[Primary injuries of corpus callosum vessels in craniocerebral injuries]. / Pervichnye povrezhdeniya sosudov mozolistogo tela pri cherepno-mozgovoi travme.

The aim of the scientific work is to establish morphological characteristics of hemorrhages in the corpus callosum as a marker of primary vascular injuries in diffuse axonal injury (DAI) in relation to the goals and objectives of forensic examination. Changes in the structures of corpus callosum were analyzed in 45 corpses of persons with traumatic brain injury who died in hospital from DAI diagnosed according to clinical and instrumental data within 24 hours after the trauma. The changes were characterized by rectic hemorrhages (haemorrhagia per rhexin) in combination with successively developing vascular, tissue, and cellular post-traumatic reactions. These changes were not observed in the control group. The following morphological characteristics of hemorrhages were established: small focal, elongated, clearly contoured hemorrhages of different sizes, up to 4 mm long, up to 0.8 mm wide, unidirectional at an angle from the lower to upper surface of the sagittal corpus callosum section, at least three, grouped in limited areas sized up to 1.5 × 1.0 cm without clear borders. The detected hemorrhages and the course of changes give reason to consider them the result of primary traumatic effects, making them a diagnostic marker of DAI.

[Morphological markers of pathophysiological changes in the neuronal processes in the acute post-traumatic period of diffuse axonal injury]. / Morfologicheskie markery patofiziologicheskikh izmenenii otrostkov neironov v ostrom posttravmaticheskom periode diffuznogo aksonal'nogo povrezhdeniya mozga.

The purpose of the study was to establish morphological markers of pathophysiological changes in the neuronal processes of in the acute (up to 36 hours) post-traumatic period of diffuse axonal injury (DAI) for the purposes of expert practice. Histological examination of the body of corpus callosum of the corpses of 66 persons dead from DAI and of 25 persons dead from various non-violent and violent causes, excluding head trauma, was performed (control group). Morphological markers of specific pathophysiological changes in the neuronal process were established by light microscopy with the use of immunohistochemical examination in acute period DAI. Uneven contours of the processes suggested displacement of cytoskeletal elements, areas of vacuolization of the cytoplasm of the processes suggested violation of intracellular transport caused by a change of permeability with preserved integrity of the process shell without mechanical separation of the process, uneven thickness (3.9 ± 1.6 µm) of the processes, varicose and cone-shaped thickening of them was a manifestation of focal edema of the neuronal process and compression of the cytoskeleton as a result of ion-enzymatic disorders, uneven coloration, areas of fragmentary compaction of neurofilaments indicated the zones of deformation and compression of the cytoskeleton, zones of granular-lumpy decay and fibrillolysis of neurofilaments indicated destruction of the cytoskeleton. Changes in the neuronal processes are a manifestation of a polyethological general pathological process and are not a differential diagnostic criterion of DAI.

[Clinical presentation and gross appearance of diffuse axonal injury in the early post-injury period]. / Klinicheskaya i makroskopicheskaya kharakteristika diffuznogo aksonal'nogo povrezhdeniya mozga v ostrom posttravmaticheskom periode.

The objective of the study was to investigate and characterize the clinical presentation, and establish macroscopic diagnostic signs of diffuse axonal injury (DAI) in the early (up to 3 days) post-injury period. In DAI, coma develops immediately after head injury and persists for 3 days post-injury until death. The coma is accompanied by dominant primary stem neurological symptoms, hemodynamic and respiratory disturbances and does not progress to a vegetative state. Lifetime computed tomography reveals cerebral hemorrhage in 40.5% of cases. We established the macroscopic signs of head injury in DAI. For the postmortem diagnosis of DAI, a detailed macroscopic appearance of pathognomonic cerebral hemorrhages is given, which are most frequently (67.5%) localized in the corpus callosum (CC), namely in the area from its genu to the middle of the trunk (97%). A rational, improved scheme of excision of CC trunk areas for the histological study is proposed.

[Problems of forensic diagnosis of diffuse axonal brain injury in the acute post-traumatic period]. / Problemy sudebno-meditsinskoi diagnostiki ostrogo perioda diffuznogo aksonal'nogo povrezhdeniya golovnogo mozga.

