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данную канюлю вводят на всю длину в позвоночный канал. После этого прозектор оттягивает поршень шприца на себя и начинает постепенно извлекать канюлю из позвоночного канала. В результате продвижения канюли по каналу ликвор, находящийся под оболочкой спинного мозга, постепенно заполняет шприц.
В случаях, когда необходимо получить наиболее чистый образец спинномозговой жидкости, лучше прибегнуть к передней люмбальной пункции. Ее отличия от классической прижизненной пункции заключается в доступе из брюшной полости между любыми двумя поясничными позвонками. Металлическую пункционную иглы вводят через межпозвоночный диск. В случаях использования иглы без мандрена сначала совершают прокол межпозвоночного диска, после чего иглу извлекают, к ней присоединяет заполненный воздухом шприц и совершают принудительное очищение ее просвета сжатым в шприце воздухом. Далее шприц с пункционной иглой вводят повторно в образовавшееся отверстие, поршнем создают условия для поступления ликвора в шприц и постепенно начинают совершать возвратное движение шприцем с иглой, в результате чего в шприце происходит скопления необходимого количества ликвора.
ВЫВОДЫ
Спинномозговая жидкость является весьма перспективным объектом исследования. Знание и умение забора ликвора позволяет более широко использовать его как в качестве дополнительного объекта для судебно-химиче-ского исследования веществ, которые оказывают действие на центральную нервную систему, так и в ряде случаев в качестве самостоятельного объекта для судебно-биохи-мического исследования.
FEATURES OF INJURIES OF THE LIVER
IN THE INTERIOR OF THE AUTOMOBILE INJURY
U. F. Norkulov, Sh. E. Islamov
Department of forensic medicine and pathological anatomy, Samarkand State Medical Institute, Samarkand, Republic of Uzbekistan The aim of the study was to determine the morphological features of liver damage in the case of intra-cabin injury in the driver and passenger of the front seat of cars. The combined damages are revealed, so liver damages on an arrangement, the form, the sizes, the direction and character differ at the driver and the passenger of a forward seat.
Keywords: interior car injury, liver damage, driver, front seat passenger
Determination of the nature and mechanism of injury in a car accident is an urgent and complex problem of forensic medicine and expert practice. It is necessary to take into account both the design features of the car interior and the possibility of obtaining the necessary data on changes in internal organs.
The purpose of the study: a comparative study of the morphological features of liver damage in intra-injury of the driver and passenger of the front seat of cars.
The materials of the study of 30 corpses in the Samarkand regional Bureau of FME, killed as a result of intra-trauma, using conventional forensic methods of research.
The driver has ruptures of the liver, located more often on the front and the diaphragmatic surface, mainly linear and irregularly star-shaped, ranging in size from 0,5x1,0 cm to 10,0x14,0 cm, the edges are uneven, the ends are rounded, at the bottom are visible tissue fibers. Locally on the surface of the main cracks are visible strands of breaks, multiple transverse layers and shear strands. Local major ruptures were local-
ized in the anterior and adjacent parts of the liver, longitudinal direction, linear, rarely zigzag and irregular stellate forms, characterized by long and deep. Local additional ruptures were also observed in the anterior part of the liver. They are located obliquely, was arched, aglaophenia, linear and zigzag, was characterized by small length and depth. Central slit-like ruptures were determined more often in the adjacent anterior part of the liver. Shockproof ruptures were localized in the posterior part of the liver, had a longitudinal direction, were linear or zigzag, differed in great length and depth. Peripheral ruptures were located in the middle and posterior parts of the liver, had an oblique direction, were curved or zigzag, their distinctive feature - long and small width and depth.
In passengers of the front seat, liver damage is more often in the form of ruptures, mainly stellate or linear, up to a depth of 2,0x3,0 cm, located mainly at the lower edge, the diaphragmatic or visceral surface of the liver. The edges are coarse-toothed, tissue defects are not proportional, the ends are often sharp, fabric bridges are located at the bottom and at the edges of the gaps. The sizes of breaks from 0, 5x1, 5 cm to 2,0x17 cm, depth to 0,5x3, 0 cm.
SUMMARY
Intra-car injury is mainly observed in people of working age. The driver and passenger of the front seat are identified combined damage. In this case, liver damage by location, shape, size, direction and nature differ in the driver and front seat passenger.
DAMAGE TO THE LOWER LIMBS
IN THE COLLISION OF CARS_
F. F. Rashidov, Sh. E. Islamov
Department of forensic medicine and pathological anatomy, Samarkand State Medical Institute, Samarkand, Republic of Uzbekistan The aim of the study was to determine the nature of the location and characteristics of damages of lower limbs in injured in the collision of cars. Localization and nature of identified external injuries can determine the relative positions of the victim and the direction of the impact of a moving vehicle.
