[Is this iatrogenic pathology or rare disease?] / Yatrogennaya patologiya ili redkaya bolezn'?

The article is devoted to the problem of diagnosis and treatment strategy of Buerger's disease rarely found in the expert and clinical practice, that is inflammatory disease of unknown etiology, affecting mainly small and medium arteries and veins of limbs. Vascular surgeons around the world have been solving this problem for many years, both in terms of timely diagnosis of this disease and its proper pathogenic treatment. The authors of the article described an expert case of Buerger's disease larvated course in 15-years-old girl, which primarily was mistakenly assessed by specialists as iatrogenic pathology of right forearm vessels in injecting aminazin solution that, according to the clinicians' opinion, led to dry gangrene formation of right wrist and its subsequent amputation. The results of the forensic histological study and retrospective analysis of all child's medical documents allowed to correctly diagnose this rare pathology but only on the stage of commission forensic medical examination in the framework of the initiated criminal proceeding against several leading medical organizations in Saint-Petersburg with a pediatric profile. The authors noted the role of routine medical manipulation in manifestation of larvated pathologic process in a teenage girl in addition to full health and well-being. The objective of present article is devoted to understanding this problem.

[Forensic medical characteristic of hanging incidents among juvenile]. / Sudebno-meditsinskaya kharakteristika sluchaev povesheniya sredi nesovershennoletnikh.

THE AIM OF THE STUDY: Was to conduct the epidemiological analysis of juveniles' deaths by hanging, registered in the Bureau of Forensic Medical Expertise, Moscow for 2017-2021 years. The number of incidents equal 61 was revealed (2.65% of whole hanging incidents for the researched period). The amount of hanging deaths among juveniles and their percent in the total quantity of deaths from this type of strangulated asphyxia increased in 2017, 2018 and 2019 years to 8 (1.6%), 15 (3.1%) and 18 (3.6%) incidents respectively; decreased in 2020 year to 7 (1.7%) incidents and increased again in 2021 year to 13 (3.0%) incidents. Juveniles died by hanging were mostly male (73.8%) aged from 15 to 18 years (63.9%). The median age for girls was 16 years (IQR 15.0-16.75) and for boys 15 years (IQR 13.0-16.5). Most of juveniles' corps were found in their place of residence: in apartments or residential houses (the whole number was 49 or 80.4%). Generally, juvenile hanging occurred between November and January (36.1% of all incidents) and in April (11.5%); less frequently were in February (1.6%), June and July (9.8%). Alcohol was found in blood of 18.2% juveniles aged from 15 to 18.

[Forensic medical characteristic of prevalence and structure of sudden juveniles' death in Moscow Region and St. Petersburg]. / Sudebno-meditsinskaya kharakteristika rasprostranennosti i struktury vnezapnoi smerti lits molodogo vozrasta v Moskovskoi oblasti i Sankt-Peterburge.

THE AIM OF THE STUDY: Was to compare the prevalence and structure of sudden death from cardiovascular diseases (CVD) in the structure of nonviolent death in Moscow Region as a representative of the large region and St. Petersburg as a city of federal importance. Frequency and structure of this parameter, as well as its dynamics were analyzed. The comparison of obtained results with data of Federal State Statistics Service was done. Nonparametric analysis of the initial data has been conducted. Clustering and visualization, based on the following parameters of initial sample, have been done: «death rate from CVD in the structure of nonviolent death¼, «morbidity rate¼, «incomes¼ and «unemployment rate¼. Correlation dependences between death rate from CVD according to the Form №42 and mentioned parameters of medical and social state of the subject have been determined. Dependences between sudden death rate from CDV and a number of medical and social parameters have been established.

[Dissection technique for organs of the neck in hanging]. / Tekhnika sektsionnogo issledovaniya organokompleksa shei pri poveshenii.

The aim of this study is to develop a comprehensive dissection technique to examine the deep structures of the neck in hanging, including extraction of the cervical spine and investigation of the removed segment with access to vertebral arteries and spinal cord. Its advantages include the unnecessity of any special instruments usage, the short period of time, which is necessary for performing dissection techniques, as well as the possible detailed examination of the spine, spinal cord and vertebral arteries. The improved dissection technique simplifies the diagnosis of injuries and increases the objectivity of the forensic medical examination in hanging.

