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

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Forensic Medical Examination of Severity at Closed Injuries of the Chest According to the Materials of the Specialized Clinic
(2023) Olkhovsky, Vasil; Gubin, Mykola; Khyzhniak, Volodymyr; Simakova-Yefremian, Ella; Polianskyi, Anton
Introduction: A closed chest injury is a frequent type of damage to the organs of the external respiratory system. Victims with such an injury may become the object of a forensic medical examination. The aim of the work was to determine the severity of closed blunt trauma of the chest based on the materials of a specialized clinic in order to determine additional diagnostic criteria for the severity of such an injury. Materials and Methods: 123 medical cards of inpatients department, patients with chest injuries, who were treated at the Kharkiv Institute of General and Emergency Surgery named after V.T. Zaitsev. Forensic evaluation of closed injuries of the chest organs was carried out according to the degree of severity of physical injuries based on the materials of clinical observations. Results: Severe injuries were found in 22 (17.9%) cases of injuries with the occurrence of a life-threatening phenomenon, namely, acute respiratoryfailure. Injuries of medium severity were found in 71 (57.7%) cases of chest injuries, mainly with rib fractures, due to the absence of danger to life. Mild injuries were found in 30 (24.4%) cases of chest injuries without rib fractures with intrapleural injuries and complications or mild chest injuries without any complications. Conclusions: It was determined that additional diagnostic criteria for closed injuries of the chest, which must be taken place when determining the severity of physical injuries, should be considered: dynamics and duration of restoration of post-traumatic morpho-functional changes of injured organs, loss of part or all of the respiratory organ (lungs), occurrence of life-threatening phenomenon.
Forensic medical determination of severity of chest injuries with thorax trauma
(2022) Gubin, Mykola; Olkhovsky, Vasil; Grygorian, Edgar
Background. Closed chest trauma with rib fractures is a common injury to the external respiratory system. Victims with such an injury may be subject to forensic examination. The aim of the study was to determine the severity of injuries in patients with closed chest trauma with violation of the integrity of the costal skeleton, treated in a specialized surgical hospital, to establish additional criteria for forensic diagnosis of such trauma. Materials and Methods. 71 medical cards of inpatients, patients with chest injuries who were treated at Kharkiv Institute of General and Emergency Surgery named after V.T. Zaitsev were analyzed. A forensic medical evaluation of closed chest injuries with rib fractures was performed according to the severity of injuries according to clinical observations. Morphological and clinical approach was used to determine severity of injuries. Results. Severe injuries were found in 14 (19.7%) cases of injuries, mainly with the occurrence of a life-threatening phenomenon, namely acute respiratory failure. Moderate injuries were found in 57 (80.3%) cases of chest injuries with rib fractures in the absence of danger to life. Conclusions. It is established that in the available scientific and methodological literature there are no diagnostic morpho-clinical signs for qualitative forensic assessment and prediction of the final results of closed chest injuries, there are different views on forensic assessment. It is determined that when applying the morphological and clinical approach of forensic assessment, additional diagnostic criteria for closed chest injuries, should be considered when determining the severity of injuries: dynamics and duration of recovery of post-traumatic morphological and functional changes of injured organs. or the entire respiratory system (lungs), the occurrence of lifethreatening phenomena. The ways of further improvement of forensic diagnostics in the assessment of these injuries by the degree of their severity are identified.
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
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).
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.
Forensic Examination of Living Persons with Blunt Trauma of Some External Respiration Organs
(2019) Olkhovsky, Vasil; Kliuiev, Oleksandr; Gubin, Mykola; Simakova-Yefremian, Ella; Khosha, Vadym
Based on retrospective morphological and clinical analysis of archival materials of Kharkiv Regional Bureau of Forensic Medical Examination, the frequency and types of injuries of some external respiration organs were determined at the examination of living persons. Peculiarities of forensic expert evaluation in determining the severity of bodily injuries associated with injuries of external respiration organs were described. Ways of improving the quality of forensic expert diagnostics of specified trauma were determined.
Forensic medical examination in cases of non-lethal larynx traumas
(2019) Olkhovsky, Vasil; Gubin, Mykola; Grygorian, Edgar
Victims with non-fatal laryngeal trauma become the object of forensic medical evaluation of the severity of bodily injuries in alive persons, carried out during pre-judicial and judicial investigation. The purpose of the study was to provide morphological and clinical analysis and characteristics of bodily injuries in cases of blunt laryngeal trauma in forensic medical examination of alive persons, to determine ways to improve the effectiveness of forensic medical diagnosis of the specified injury. Subjects and Methods. The study involved morphological and clinical analysis of 47 forensic medical expert conclusions in the leading forensic medical examination institution of Kharkiv region. Results. Frequency and types of blunt traumas of the larynx at examination of alive persons were determined. Specific features of forensic medical expert evaluation of bodily injuries severity in alive persons with blunt traumas of larynx were determined. Severe bodily injuries were defined in 3 cases (6.4 % of cases) of laryngeal traumas with the development of mechanical asphyxia. Moderate bodily injuries were determined by experts in 9 cases (19.1 % of cases) of blunt traumas of the larynx, accompanied by fractures of its cartilage; in 4 persons (8.5 % of cases) of blunt traumas of the larynx, accompanied by hematoma, edema of soft tissues of the larynx; in one case of blunt laryngeal trauma with acute edema, its second-degree stenosis. Mild bodily injuries which caused short-term disorder in 25 persons (53.2 % of cases) and mild bodily injuries which caused slight transitory effects in 4 persons (21.1 % of cases) were determined by experts in forensic medical examination of blunt laryngeal trauma with the development of acute posttraumatic laryngitis. The study implied elaboration of methods and an algorithm for improvement of forensic medical diagnostics in this type of injuries. Conclusions. Medicolegal diagnosis of blunt laryngeal trauma can be associated with underestimation and overestimation of the severity of bodily injuries by experts, which requires further research in the field of establishing unbiased expert diagnostic criteria for assessing such injuries.
Museum of forensic medicine and medical Jurisprudence department of kharkiv national medical university
(2015) Olhovsky, Vasil; Kaplunovsky, Petro; Gubin, Mykola; Khyzhniak, Vladimir; Sokol, Vjacheslav