[Application of biochemical research methods for solving questions of forensic medical practice]. / Primenenie biokhimicheskikh metodov issledovaniia pri reshenii voprosov sudebno-meditsinskoi praktiki.

A review of the techniques used by Nizhny Novgorod forensic physicians in studying the possibility of using biochemical methods in expert practice is presented. Changes at the molecular level in pathological conditions precede functional and morphological disorders in tissues and organs. The use of biochemical methods - in particular, the study of the concentration of myoglobin and substances of low and medium molecular weight - significantly expands the possibilities of forensic-medical ekspertise. The authors study investigated the effect of the sampling period and the storage conditions of biomaterial on the results of biochemical studies; the dynamics of myoglobin content in determining whether a victim was dead or alive at the time of injury, and how long ago the injury occurred; and the nature of ischemic myocardial damage. The possibility of using substances of low and medium molecular weight in determining the cause of death was evaluated.

[The application of the methods for the measurement of tissue pressure during the comprehensive evaluation of the state of cadaveric tissues for the purpose of forensic medical expertise].

The present paper reports the results of the application of measurements of cadaveric tissue pressure (CTP) in forensic medical thanatology for the determination of the initial position of the corpse and the identification of the visually undetectable bleeding sites on the scalp during examination at the place of its discovery. Moreover, the study of the tissue pressure parameters in the affected tissues may be used to determine the intravitality of the injury and dynamics of its prescription. The parameters of intra-organ tissue pressure suggest its dependence not only on the prescription of the death and manifestations of the postmortem processes but also on the character and extent of the pathological process in the tissues of the organ of interest; these findings can be used for the verification of various diagnostic procedures including those for the objective elucidation of the cause of the death. It is concluded that the investigations along these lines extend the possibilities for the use of quantitative parameters of CTP for the substantiation of expert conclusions based on the results of forensic medical examination.

[On the determination of the age of the unidentified corpses].

The objective of the present study was to determine the age of the unidentified corpses based on the investigation of the structure (wall width) of proximal epiphysis of the humeral bone. The results of analysis of the ongoing identification studies suggest the necessity of the development of the new methods for the determination of the human age including those based on the quantitative structural criteria for the long tubular bones. The original method proposed by the authors envisages the preparation of the stains from the frontal sawcuts of the humeral bone on the paper with the identification of the parameters of interest and calculation of the morphometric coefficients (MC). The significant differences in these coefficients suggest the possibility of using the proposed method for the purpose of identification expertise.

[The cytological possibilities for the early diagnosis of neuroleukemia]. / Tsitologicheskie vozmozhnosti rannei diagnostiki neiroleikemii.

The authors present the results of analyses of 425 samples of the cerebrospinal fluid from 67 patients with acute leukemia and from 30 ones with chronic myeloleukemia, carried out by the sedimentation method. This method permits concentration of the cells on a small site of the slide, involving the minimal injury to the cells, and thus helps obtain the cellular picture of the liquor, available for morphologic analysis. Detection in the sedimentation preparations with normal parameters of liquor cytosis of the blast cells in patients with acute leukemia and of the entire spectrum of maturing granulocytes with blasts in chronic myeloleukemia patients permits the diagnosis of the preclinical stage of neuroleukemia and thus helps detect the patients, for whom all the measures, included in the neuroleukemia prevention program, are absolutely obligatory and whose cerebrospinal fluid cellular composition should be regularly checked up.

[The cytological and biochemical aspects of studying the cerebrospinal fluid in patients with chronic myeloleukemia]. / Tsitologicheskie i biokhimicheskie aspekty issledovaniia spinnomozgovoi zhidkosti u bol'nykh khronicheskim mieloleikozom.

The investigation of cell composition and different biochemical parameters (ceruloplasmin, lactate dehydrogenase, aldolase, ferritin, beta-2-microglobulin) in cerebrospinal fluid has been performed in 37 patients with chronic myeloid leukemia at different clinicohematological stages. The age of the patients ranged from 16 to 67 years. CNS involvement has been diagnosed in 8 (21.6%) patients by clinical and cytological criteria and in 5 (13.5%) patients on the basis of changes in liquor cytograms and in biochemistry. Morphological substrate of leukemic infiltration may be represented by blast cells and cells of granulocytic line of all stages of differentiation. Direct correlation has been established between ferritin and beta-2-microglobulin levels in liquor and its cytological patterns. This permits a conclusion on possible usage of liquor concentration of beta-2-microglobulin and ferritin measurements as additional tests in the diagnosis of neuroleukemia in chronic myeloid leukemia.

[Factors influencing the serum ferritin level in acute leukemia patients before chemotherapy]. / Faktory, vliiaiushchie na uroven' syvorotochnogo ferritina u bol'nykh ostrymi leikozami do nachala khimioterapii.

Serum ferritin level was studied in 158 adult patients with different forms and variants of leukemia, and it was found to be elevated in 85.4% of cases. A number of factors influencing ferritin concentration in the blood serum have been established: a high degree of serum iron deficiency, leukemic intoxication, infectious complications (pneumonia, sepsis, necrosis, etc.), hemolytic syndrome. All these factors should be taken into consideration in evaluating serum ferritin levels in acute leukemia patients.