[Arterial fibromuscular dysplasia as a factor in sudden cardiac death in young adults]. / Fibromuskulyarnaya displaziya arterii ­ odin iz faktorov vnezapnoi serdechnoi smerti lits molodogo vozrasta.

The objective of the study is to consider the problem of diagnostics of a rare vasculopathy, fibromuscular dysplasia of coronary arteries, by the case study of a 19-year-old serviceman, an athlete with sudden death occurred during slight physical exertion. After repeated histological examination as part of the forensic medical examination, the diagnosis was made: «multifocal fibromuscular dysplasia of the coronary arteries and ascending aortic arch, complicated by acute left ventricular failure.¼ This disease often manifests with the acute coronary syndrome in people of young age. Therefore, special attention was given to the macroscopic and histological features of fibromuscular dysplasia of arteries.

[Comparative analysis of the volume and structure of non-violent death in St. Petersburg and Novgorod region over the past 5 years]. / Sravnitel'nyi analiz ob"ema i struktury nenasil'stvennoi smerti v Sankt-Peterburge i Novgorodskoi oblasti za poslednie 5 let.

The purpose of the work is to study the dynamics of the volume and structure of forensic medical research on cases of non-violent death in the Russian Federation for the period from 2016 to 2020 using the example of two regions of the Federation that differ in socio-economic terms. The material for the study was the annual reports of the «St. Medical Examination¼ and «Novgorod Bureau of Forensic Medical Examination¼. It was established that during the study period in St. Petersburg and the Novgorod region, non-violent death was dominant in the structure of forensic medical examinations of corpses, accounting for about 80%. The leading place was occupied by diseases of the circulatory system and neoplasms, they were more common among residents of the Novgorod region. A positive fact was that since 2016, the residents of the Novgorod region, in contrast to the residents of St. Petersburg, there has been a trend towards a decrease in the number of deaths from diseases of the cardiovascular system. Mortality from oncological diseases increased from year to year in both subjects of the Federation. The most rare causes of death were infectious diseases and diseases of the nervous system. For both groups of diseases, higher mortality was also among residents of the Novgorod region. Both in St. Petersburg and in the Novgorod region there was a gradual decrease in the total number of cases of stillbirths and deaths of children under the age of 1 year. For the entire study period, this indicator, as for most diseases, was higher in the Novgorod region. In the year of the spread of a new coronavirus infection, mortality from most non-communicable diseases increased.

[Problems of expert assessment of a case of fatal rupture of the wall of the rudimentary horn of the uterus in ectopic pregnancy]. / Problemy ekspertnoi otsenki sluchaya fatal'nogo razryva stenki rudimentarnogo roga matki pri ektopicheskoi beremennosti.

Recently in the Russian Federation there has been a significant increase in the number of commissions of forensic medical examinations on «medical cases¼ associated with inappropriate provision of medical care to the population. The problem of investigating such crimes is one of the most difficult tasks facing law enforcement agencies. A special place among them is occupied by examinations related to maternal mortality. Bleeding is one of the main causes of maternal mortality, the share of which in Russia in 2019 was 14.5%. An illustrative example of conditionally preventable death is the case of an unfavorable outcome of a pathological pregnancy in patient A., 25 years old, which ended in a sudden spontaneous rupture of the rudimentary horn of the uterus with massive intra-abdominal bleeding. The underestimation of the results of MRI and ultrasound diagnostics led to a medical error in establishing the variant of an anomaly in the development of the uterus in patient A. and entailed the wrong tactics for managing her pregnancy under observation in a private medical organization.

[Fatal self-harm with scissors with the formation of a comminuted depressed terraced fracture of the cranial vault]. / Smertel'nye samopovrezhdeniya nozhnitsami s obrazovaniem oskol'chatogo vdavlennogo terrasovidnogo pereloma svoda cherepa.

