Forensic evaluation of cervical spine distortion injuries in non-fatal road traffic accidents: An observational study

Background. The study relevance is substantiated by the growing numbers of road vehicles and cervical spine traumas occurring among all spinal injuries. Currently, there is no common vision of the cervical trauma pathogenesis, diagnostic algorithm or treatment, which stipulates difficulties in the forensic evaluation of soft tissue injuries of the neck, especially combined with the head or spine traumas around neck, as well as certain diseases.Objectives. A study of the incidence of cervical spine distortion injuries and their clinical and forensic assessment for severity to human health.Methods. A retrospective selective single-stage trial and analysis of 32 forensic medical reports on road accident and physical injury administrative cases in 2017 (single year) have been conducted. Normally distributed data are presented as mean (M), standard deviation (SD) and percent shares. The significance of inter-share variation was estimated with Student’s t-test.Results. Cervical spine distortion injuries more frequently associated with traumas to drivers than passengers inside the salon (81.2%), especially in passenger vehicles, with front-seat travellers inflicted most often (60.0%). Cases of independent pathology were very rare. The most common were combinations with soft tissue injuries, combined blunt trauma to the head, torso and limbs, with craniocerebral or maxillofacial trauma. Cervical osteochondrosis was revealed in 18% cases. Primary diagnosis predominantly grounded on complaints and history (67%), with only 12% cases using a comprehensive neurological examination or instrumental methods. The severity was assessed in the context of concomitant injuries. Acute and moderate severity had equal rates of 6.2%, light severity — 37.5%, no damage — 9.3%. Non-qualified remained 39.8% cases due to a lack of full clinical and instrumental examination (66.7%) or the victim’s failure to appear (13.3%); 20% cases were expert-reported as uncertain for trauma circumstances and mechanism.Conclusion. Further research and systematisation of the data accumulated are necessary. The following clinical and forensic evaluation, as well as statistical analyses will facilitate common diagnostic and severity assessment algorithms to develop for mechanical soft tissue and ligament injuries of the cervical spine

ANALYSIS OF INTERACTION OF QUALITY POISONING AND QUANTITY INDICES ON THE BACKGROUND OF ETHANOL ALCOHOLIC LIVER DISEASE

We studied the correlation between quantitative and qualitative-governmental indicators for poisoning with ethanol on a background of alcoholic liver disease (110 cases). The positive and negative relation between the varying degree of alcohol content in the departments of venous and alkogolokislyayuschih activity of enzyme systems (AOFS) level alkogolemii and necro-inflammatory processes in the liver, morphological manifestations of poisoning with ethanol and the state AOFS. Revealed high negative correlation between the diameter of the portal vein, the number of blood vessels of medium caliber and the development of fibrosis

Diagnostics of Fibrosis in Alcoholic Liver Damage

Aim. In this article, the authors determine the severity (index) of histological activity (HAI) and fi brosis in various forms of alcoholic liver disease drawing on the autopsy material, as well as suggest a marker for detecting fi brosis.Materials and methods. The authors studied 110 autopsies and histopathological studies of people who died from ethanol poisoning in the setting of various forms of alcoholic liver damage (95) and traumatic brain injury – control (15). Alcohol dehydrogenase (ADH) activity was studied through histochemical methods; values were estimated through the quantitative morphometry of the histochemical reaction product using the MORFOLOG program developed at the Department for Forensic Medicine (V.A. Porodenko, 1996). Statistical analysis was performed using the STATISTICA 10 software package and a created Exсel database. In order to determine the signifi cance between two compared values, the Student’s t-test was employed. Correlations were estimated using the Spearman’s rank correlation coeffi cient (r).Results. The study revealed various degrees of histological activity and fi brosis in the setting of alcoholic steatosis, hepatitis and cirrhosis. The initial liver damage is characterised by minimal / weak activity and F0–F2 stage of fi brosis. With the progression of the pathological process in the liver, HAI is estimated as moderate and severe (F2–F4 stage of fi brosis). There is a correlation between the development of perisinusoidal and pericellular fi broses (r = –0.655), septae (r = –0.435), connective tissue in the portal tracts and around a vein (r = –0.517) and the number of medium caliber vessels in the liver, as well as between the portal vein diameter and the development of perisinusoidal and pericellular fi broses (r = 0.377). The authors noted high and moderate positive correlation between the ADH activity in zone 3 of the liver acini and the development of necroses and fi brosis, minor cholestases, expansion of the perisinusoidal spaces. The calculated index of fi brosis and ischemic liver damage correlates with its impaired morphofunctional state.Conclusion. The obtained data indicate that fi brosis develops in the early stages of alcoholic liver damage, whose severity can be assessed using the proposed method for determining the index of fi brosis and ischemic liver damage, given that it refl ects both the structural and functional state of the organ

PATOMORFOLOGICHESKY ASSESSMENT ETHANOL POISONING AMID ALCOHOLIC LIVER DISEASE

Morphological pattern of alcohol poisoning and its evaluation remains controversial issue to date. In this paper we analyzed and evaluated pathologic features ethanol intoxication in patients with various forms of alcoholic liver disease (ALD)