[Dynamics of serum ferritin level at various points in the course of acute leukemia]. / Dinamika urovnia syvorotochnogo ferritina v raznye periody techeniia ostrykh leikozov.

Dynamics of serum ferritin levels was studied in 87 adult patients with varying forms of acute leukemia at different stages of the disease development (the first attack, complete and non-complete remission, the first and second relapse, terminal stage). A direct correlation has been established between ferritin concentration and the disease course phase. It has been shown that ferritin is a universal criterion for the evaluation of leukemia process activity useful for all forms of acute leukemia: lymphoblastic, non-lymphoblastic and low-percent.

[The clinical importance of the radioimmunological determination of the beta 2-microglobulin in acute leukemia patients]. / Klinicheskoe znachenie radioimmunologicheskogo opredeleniia urovnia beta 2-mikroglobulina u bol'nykh ostrym leikozami.

The concentration of beta 2-microglobulin in the blood serum was examined in 141 patients with acute leukemia. There were 63 men and 78 women aged 14 to 78 years. Studies performed before chemotherapy was instituted revealed a statistically significant increase in serum beta 2-microglobulin in all varieties of acute leukemia as applicable to the control values. There was a considerable scattering of individual indicators of protein concentration in the serum, which did not allow the use of measurements of beta 2-microglobulin in the blood serum as a criterion for differential diagnosis in identification of certain clinicomorphological varieties of acute leukemia. A direct correlation was established between the concentration of serum beta 2-microglobulin and the phase of the disease. The data obtained indicate that the beta 2-microglobulin test is of great help for the control of remission completeness in acute leukemias and for early diagnosis of relapses.

[Beta 2-microglobulin in the diagnosis of specific involvement of the kidneys in acute leukemias]. / Beta 2-mikroglobulin v diagnostike spetsificheskogo porazheniia pochek pri ostrykh leikozakh.

Measurements of the serum and urinary beta 2-microglobulin (beta 2-Mg) concentrations in 138 adult patients with various forms of acute leukemia, which were carried out in various periods of the disease, have revealed that serum beta 2-Mg levels were two times higher in the patients with leukemic involvement of the kidneys (5.54 +/- 3.50 mg/l) than in those without renal involvement (2.77 +/- 1.07 mg/l). Consequently, urinary beta 2-Mg excretion was much higher in the patients with renal involvement than in those with intact kidneys (1.512 +/- 3.222 mg/l vs. 0.388 +/- 1.175 mg/l). Mathematical analysis has shown that the risk of leukemic involvement of the kidneys makes up 93.3 percent in acute leukemia patients with serum beta 2-Mg levels surpassing 6.0 mg/l. This permitted a conclusion on the diagnostic value of beta 2-Mg measurements for the detection of specific involvement of the kidneys in acute leukemia.

[Siderophilic erythrokaryocytes of the bone marrow at various periods during the course of acute leukemia]. / Siderofil'nye éritrokariotsity kostnogo mozga v raznye periody techeniia ostrykh leikozov.

Investigation of the iron-containing granules in erythrokaryocytes of bone marrow from 89 patients with acute leukemias at different disease periods has demonstrated that siderophilia of the nuclear elements of red blood cells depends in many respects on the function of erythropoiesis which is materially influenced by various kinds of chemotherapy (induction, consolidation, maintenance and antirelapsing). Nevertheless, since the established correlation is marked to a moderate degree, the other factors may exist that influence granular siderophilia of medullary erythrokaryocytes, particularly the distribution of iron between the leukemic tissue and erythroid cells, manifesting dissimilarly in different patterns and variants of acute leukemias.

[Siderophilic erythrokaryocytes of the bone marrow at different periods in the course of acute leukemia]. / Siderofil'nye éritrokariotsity kostnogo mozga v raznye periody techeniia ostrykh leikozov.

Investigation of the degree of granular siderophilia of bone marrow erythrokaryocytes in 180 adult patients with different patterns and variants of acute leukemia promoted the development of a new assessment criterion, a coefficient of the mean granular distribution. During the diagnosis establishment before the institution of the cytostatic therapy, the significant differences were revealed in the degree of siderophilia of erythrokaryocytes of the bone marrow in lymphoblastic and myeloblastic leukemia as were those between M5a and M5b subvariants of acute leukemias. The differences thus found can be used in medical practice as an additional differential-diagnostic test in cytochemical typing of acute leukemias.

[Erythromyelosis in the outcome of partial red cell aplasia]. / Eritromieloz v iskhode partsial'noi krasnokletochnoi aplazii.

The authors describe two women with a history of partial red-cell aplasia of the bone marrow without any remissions for 2 and 3 years, followed by the development of erythromyelosis. The latter lasted from 1 to 2 years, the total illness duration being 4 to 5 years. All the attempts to achieve remissions with the use of splenectomy, mono- and polychemotherapy with a purpose of immunosuppression ended in failure. Partial red-cell aplasia is viewed as preleukemia.