A case from practice is presented - the infliction of fatal self-harm with clerical scissors with the formation of a comminuted depressed terrace-like fracture of the cranial vault. The given case is interesting for forensic experts, first of all, because it demonstrates the possibility of suicide with an unusual object - scissors and an area of injury that is unlikely for self-infliction - the vault of the skull.

[Morphofunctional characteristic of the microvasculature of the lung tissue in acute fatal ethanol poisoning]. / Morfofunktsional'naya kharakteristika mikrotsirkulyatornogo rusla legochnoi tkani pri ostrom smertel'nom otravlenii etanolom.

The purpose of this work is an in-depth study of main morphological features and pathogenesis of acute lung injury in cases of acute fatal poisoning with ethanol; assessment of microcirculation disorders in the respiratory system; details of the mechanisms of development of non-cardiogenic pulmonary edema. An analysis of 160 deaths of men and women aged 19 to 85 years from acute ethanol poisoning was made. Histological preparations were colored with hematoxylin and eosin according to the Van Gieson method, elastic fibers - according to Weigert. It was established that the first reaction in response to the effect of ethanol is hemodynamic disorders, then interstitial and alveolar edema develops; pronounced changes occur in endothelial cells, which lead to plasmorrhagia and hyalinosis.

Disorders of microcirculation in the mechanism of bisphosphonate osteonecrosis: preliminary study in rats.

We investigated the possibilities of angioprotection and the reduction of osteonecrosis in rats that had been given bisphosphonates. In our experiment, 27 rats were divided into three groups: Group 1 was injected with saline; Group 2 was given zoledronic acid for six weeks; and Group 3 was given zoledronic acid for six weeks, with added doses of sulodexide after three weeks. After that we constructed a model of how the teeth should be extracted. The velocity of linear blood flow in the periodontal area of an extracted tooth in rats was studied using laser and high-frequency Doppler ultrasound (with the application of the vasoactive substance acetylcholine 3% for 1min). We evaluated changes in the structure of the bony tissues of the head using computed tomography, comparing the control group with the saline group. A rapid reduction in microcirculation was detected during the use of zoledronic acid for six weeks. A smaller reduction in microcirculation was detected after three weeks of treatment with sulodexide and zoledronic acid. There was a reduction in blood flow in the mucous membranes and, to a greater extent, in bony tissue. Zoledronic acid causes significant impairment of the periosteal blood flow to the mucous membranes because of a complex of disorders, which includes both the cellular component (impaired endothelium-dependent vasodilation of the mucous membrane vessels) and by reducing the intensity of microcirculation in the mucous membranes and bony tissues. Sulodexide, however, improves the restoration of blood flow and reduces the severity of osteonecrosis.

[The peculiarities of the relationship between the effector cells of the local immune system in the broncho-vascular barrier of the breast-fed infants presenting with certain acute respiratory viral infections]. / Osobennosti vzaimootnosheniia kletok-éffektorov mestnogo immuniteta bronkhovaskuliarnogo bar'era u detei grudnogo vozrasta pri nekotorykh ostrykh respiratornykh virusnykh infektsiiakh.

The acute respiratory viral infections (ARVI) are ranked among the most widespread diseases affecting the children in the early infancy. They account for 60 to 85.4% of all infections recorded in the young children. AIM: The objective of the present study was to elucidate the peculiar features of the accumulation of the effector cells of the local immunity system and intercellular interplay in the broncho-vascular barrier of the breast-fed infants presenting with various ARVIs. MATERIAL AND METHODS: We undertook the analysis of 32 cases of infections caused by influenza A and B viruses and of the adenovirus infection verified by the immunofluorescence assay. The group of comparison was comprised of 10 children presenting with congenial heart disease in the absence of the signs of inflammatory processes in the lungs. The tissue samples were harvested from the upper lobe of the lung at the level of the lobe bronchus and a terminal bronchiola. The materials for the histological study were prepared using the Romanovsky method. The effector cells were examined in the lamina propria of bronchial mucosa and the submucous layer. The morphometric analysis included direct counting the number of lymphocytes, mast cells, macrophages, plasmocytes, eosinophils, and neutrophils with the subsequent recalculation of the data thus obtained per unit volume of the connective tissue. The results of the morphometric analysis were subjected to the statistical treatment. RESULTS: The study has demonstrated that the young children suffering from a viral infection, regardless of the type of the causative factor, experience a change in the total number and the ratio of the effector cells at all the levels of the broncho-vascular barrier.