THE DIAGNOSIS AND TREATMENT OF PRIMARY PULMONARY HYPERTENSION: A MODERN VIEW ON THE PROBLEM

There are basic principles of diagnostics and treatment of patients with the primary pulmonary hypertension - Aersy desease. Clinical examples of this pathology, illustration of an echocardiology

Death from the introduction of Ceftriaxone in the presence of Lidocaine (case report)

In clinical and expert practice, pathological processes such as toxic reactions and anaphylaxis may develop following the introduction of the local anesthetic lidocaine; however, information about the death of children is limited and scattered. The morphological signs of these cases are non-specific, which leads to difficulty in interpreting the results of the study and determining the causes of death. This report described the death of a child following intramuscular administration of ceftriaxone in a 2% lidocaine solution. The results of the primary and commission examination of the corpse and data of repeated pathohistological examinations of a 2-year-old child are presented. The objective expert conclusion about the cause of death following the intramuscular administration of ceftriaxone in a 2% lidocaine solution was toxic effects (overdose) or anaphylactic shock, which requires assessing the sequence of the event and nature of the clinical picture, taking into account the route of drug administration, comprehensive pathohistological and morphological studies, and mandatory forensic chemical determination of the concentration of these drugs in the internal organs and blood. Morphological signs of an allergic reaction can be verified based on pathomorphological data, including changes in the target organs of anaphylaxis and pronounced hemocirculatory disorders. In our opinion, further in-depth study and systematization of available data are needed

The case of myocardial infarction the young woman through 6 months after childbirth

The article presents the main reasons for the development of myocardial infarction of young women. We gave a clinical example of this disease the young woman 29 years old through 6 months after childbirth

TYPICAL AND ATYPICAL FORMS OF CELIAC DESEASE: DIFFICULTIES IN THE DIAGNOSIS

The review analyzes materials devoted to the study of various forms of celiac disease. Particular attention is paid to the systematization of clinical manifestations and features of diagnosis of atypical forms of celiac disease. Data are given on the incidence and mechanisms of progression of disorders in the combination of celiac disease and a number of autoimmune diseases, including type 1 diabetes mellitus. This literature review promotes a better understanding of the problem of celiac disease by specialists, which will improve early diagnosis and determine the rational tactics of managing patients with different forms of the disease

CHANGE OF HEART MUSCLE PERSONS WITH ALCOHOLIC LIVER

Mortality from alcoholic cirrhosis in cases of transplantation in patients with cirrhotic cardiomyopathy (CCM) is high enough. However, the prevalence of the MSC in individuals with alcoholic liver cirrhosis, as well as alcoholic сardiomyopathy (AKMP) for various forms of alcoholic liver disease (ALD) is not fully understood. The paper presents data on changes in the heart muscle in patients with ALD

Liver pathologies in the structure of deaths from gastrointestinal diseases in Krasnodar Krai in 2014–2018

Aim. To determine the frequency of liver pathologies among the causes of death from gastrointestinal diseases in Krasnodar Krai in 2014–2018.Materials and methods. The prevalence of liver pathologies in the structure of deaths from gastrointestinal diseases was studied according to the annual reports of the Bureau of Forensic Medical Examination of the Ministry of Health of Krasnodar Krai (FME Bureau), medical certificates of death (form No. 106/U-08) issued by forensic experts and registered in the mortality monitoring database (Parus information system), and data obtained from the Medical Information Analytical Centre of Krasnodar Krai for 2014-2018.Results. Liver pathologies account for more than 50% cases in the structure of mortality from gastrointestinal diseases. More frequently, this reason caused death in 50–60 year old men and 60–65 year old women. Liver pathologies were found mainly in urban residents. It is noteworthy that, in the studied period, such deaths most frequently occurred at home, on the street, in public transport, etc.; only about 15% of patients died in hospitals. Among the registered liver diseases leading to death (ICD 10, headings K70–K77), cirrhosis of various etiologies was the leading cause, with “unspecified cirrhosis” being ranked the first place. Over the studied period, this cause of death showed a growing trend. Thus, 67.12%, 74.59%, 89.58% and 85.12% of such cases were registered in 2015, 2016, 2017 and 2018, respectively. In 2014–2016, cirrhosis and liver fibrosis (code K74), and alcoholic cirrhosis (code K70.3) were ranked the 2nd and 3rd more frequent death cause, respectively. Since 2017, alcoholic cirrhosis of the liver has occupied the 2nd place. However, over the 2014–2018 period, a decrease in the frequency of cirrhosis of alcoholic etiology was noted: its share was 10.52% of all cirrhosis in 2015, decreasing to 10.17%, 6.59%, 4.86% and 4.39% in 2015, 2016, 2017 and 2018, respectively.Conclusion. Although mortality due to gastrointestinal diseases continues to decrease, liver pathologies remain to be the leading cause in 50% of such deaths. The leading disease is cirrhosis and unspecified liver fibrosis. According to the FME Bureau, deaths from cirrhosis occur outside hospitals in more than 85% of cases. The absence of cirrhosis verification by the etiological factor during autopsy requires the development of an algorithm of action, which should include a full-fledged investigation of the corpse, subsequent histological examination, assessment of pathomorphological signs taking into account clinical and medical history data and exclusion of the viral process by conducting serological tests