Кафедра судової медицини, медичного правознавства імені заслуженого професора М.С. Бокаріуса

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Forensic medical aspects of the severity of chest injuries according to the results of the examination of patients in a specialized hospital
(2024) Gubin, M.; Malykhina, O.; Voitov, E.; Serbinenko, I.; Gaynanova, V.
Closed chest trauma can cause impaired functioning of the respiratory system. Victims with closed chest trauma may be subject to forensic medical examination. The purpose of the study is to determine the severity of closed blunt chest trauma from a forensic perspective based on the results of an examination of patients in a specialised hospital to identify additional diagnostic criteria. The material for the study was the medical records of 103 inpatients of the Zaycev V.T. Institute of General and Emergency Surgery. Considering the diagnostic examination of the victims in the observation groups, the severity of the injuries was determined. Severe bodily injuries were diagnosed in 19 (18.4%) cases of closed chest injuries with acute respiratory failure and loss of part or all of an organ (lung). Injuries of moderate severity were diagnosed in 70 (67.9%) cases of closed chest trauma, mostly with rib fractures, in the absence of life-threatening injuries. Minor injuries were diagnosed in 14 (13.6%) cases of chest trauma without rib fractures with intrapleural injuries and complications or without any complications. It has been established that in the forensic assessment of closed chest injuries, additional diagnostic criteria should be considered: the presence of acute respiratory failure, the dynamics and duration of recovery of post-traumatic morphological and functional changes in injured organs, and the loss of part or all of an organ (lung).
Forensic evaluation of clinical observations of injuries of some external respiratory organs
(2022) Gubіn, Mykola; Malykhina, Olena; Voitov, Yevgen; Serbinenko, Igor
In the structure of injuries of the external respiratory system, closed chest injury occupies a leading place. Such injuries in victims may be a reason for forensic medical examinations. The aim of the work was to establish a forensic medical assessment of the severity of injuries of the respiratory system based on clinical observations of closed blunt trauma of the chest to determine additional diagnostic criteria for its seriousness. The material for the study was medical records of 126 patients of the Kharkiv Institute of General and Emergency Surgery, named after V.T. Zaitseva, who had chest injuries. According to the materials of clinical observations of closed chest injuries, the severity of injuries in the victims was assessed. In 24 (19%) cases of closed chest injuries, severe injuries were found mainly with acute respiratory failure as a life-threatening condition. In 72 (57.2%) cases of closed chest injuries, mainly with rib fractures, moderate injuries were found in the absence of danger to life. In 30 (23.8%) cases of chest injuries without rib fractures with intrapleural injuries and complications and mild chest injuries without any complications, assessed as minor injuries. It is established that in the forensic medical examination of closed chest injuries, it is necessary to consider additional diagnostic criteria: the presence of life-threatening phenomena, the dynamics and duration of recovery of post-traumatic morpho-functional changes of injured organs.
Forensic medical assessment of morphological changesat different postmortem interval
(2021) Grygorian, Edgar; Gubin, Mykola; Olkhovsky, Vasil; Shishkin, Volodymir
Purpose: The postmortem interval (PMI) evaluation is one of priorities while performing aforensic medical examination of corpse. To date, there is lack of information on morphologicalpostmortem changes of some internal organs. Considering the persistent need to develop themethod for a precise assessment of PMI, postmortem changes in these potentially informativeorgans were evaluated. The aim of study was to analyze morphological postmortem changesin prostate and uterus. Materials and Methods: histological samples of 40 prostate and40 uterine tissues (n=80) from corpses of deceased aged 18–75 years. Only cases withknown time of death were included to study, the time of death was taken from policereports. Exclusion criteria were cases of violent death, death with massive blood loss, tumorsof studied internal organs and cases when diagnosis was not made by a forensic medicalexaminer. The PMI of studied cases ranged from 1 to 6 days. Histological slides were madewith a staining by hematoxylin and eosin, x200 magnification, using Olympus ÂÕ41 andOlympus ÂÕ46 microscopes, Olympus SC50 camera. Postmortem morphological changeswere evaluated by a calculation of blank spaces percentage in microscopical structuresusing a JS-based software. Relationship between PMI and morphological changes wascalculated by the Spearman's rank correlation. Results: the average percentage of blankspaces in uterine tissues was smaller than in prostate tissues (1.99 and 9.65, respectively).The slower growing of blank spaces was in uterus. In prostate samples, a notable increaseof blank spaces was observed between 48 and 72 hours after death. After this period, theincrease slowed down and then an increase was observed again between 120 and 144 hoursafter death. In uterine samples, a slight acceleration was observed between 72 and 120 hoursafter death and then slowing down between 120 and 144 hours after death. Blank spaces inevaluated histological slides were increasing directly proportional to the PMI, a statisticallysignificant interconnection was defined (p < 0.05). Conclusions: The morphological post-mortem changes in prostate and uterus were developing at certain time frames. Blank spacespercentage, in studied histological slides, were increasing directly proportional to the PMIincrease, a statistically significant interconnection was defined. Therefore, the results ofstudy show the possibility of the evaluation of a postmortem time interval by assessing suchmorphological changes in these organs, which could be used in forensic medical cases
Main factors causing negative complications of the function of the lower limbs after receiving mechanical traumatic injuries
(2021) Sokol, Vjacheslav
