Наукові праці. Кафедра судової медицини, медичного правознавства імені заслуженого професора М.С. Бокаріуса
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Item Forensic medical determination of severity of chest injuries with thorax trauma(2022) Gubin, Mykola; Olkhovsky, Vasil; Grygorian, EdgarBackground. 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.Item Forensic medical examinattion of living persons in cases of injury of the external respiratory organs(2021) Olkhovsky, Vasil; Gubin, Mykola; Grygorian, EdgarBackground. 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.Item Morphological features of the uterus in women at different time intervals of the postmortem period as diagnostic criteria for establishing the postmortem interval(2021) Olkhovsky, Vasil; Grygorian, Edgar; Myroshnychenko, Mykhailo; Kozlov, Sergii; Suloiev, Kostiantyn; Polianskyi, Anton; Kaplunovskyi, Petro; Fedulenkova, Yuliia; Borzenkova, IrynaThe aim is to identify the morphological features of the uterus layers in women at different time intervals of the postmortem period as diagnostic criteria for establishing the postmortem interval. Materials and methods: In the study we used surgical and autopsy material – uterine tissue fragments. All materials were divided into two groups. The 1st group (G 1) included surgical material from women (n=6) who underwent removal of the uterus, or uterus with the appendages due to leiomyoma, uterine prolapse. The 2nd group (G 2) included autopsy material from 42 women with known causes of death and postmortem period (from 24 to 48 hours – 6 cases, from 49 to 72 hours – 7 cases, from 73 to 96 hours – 8 cases, from 97 to 120 hours – 6 cases, from 121 to 144 hours – 8 cases, more than 144 hours – 7 cases). Histological and immunohistochemical study methods were used. Results: A comprehensive morphological study of the women uterus revealed a time-dependent increase of postmortem changes in this organ linked with the increase of postmortem period. In cases of postmortem period duration up to 144 hours, the structural elements of the uterine layers were identified. In cases where the duration of the postmortem period was more than 145 hours, microscopically the uterus was represented by eosinophilic fibrous or dusty masses, the histogenesis of which could not be determined. The processes of autolysis occurred more intensely and faster in the mucous membrane of the uterus, in comparison with the muscular and serous membranes, and in the vessels – in their inner membrane, in comparison with the middle and outer membranes. Autolytic changes in the muscular membrane of the uterus and vascular walls occurred more intensely in muscle fibers compared to connective tissue fibers. Conclusions: The histological and immunohistochemical features of the women uterus at different postmortem periods have a certain forensic medical significance and can be used for establishing the postmortem interval.Item 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, Olegthe 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.