卷 5, 编号 4 (2019)

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.

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.

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. 

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