The article is devoted to an important and relevant area of forensic and clinical research to clarify and implement in medical theory and practice the main factors that cause negative complications of lower extremity function after fractures and other injuries due to mechanical trauma during traffic accidents ( further - road accident) and lead to permanent disability of more than 33%. Therefore, the aim of the study was to identify the criteria that indicate the occurrence of severe consequences of mechanical injury in the form of permanent disability of more than 33%, and to determine the value of these prognostic criteria. The material of the study was 180 forensic examinations and tests and medical records of victims of road accidents. Of these, 120 examinations and research - the main group, and 60 - control. A number of current legal documents describing the concepts and types of disability have also been studied. The methods were scientific analysis of legal sources and methods of descriptive statistics of medical and forensic documentation. The results of the study allowed us to identify 8 groups of symptoms that cause the negative consequences of post-traumatic changes in the form of permanent disability of more 528 than 33%. Based on the study of these signs, prognostic criteria for modern forensic assessment of the severity of injuries burdened with loss of general ability to work in the above range were developed. The ranking of these prognostic criteria in the main group (voters) was carried out. A number of clinical and forensic features of modern forms and types of mechanical trauma of the lower extremities during an accident and the consequences of such injuries have been identified. A number of inconsistencies of by-laws regulating forensic medical examination in the field of glossary on permanent disability are shown. Conclusions and recommendations for improving the theory and practice of forensic determination of the degree of disability are given.
Forensic medical examinattion of living persons in cases of injury of the external respiratory organs
(2021) Olkhovsky, Vasil; Gubin, Mykola; Grygorian, Edgar
Background. Trauma of external respiratory organs in victims is often a reason for the referral to forensic medical examination by law enforcement. The purpose of this work was to analyze the peculiarities of formation of forensic medical expert conclusion, based on the results of determining the gravity of bodily injuries in victims with closed trauma of the organs external respiration, depending on their morphological and clinical characteristics and gravity, to find the ways to unify expert assessment. Subjects and Methods. 183 conclusions of forensic medical examination in Kharkiv Regional Expert Institution, on the cases of a closed blunt trauma of the organs of external respiration, were analyzed. Results. According to the mechanism of bodily injuries, in 171,1 (93,4 %) cases there was an impact of blunt solid objects on the neck and chest, in 11 (6 %) cases there was a compression of the neck by hands or other blunt solid objects, in 1 (0,5 %) case – a compression of the neck by hands and a loop. At the given trauma, modern experts' approaches to an assessment of bodily injuries were defined. Severe bodily injuries were defined in 17 (9,3 %) cases of trauma, with the emergence of life-threatening events such as acute respiratory failure, traumatic shock, mechanical asphyxia. Moderate bodily injuries were determined by experts in the 151 (82,5 %) cases, mostly injuries from fractures of ribs and cartilage of the larynx, at absence danger to life. Light bodily injuries were determined by experts in 15 (8,2 %) cases of mostly laryngeal injuries, complicated by its post-traumatic inflammation. The absence of unified scientific and methodological approach for the objective assessment of injuries of the external respiratory system organs has been defined. Conclusions. When conducting a forensic medical assessment of such injuries, there are cases of both underestimation and overestimation of the gravity of bodily injuries. According to the results of the performed investigation, further ways to unify morphological and clinical approaches at forensic-medical assessment of these bodily injuries were defined.
Forensic medical assessment of closed laryngeal injuries in deceased persons
(Forensic medical assessment of closed laryngeal injuries in deceased persons / V. Olkhovsky, O. Kliuiev, M. Gubin, E. Simakova-Yefremian, E. Grygorian, V. Khosha, O. Uhrovetskyi // Problems of Forensic Sciences. – 2019. – Vol. 119. – P. 201–209., 2020) Olkhovsky, Vasil; Kliuiev, Oleksandr; Gubin, Mykola; Simakova-Yefremian, Ella; Grygorian, Edgar; Khosha, Vadym; Uhrovetskyi, Oleg
the aim of the study was to conduct a morphological analysis and to characterize the injuries in cases of blunt laryngeal injury in deceased persons in order to determine the ways of improving the efficiency of forensic medical evaluation of that injury. Laryngeal injuries are often lethal. At the same time, in cases of combined lethal traumas, the larynx injury itself is not always the one causing the death. Thus, the severity of larynx injuries should be estimated precisely in examination of deceased persons. Findings of 17 forensic medical examinations in cases of fatal closed laryngeal injuries were analyzed. Forensic medical examinations were carried out directly with our participation, on the Kharkiv Regional Bureau of Forensic Examination, during 2011–2018. Scientific and methodological sources on relevant cases were analyzed. According to the mechanism of trauma: in 8 cases (47.1%) there was a shock impact of blunt solid objects to the neck, in 5 (29.4%) cases – ligature or manual strangulation of the neck, in 2 (11.8%) cases – strangulation by blunt solid objects, in 2 (11.8%) cases – combination of manual and ligature strangulation. Severe injuries were estimated in 11 (64.7%) cases of death, most of which were caused by mechanical asphyxia. Moderate severity injuries – in 6 (35.3%) cases of closed neck injury, the causal link between the laryngeal injury and the death was not established. analysis revealed the absence of clear diagnostic criteria which could allow to objectively determine a severity of laryngeal injuries in deceased persons. The ways to improve forensic medical examinations in cases of fatal laryngeal injuries were determined.