Experimental model of osteonecrosis of the jaw in rats treated with zoledronic acid.

We have examined the development of medication-related osteonecrosis of the jaws (MRONJ) in rats with no previous accumulation of zoledronic acid in the mandible. Ten male Wistar rats (weight 350-400g) were anaesthetised with chloral hydrate 450mg/kg intraperitoneally and the first and second mandibular molars on the left side were extracted. The five experimental rats were given six injections of zoledronic acid 0.18mg/kg over the next four weeks (total dose 1.08mg/kg). Two injections were given at once as an intravenous bolus injection (0.36mg/kg). Then rats were given 4 injections (0.18mg/kg) with 1 week interval over the next four weeks, after which they observed for a further four weeks. The five control rats were injected with saline. At the end of the eighth week, the animals were killed by asphyxiation in a carbon dioxide chamber, and their bone structure was visualised using cone-beam computed tomography (CT) and Galaxis software. We then studied the mandibles histopathologically to investigate the incidence of necrosis and infiltration of inflammatory cells. The cone-beam CT images in the experimental group showed deficiencies in the bone structure in the extracted molar area of the lower alveolar ridge. The histological findings in the mandibles of the group given zoledronic acid showed necrosis and infiltration of inflammatory cells, which were not present in the control group. We conclude that the immediate effect of zoledronic acid on the bone tissue during regeneration is an important factor in the development of MRONJ, in addition to the previously reported effects of the duration of treatment with zoledronic acid.

[The functional activity of lymphocytes in the spleen and peripheral blood in association with the toxic effect of household gas].

The objective of the present work was to study the population composition and functional activity of lymphocytes in the spleen and peripheral blood of the rats exposed experimentally to the toxic effect of household gas. The study included the morphofunctional examination of the state of the immune organs and the immunological investigation of the population composition and functional activity of lymphocytes from the peripheral blood of the experimental animals. We also evaluated the activity of nucleic acids, NADH2-dehydrogenase, and 5'-nucleotidase. The study revealed the relationship between the pathological and histochemical changes and the shifts in the population composition and functional activity of lymphocytes in the spleen and peripheral blood of the rats. Specifically, the action of household gas induced by the profound inhibition of the proliferative activity of the lymphocytes, enhanced the suppressive activity of the immunoregulatory cells (T-suppressors), and altered the population composition of the effector cells in the spleen and peripheral blood. It is concluded that the impairment of the functional activity of T-lymphocytes under the influence of household gas should be attributed not only to its direct toxic action but also to the increased activity of T-suppressors.

[The myocardial histo-hematic barrier as a morphological criterion to be used for forensic medical diagnostics of alcoholic cardiomyopathy].

The author estimates the effectiveness of morphological diagnostics of alcoholic cardiomyopathy taking into consideration the general patterns of the structural and functional organization of the heart with special reference to myocardial histo-hematic barrier (HHB) the components of which are characterized by specific structural and functional properties and close relationships between them. It was shown that the morphological changes in the histo-hematic barrier reflect the range of variability of its morphological components and may be used as the indicators of its integrity and stability in the case of disorder. The study has demonstrated that the structural and functional degradation as well as decay of myocardial components may occur under the influence of both an ultrastrong acute impact and latent chronic intoxication or the diseases accompanied by rapid or slow persisting disintegration of the structural organization of the organ. The author maintains that the maximally high informative value of the assessment of the morphological criteria for alcoholic cardiomyopathy can be achieved with the use of special immunohistochemical methods allowing the concrete components of the biological structures to be identified and giving the exact location of the cellular and tissue components in the affected regions. Such an approach permits to detect the developing pathological changes at the molecular level with a high degree of accuracy and visualize the structural reorganization, if any, of each component of the myocardial histo-hematic barrier responsible for the lesions associated with alcoholic cardiomyopathy.