duration.

Russian Journal of Forensic Medicine. 2019;5(4):9-14
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CHARACTERISTIC OF INDICATORS OF DISCREPANCY IN THE FINAL CLINICAL AND FORENSIC AUTOPSY DIAGNOSES IN CASES OF DEATH FROM EXTERNAL REASONS IN THE MOSCOW REGION FOR THE PERIOD OF 2014–2018
Maksimov A.V., Kuchuk S.A.
Abstract

Objectives. To investigate the dynamics, structure and frequency of the discrepancy in the fnal clinical and forensic autopsy diagnoses in cases of death from external causes.

 Material and methods. We studied the materials of the Bureau of Forensic Medical Examination of the Moscow Region for 2014–2018. Te extent of examinations was 8415 cases of deaths of persons who died in hospitals of the Moscow Region and underwent the forensic examination. It was a complete research. Research methods: documentary, statistical, graphic, comparative analysis. Te quality index of intravital diagnostics was calculated. Te indicators of comparison of the fnal clinical and forensic autopsy diagnoses were analyzed for the reasons of discrepancy in diagnoses, the infuence of incorrect clinical diagnosis on the adverse outcome was established. Descriptive statistics is presented in the form of relative intensive and extensive coefcients.

 Results. As was found, in the Moscow Region in the period of 2014–2018 the proportion of discrepancy in diagnoses in cases of death from external causes decreased from 12.8 % to 9.6 %. Te percentage of discrepancy in diagnoses in cases of death from traumatic brain injury decreased from 12.9 % to 6.6 %, spinal injury from 11.4 % to 4.4 %, combined injury from 7.8 % to 3.7 %. 

Conclusion. In hospitals the Moscow region in the period of 2014–2018 diagnosis of head injury, spine, combined blunt trauma of the body was improved. 

Russian Journal of Forensic Medicine. 2019;5(4):15-19
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ALGORITHM FOR MEDICAL EXAMINATION OF ENDODONTIC TREATMENT
Iordanishvili A.К., Barinov E.K., Salmanov I.B.
Abstract

Evaluation (including within the framework of medico-legal examination) of the quality and efectiveness of endodontic dental treatment is a matter of current interest in the clinical dentistry.

Obiectives. Te aim of the work was to develop an algorithm of medico-legal examination in case of endodontic treatment, to test this algorithm in the work of the commissions of medical care quality control in the departments of therapeutic dentistry of outpatient dental clinics.

Material and methods.Te material of the study was the reports of daily activities of dental clinics of various forms of ownership (municipal, departmental, private) in 3 regions of Russia (Moscow, St. Petersburg, Rostov-on-Don), including periodic reports and reference reports, ofcial statistical reports of the activities of the examined clinics, including registration books of the work of the commissions of the quality of medical care. Tese materials were used as a source of primary statistical information. Afer grouping of the information contained in them, the main data characterizing organization, condition and quality of endodontic care were recovered taking into account nosological entities: pulpitis and periodontitis. Taking into account the medical, statistical and analytical nature of the study, the main conclusions and recommendations were formulated on the basis of a retrospective study of these materials.

Results. Based on the studies carried out and recommendations of the European Endodontic Association on provision of the standard of endodontic treatment, an algorithm for medico-legal examination of endodontic treatment was proposed. Tis algorithm allows to assess the quality and efectiveness of endodontic treatment of pulpitis and periodontitis in diferent terms (immediately afer treatment, remote period)

Conclusion. Te use of the developed algorithm in clinical practice in internal quality control of endodontic care has shown its efectiveness. A large number of clinical cases of insufcient quality of endodontic treatment and its low efectiveness in the remote period indicate persistence of the potential for claims from patients.

 

Russian Journal of Forensic Medicine. 2019;5(4):20-25
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POSTTRAUMATIC PSYCHOPATHOLOGICAL MANIFESTATIONS OF THE HEAD INJURY IN MEDICO-LEGAL PRACTICE
Solodun Y.V., Zlobina O.Y., Piskareva T.М., Ivanova L.I.
Abstract

Neuropsychopathological problems are an intrinsic part of the clinical presentation of traumatic brain injury, its sequelae and outcomes, and require special attention when evaluating the degree of severity of harm to human health. The article discusses the issues of severe psychopathological sequalae after non-severe head injury in medicolegal practice. 

Objectives. To develop additional criteria of the medico-legal diagnostics and assessment of harm to health in cases of appearance of severe posttraumatic neuropsychiatric disorders after the mild traumatic brain injury. Material and methods. Materials of the Irkutsk Regional Bureau of Forensic Medical Examination were studied. We used common scientific research methods, an analysis of the literature on the research topic, a description and analysis of the expert case.

Results. Existing conceptions and theories in understanding traumatic brain injury admit the possibility of the development of severe psychopathological manifestations lead to the neuropsychiatric disorder even in cases of mild traumatic brain injury. Practical medico-legal cases support this point.

Conclusion. Additional criteria are defined for medico-legal diagnostics and assessment of harm to health in a case of severe neuropsychiatric outcomes of mild traumatic brain injury.