Postmortem Interval Assessment Criteria : A Retrospective Study
(2020) Olkhovsky, Vasil; Kliuiev, Oleksandr; Grygorian, Edgar; Gubin, Mykola; Simakova-Yefremian, Ella; Khosha, Vadym
Introduction, Materials and Methods : In this study, an analysis of forensic medical reports was conducted in order to define new criteria for postmortem interval (PMI) assessment, to improve the accuracy of its determination by forensic medical experts. In the study, 2972 forensic medical examinations of corpses were analyzed. The location of the corpse, Degree of fatness, Body length, Age and Histological changes of some internal organs were observed. Dynamometry method was used for Postmortem Interval (PMI) estimation. The results were calculated using Spearman rank correlation coefficient. Results : There was a significant moderate correlation of histological changes of some internal organs; weak correlation of corpse location, degree of fatness, body length; and significant very weak correlation of age (p <0.05).
Retrospective analysis of primary forensic medical examinations of the lower extremities mechanical trauma
(2020) Sokol, Viacheslav; Kolesnichenko, Vira; Protsenko, Olena
The purpose of the study was to perform a retrospective analysis of primary forensic medical examinations that established moderate severity of bodily injuries in victims with mechanical injuries of lower extremities. The study revealed the predominance of road traffic injuries (92%); 8% were falls from the own height. Road traffic injuries were characterized by a predominance of people at working age (73%); vehicle hitting a pedestrian (86%); getting injured with polytrauma (82%); formation of diaphyseal fractures of the thigh and shin (78%); the presence of comorbid diseases (61%). The authors consider it necessary to revise the existing and to substantiate new medical criteria for determining the severity of bodily injury, taking into account the features of connective and muscle tissues reparative regeneration.
Features of mechanical injuries of the lower extremities according to a forensic medical examination: a retrospective analysis
(2020) Sokol, Viacheslav; Sokol, Kostyantin; Kolesnichenko, Vira
The aim: To study the structure of lower extremities’ mechanical injuries and the reasons for an additional (commission) forensic medical examination appointment, according to a retrospective analysis. Materials and methods: research protocols were116 reports of additional (commission) forensic medical examinations of victims with mechanical trauma to lower extremities; research methods – retrospective analysis, statistical method. Reports of forensic medical commission examination were selected by random sampling, for the period February – June 2018. Results: As a result of a retrospective analysis of commission (additional) forensic medical examination, the prevalence of road traffic injuries (109; 94.0% cases) in mechanical injuries of the lower extremities was established. Domestic (5; 4.2%), work (1; 0.9%) and sports (1; 0.9%) injuries were also indicated It was found that to establish the degree of permanent disability loss according to the outcome of fractures of the femur and shin bones, commission examinations were appointed in 24.1% of cases. The main reason for the commission examinations appointment was to establish the bodily injuries presence (6.9%), as well as to establish the bodily injuries presence and their severity (62.9%) in cases of road traffic injury (lethal and non-lethal). Conclusions: The use of commission forensic medical examination is mainly related to the criminal law criteria of the preliminary investigation stage. The reason for conducting commission examinations on medical criteria is to establish the outcome of a fracture of the lower limb.
Relation of postmortem changes development and exact postmortem interval
(2020) Grygorian, Edgar; Olkhovsky, Vasil; Gubin, Mykola
Purpose: Precise postmortem interval evaluation is crucial in cases when violent types of death are suspected by a forensic medical examiner. There are different factors that could affect results of postmortem interval (PMI) evaluation by a forensic medical expert. The aim of this study was to investigate the relationship between the known postmortem time interval and the degree of particular postmortem changes development. Materials and Methods: A cross-sectional analysis of 116 forensic medical examinations of deceased persons (of them, 58 females and 58 males), in cases of non-violent death, was performed. The data about the time of death was obtained from police preliminary records provided to the examination - only the cases with known time of death were included in the study. Postmortem changes were evaluated by Total Body Score (TBS) [1] at equal time interval after death (48 hours ± 3 hours). Interconnection between postmortem changes degree and PMI was estimated using Spearman's rank correlation. Difference between sexes was evaluated using Mann-Whitney U test. Results: "Thickness of clothes" criterion reached the highest positive correlation coefficient, "ambient temperature" criterion had also a significant positive correlation. The rest of the studied criteria had very weak correlation with the development of postmortem changes. Conclusions: Several criteria had significant (p < 0.05), yet week, impact on the postmortem changes development. The other criteria were statistically insignificant.