卷 5, 编号 2 (2019)

Purpose of research: To study methodological, organizational and normative problems of comparison of final clinical and pathological-anatomical diagnoses in the Russian Federation on the basis of a review of domestic and foreign publications.

Abstract: Clinical and anatomical comparisons remain the most important function of quality control of medical and diagnostic work. Cases of divergence of diagnoses should be the subject of professional discussion in the medical community with the adoption of appropriate administrative measures to address deficiencies in the provision of medical care. Currently, there is no adequate regulatory regulation of the issue of comparison of clinical and pathological-anatomical diagnoses. This gives rise to many problems, including the subjectivism of the pathologist in the interpretation of the actions of the clinician, the permanent threat of criminal liability of medical workers for misdiagnosis. Penalties for discrepancies in diagnoses imposed by the Сompulsory Health Insurance Fund lead to an artificial underestimation of the divergence of diagnoses in medical organizations and to incorrect statistical accounting. The underestimation of the role of comorbid diseases and the lack of clear norms of their use in the diagnosis create difficulties in the correct assessment of the disease tanatogenesis, limits the analysis of morbidity and mortality for multiple reasons and entails the loss of some of the available information. 

The article presents the results of the analysis of the dynamics of the discrepancy between the final and forensic diagnoses in the Moscow region in cases of death from diseases for the period 2014–2018. The scope of the study was 3114 cases of deaths in hospitals of medical organizations and aimed at forensic research to determine the cause of death. The study found that in the Moscow region over the past five years there has been an improvement in the diagnosis of diseases of the circulatory system, respiration, digestion, tumors and tuberculosis. In the analyzed period of time there was a decrease in the specific weight of the discrepancy of diagnoses in cases of death from diseases from 63.7 % to 48.4 %.

The article analyzes the data of autopsy and pathohistological examination of persons who died from ethanol poisoning against the background of various forms of alcoholic liver damage – adaptive hepatopathy (AGP), steatosis (AS), hepatitis (AG), cirrhosis (AC); assesses the morphological changes of the liver. New data on localization, character, degree of steatosis and fibrosis in liver acinuses were obtained. The results of the study can be used as additional criteria for the diagnosis of acute and chronic ethanol intoxication, which allows to objectify the expert conclusions in the production of forensic medical examination (research) of the corpse.

The article presents the first national experience of using pre-sectional CT-research in forensic medical expert practice. The first results of implementation of virtopsy in thanatological practice of the Bureau of Forensic Medical Expertise of Moscow Region are presented.

The article is devoted to the rare occasion of death from ingestion of pointed metallic objects damaged internal organs. Highlight clinical and pathological feature of manifestation of injury of stomach, liver, pancreas, heart, with the development of inflammatory complications.

The article deals with the issue of detection of rocuronium in biological objects. The analysis was performed by high-performance liquid chromatography / mass-spectrometry with “electrospray” ionization. We have a case of forensic practice.

Article is devoted to questions of the organization of the training process and the analysis of efficiency and quality of training of students depending on various ways of the organization and management of process of educational cognitive activity on classes in the subject “Medicolegal Research of a Corpse”.

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