Russian Journal of Forensic Medicine. 2019;5(4):28-33
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EXPERT PRACTICE
STRANGULATION BY RECOVERY – A RARE MANIFESTATION OF A RECOVERY INJURY
Windgassen М., Rößler L., Tsokos M., Oesterhelweg L.
Abstract
Recovery injuries can be misinterpreted as vital injuries during the external examination or the autopsy of a body. While usually – if the finding situation and the circumstances of recovery are known – there should be no problem for the experienced forensic pathologist to differentiate between vital injuries and recovery injuries, in some cases with missing information there might be pitfalls in the interpretation of the findings. We report a case of an unusual recovery injury which could be solved through careful reconstruction of the circumstances.
Russian Journal of Forensic Medicine. 2019;5(4):32-33
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SYPHILITIC AORTITIS WITH FATAL OUTCOME IN YOUNG AGE
Krupin K.N., Nedugov G.V.
Abstract
This report presents a case postmortem diagnosis of the syphilitic aortitis оf a 26-year-old man associated with an aneurysm of ascending aorta complicated with dissection, rupture of the aneurism and cardiac tamponade. Authors conclude about the need to include syphilis into the list of the differential diagnosis of any lymphoplasmocytic aortitis and of any ascending aorta aneurysm.
Russian Journal of Forensic Medicine. 2019;5(4):34-38
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A RARE CASE OF SPONTANEOUS RUPTURE OF THE LEFT COMMON ILIAC VEIN WHICH WAS THE LATE COMPLICATION OF CAVA FILTER INSTALLATION
Chumakova Y.V., Tereshchenkov V.A., Kislov M.A., Bulanova Е.V.
Abstract

The article is dedicated to a rare case of spontaneous rupture of the pathologically altered left common iliac vein which was a late complication of the cava filter placement. To date this complication has not been described in the national medical literature. In foreign literature only 21 cases of spontaneous rupture of the iliac vein with unclear cause were registered. The article presents a case observed in the practice of the Bureau of forensic medical examination of the Moscow region. It was found that on he background of a number of conditions (occlusion of the inferior vena cava; pathological changes in the venous wall, taking into account its anatomical location; immobilized state of the patient; lack of adequate anticoagulant therapy; predisposing factors in the form of muscle tension) spontaneous rupture of the left common iliac vein should be considered as one of the late cava filter placement complications.

Conclusion. Thus, the authors of the article have established the causes of spontaneous rupture of the iliac vein, as well as proposed the inclusion of this pathology in the official list of the late cava filter placement complications. 

Russian Journal of Forensic Medicine. 2019;5(4):39-43
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MANUAL FOR THE FORENSIC MEDICAL EXPERT
MEDICO-LEGAL EXPERTS OF THE INVESTIGATIVE COMMITTEE OF THE RUSSIAN FEDERATION: THE BEGINNING OF THE BIG WAY
Spiridonov V.A.
Abstract
The initial stage of the work organization and carrying out of medico-legal examinations in the system of the Investigative Committee of the Russian Federation is clarified. The prospects of activities of the medico-legal experts of the Investigative Committee in the light of the founding a separate expert institution are discussed.. As a result of the positive experience obtained from the work of the medico-legal experts of the Investigative Committee, the regional departments of the Investigative Committee were given the opportunity to introduce the positions of medico-legal experts. The department of medico-legal examinations was created in the department of organization of forensic science activities of the Main Department of Forensic Science (Forensic Center), the head of the department was appointed, and painstaking work was begun on selection of personnel and organization of the performing the medico-legal examinations.
Russian Journal of Forensic Medicine. 2019;5(4):44-47
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METHODOLOGICAL RECOMMENDATIONS FOR THE FINAL COMPARISON OF THE CLINICAL AND PATHOLOGICAL / FORENSIC DIAGNOSES
Zabozlaev F.G., Zairatyants O.V., Kakturskii L.V., Klevno V.A., Kuchuk S.A., Maksimov A.V.
Abstract
The Guidelines for comparing the final clinical and pathological / forensic diagnoses are a joint work of the working group of professional non-profit medical associations – the Russian society of pathologists and the Association of forensic experts, placed in the information system of the Ministry of health of the Russian Federation «Electronic rubric of clinical recommendations’ in the section «Guidelines». Presents the guidelines contain structured information on issues between final clinical and postmortem / forensic medical diagnosis: lists the terms and definitions, describes the rules for mapping of diagnoses and recommendations for determining the cause and category of a divergence of diagnoses, recommendations for the design of the matching results for further diagnoses of clinical-expert work. The purpose of the guidelines is the formation of uniform requirements for the rules of comparison of the final clinical and pathological / forensic diagnoses.
Russian Journal of Forensic Medicine. 2019;5(4):48-56
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REVIEWS
REVIEW OF THE THREE-VOLUME EDITION «MEDICOLEGAL EXAMINATION OF A CORPSE» PENNED BY DAVID DOLINAK, EVAN W. MATCHES, EMMA O. LEW (TRANSLATION FROM ENGLISH UNDER THE EDITORSHIP OF PROFESSOR V . A. KLEVNO)
Tsiatsiuyeu A.M.
Abstract
Candidate of Medical Sciences, Associate Professor A. M. Tsiatsiuyeu has reviewed the three-volume textbook «Medico-legal examination of a corpse» penned by D. Dolinak, E. W. Matches, E. O. Lew (translated from English under the editorship of Prof. V. A. Klevno), published in 2019 by the «Practical medicine» publishing house. The textbook is recommended for use by forensic pathologists, interns and clinical residents in the specialty «Forensic Medicine», and as additional literature by students of medical schools studying forensic medicine. In addition, the book can be used by law enforcement officials, courts and advocates.
Russian Journal of Forensic Medicine. 2019;5(4):57-59
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INFORMATION
CYCLES OF THE DEPARTMENT FORENSIC MEDICINE “MOSCOW REGIONAL RESEARCH CLINICAL INSTITUTE N. A. M. F. VLADIMIRSKIY” FOR 2020
Editorial a.
Abstract
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Russian Journal of Forensic Medicine. 2019;5(4):60
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AUTHOR’S INDEX OF ARTICLES PUBLISHED IN RUSSIAN JOURNAL OF FORENSIC MEDICINE, VOL. 5 – 2019
Editorial a.
Abstract
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Russian Journal of Forensic Medicine. 2019;5(4):61-63
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