The article refers to actual problems of forensic diagnostics of diffuse axonal brain injury in the acute post-traumatic period, that is of particular importance in the case of head trauma in conditions of non-evidence. To solve the existing problems, it is necessary to conduct a comprehensive study aimed at improving the diffuse axonal brain injury examination by developing a unified methodological approach to running the forensic medical diagnostics of this form of traumatic brain injury and determining the duration of the acute (up to three days) post-traumatic period.

[Methodology for forensic diagnosis of diffuse axonal injury]. / Metodologiya sudebno-meditsinskoi diagnostiki diffuznogo aksonal'nogo povrezhdeniya golovnogo mozga.

An original methodological approach for forensic diagnostics of diffuse axonal injury (DAI) was developed based on the comprehensive study results. The approach is based on the algorithm of expert actions, including utilizing the developed rational methods set to identify pathognomonic morphological features using accessible and effective histological techniques. Also, the approach includes ways of analysis and estimation of these features. The proposed methodological approach aims to provide an objective diagnosis of this type of traumatic brain injury (TBI) and establish the age of its acute post-traumatic period. The known and generally accepted definitions of DAI and TBI are clarified.

[Diagnostic mistakes in diffuse axonal brain injury]. / Oshibki pri diagnostike diffuznogo aksonal'nogo povrezhdeniya mozga.

Based on the study results it were identified and systematized the most common deficiencies and mistakes that negatively affect the diagnosis of diffuse axonal brain injury and its genesis detection in the early post-traumatic period. It makes possible to organize correctly the diagnostic process and prevent an erroneous assessment of morphological changes in the brain during the examination of traumatic brain injury.

[Forensic criteria for determining the time of diffuse axonal damage in the event of traumatic brain injury]. / Sudebno-meditsinskie kriterii diagnostiki davnosti diffuznogo aksonal'nogo povrezhdeniya mozga pri cherepno-mozgovoi travme.

OBJECTIVE: Establishing the diagnostic criteria for diagnosing of brain diffuse axonal injury duration as a separate form of traumatic brain injury. The dynamics of structural and functional changes in the neuron-gliovascular module and neuroinflammatory response revealed at the light-optical level and their diagnostically significant morphological signs established as a result of a comprehensive study that can be considered as evidence-based criteria for the diffuse axonal brain damage duration.

[The original method for corpus callosum autopsy study in the case of diffuse axonal brain injury]. / Original'nyi sposob sektsionnogo issledovaniya mozolistogo tela pri diffuznom aksonal'nom povrezhdenii golovnogo mozga.

The article offers an original method for human corpus callosum autopsy examination in the case of diffuse axonal injury (DAI) and a rational scheme for sampling its zones for microscopic examination, aimed at determining the morphological characteristics of injuries, taking into account their anatomical and topographic localization. The results of the comparative study prove the objectivity and high efficiency of the proposed approach to post-mortem diagnosis of DAI.

[Axotomy in the postmortem diagnosis of diffuse axonal brain injury]. / Aksotomiya v posmertnoi diagnostike diffuznogo aksonal'nogo povrezhdeniya golovnogo mozga.

The results of the study of the significance of axotomy in the postmortem diagnosis of diffuse axonal brain damage are presented. In the corpus callosum, two main types of changes in the processes of neurons were found: damage to the processes without mechanical rupture and axotomy. The revealed polymorphism of damage to the processes of neurons indicates the heterogeneity and staging of pathological processes caused both by the trauma itself and by developing reactive post-traumatic changes. Severe damage to the processes is secondary and not earlier than 2 days after the injury lead to axotomy, the morphological manifestation of which is retraction balls with a diameter of 15.5±6.33 µm, detected by staining with hematoxylin and eosin. Research results indicate that axotomy should not be differentiated into primary and secondary.

[Postmortem diagnostic of diffuse axonal injury considering histoarchitectonic of the corpus callosum]. / Posmertnaya diagnostika diffuznogo aksonal'nogo povrezhdeniya s uchetom gistoarkhitektoniki mozolistogo tela.

The results of studying the morphological signs of diffuse axonal injury (DAI) postmortem diagnosis in the brain are presented. It was investigated the histoarchitectonics of the corpus callosum in various types of non-violent and violent death. In the indusium griseum of the corpus callosum, neurons were identified; the features of the morphology and the interposition of the neurons processes, glia and vessels in various parts of the corpus callosum were studied. Taking into account the revealed architectonics of the corpus callosum, changes in DAI were determined. It was found that the main diagnostically significant morphological sign of DAI is hemorrhages localized in the trunk and indusium griseum on sagittal corpus callosum sections, which may be important in solving expert questions about the morphogenesis of hemorrhages in the corpus callosum.

[Determining the prescription of brain injuries based on the changes of the nucleolus organizer in astrocytes]. / Opredelenie davnosti povrezhdenii golovnogo mozga po izmeneniiam iadryshkovogo organizatora v astrotsitakh.

The well apparent signs of the proliferative reaction and activity of the nucleolus organizer in astrocytes within the zone of injury and at its periphery are considered to be the indicators of the participation of these cells in all the phases of the inflammatory and reparative processes associated with the brain injury. The objective of the present study was the evaluation of the changes in the number of the nucleoli in the nuclei of astrocytes during the acute post-traumatic period following the craniocerebral injury. A total of 26 cases of death of the men and women at the age from 36 to 50 years caused by the craniocerebral trauma were available for the examination. The tissue samples were stained with hematoxylin and eosin, based on the use of the Perls' Prussian blue staining protocol or by means of the AgNOR staining technique. The astrocytes in the regions immediately adjacent to the sites of brain injury were shown to undergo areactive necrosis during the first hours after the damage had been inflicted. The evaluation of the changes in the astrocytes required taking into consideration the influence of autolysis on the character of the signs being identified. The increase of the number of points in the astrocytes in which RNA replication occurs within days 2-4 after the injury can be accounted for by the accumulation of the granules containing silver in the cell nuclei. The cross reactions between hemosiderin and RNA await further investigations. It is concluded that the methods employed in this study may be of diagnostic significance for the purposes of forensic medical histology if used in the combination with other specialized techniques for determining the prescription of the craniocerebral injuries. The combination of the morphological and functional studies opens up the promising prospects for the investigations into the necrotic and proliferative processes in astrocytes associated with brain injuries of different origin.

[The morphological characteristic of the cerebellar cortex in the case of a burning injury]. / Morfologicheskaia kharakteristika kory mozzhechka pri ozhogovoi travme.

The objective of the present study was the development of the additional forensic medical criteria for the diagnostics of the intravitality and prescription of the burning injury making use of the morphological changes in the cerebellar cortex. A total of 82 cases of the death from the second- and third a, b-degree flame burns in 63 men and 19 women at the age from 20 to 65 years were available for the analysis. The condition of the cerebellar cortex was evaluated within 0 to 72 hours after the trauma had been inflicted. The routine histological staining technique using hematoxylin and eosin were employed as well as the Nisslin staining carried out in the combination with the immunohistochemical reaction based on the application of the antibodies against the glial fibrillary acidic protein (GFAP). In the case of death during the acute period after the burning injury, the histological study revealed a characteristic complex of the morphological features including the acute swelling of neurons, the increasing expansion of perivascular and pericellular spaces, as swell as hyperoxyphilia of microglia. The astrocytes of cortical II-III layers proved highly sensitive to tissue hypoxia as appears from their reaction with anti-GFAP antibodies. It is concluded that the results of the evaluation of the blood supply of the cerebral hemisphere cortex with the use of immunohistochemical methods may be helpful as the additional criteria for the purpose of forensic medical documentation of intravitality and prescription of the burning injury.

[A case of the fatal injury by technical electricity from a mobile device (cell phone) connected to the circuit].

The authors report a case of the fatal injury by technical electricity from a mobile device (cell phone) attached to the circuit in a moist environment as a result of the unsafe handling of the gadget (when taking the bath).

[Forensic medical evaluation of pancreatic lesions in cases of lethal hypothermia].

The objective of the present study was to evaluate changes in the human pancreas in case of lethal hypothermia (LH). Scarce data available from the forensic medical literature give evidence of considerable morphological changes in the pancreas including irregular blood filling with areas of venous hyperemia, focal spasm of arterioles, slowed down autolysis, spasm of pancreatic ducts in the absence of desquamation of their epithelium into the lumen, secretion deposited and visualized in accessory cells. Hepatitis develops despite general hypothermia. Morphological alterations in Langerhans islets and qualitative changes in the relative number of endocrinocytes remain to be assessed more thoroughly.