Keywords: car injury, collision, pedestrian, lower limb injuries
In the forensic relation the urgency of the problem of studying transport accidents is connected with the change in the nature and severity of injuries caused by a sharp increase in the number of cars with their individual design features. Certain difficulties often arise when determining the location of a pedestrian who died in the collision of a car.
The purpose of the study: the Study of the nature of the location and characteristics of damages of lower limbs affected by the impact of modern passenger cars.
Materials and methods. Materials of forensic medical research of 22 corpses in the Samarkand regional Bureau of FME, died in connection with arrival of modern cars with a fatal outcome, with use of the generally accepted forensic medical methods of research are studied.
Research result. In our research, we distinguished between two types of collision between a car and a pedestrian. In a frontside collision of a car with a person-the primary impact of the car parts was caused below the center of gravity of the human body, as well as due to friction on the side surface of the car, hitting parts above the center of gravity, rotation around the vertical axis, dropping, falling, hitting and moving along the road. Injuries on the lower limbs in the form of abrasions and bruises caused by the impact of the car parts are localized on several levels and surfaces, and the interaction with the road -
on one. Abrasions caused by the movement of the car, directed obliquely with respect to the vertical axis of the body Damage caused by a blow to the car, deeper, extensive, often located on one side of the body.
In a mid-side collision of a car with a person-the primary impact of the car parts is applied or higher, or at the level of the center of gravity of the human body. The mechanism is referred to as under option injuries consisted of shock, friction, falling, and hitting the road. On the skin there are horizontal striped traces of friction left by the car parts. Soft tissue lower extremities carmenebrn stratified. Soft tissues in the fracture zone are slightly impregnated with blood, while at the point of impact of the bumper there were massive bruises.
SUMMARY
The results of the research indicate that the collision of a moving car with a person on the localization and nature of the identified external injuries can determine the relative position of the victim and the direction of the impact of a moving car.
M FORENSIC MEDICAL ASPECTS OF THERMAL INJURY
A. F. Hayrullaev, Sh. E. Islamov
Department of forensic medicine and pathological anatomy, Samarkand State Medical Institute, Samarkand, Republic of Uzbekistan The aim of the study was to establish morphological criteria for assessing the degree of burns, to determine the severity of injuries in thermal injury. It is noted that it is necessary to take into account the degree and area of thermal and morphological changes, respectively, in determining the severity of injuries. Keywords: thermal injury, degree of burn, forensic medical criteria
Currently, there is a constant increase in the number of fires in residential and industrial premises, transport, which leads to death. It should be noted that thermal injury requires a special scientific and methodological approach in determining the severity of the damage to health, as it is a frequent type of forensic research.
The aim of the study was to determine additional morphological criteria for determining the severity of fatal thermal injury.
Materials and methods of research. We have analyzed 12 conclusions of the FME conducted on the thermal injury in 2017 in the Samarkand regional Bureau of the FME.
The data obtained indicate that the victims, delivered from the fire, had several degrees of thermal damage to tissues at the same time. So the first degree is established according to the following criteria: drying and compaction of the skin, slight opalanie hair, change of skin color from pinkish-yellow to light-brown color, the overlay of soot on unprotected areas of the body, rash of the skin in areas covered by clothing. In the second degree observed detachment of the epidermis with the formation of bubbles filled with transparent or slightly turbid with a reddish tinge of liquid; devoid of the upper layer, the skin was more often rough yellow or yellow-brown crust, sometimes the epidermis exfoliated without the formation of bubbles, and its detachment was found only with little mechanical action. At the third degree of thermal changes, the skin became dry and dense, the epidermis, as a rule, was absent, the tissues of brown or brownish-black color with injuries in the form of multidirectional linear, different depth of cracking, exposing fat, and sometimes muscles. At the fourth degree, there were various damages not only to soft tissues, but also to bones, which were destroyed by minor mechanical action. Naked internal organs are dense, black, sharply reduced in size.
Blood survived only in areas as far as possible from areas with similar changes, with its thickening up to the formation of dry easily crumbling lumps of red color.
SUMMARY
The results show that it is necessary to take into account the degree and area of thermal changes in determining the severity of injuries. And on morphological signs it is possible to define influence of high temperature of an open flame.
СМЕРТЬ МОЗГА: КЛИНИКО-ИНСТРУМЕНТАЛЬНЫЕ И ПАТОМОРФОЛОГИЧЕСКИЕ КОРРЕЛЯЦИИ_
И. Д. Стулин1, Р. С. Мусин1, Д. С. Солонский1, А. В. Кащеев1, Л. А. Савин1, С. А. Труханов1, М. В. Синкин2, М. А. Болотнов1, А. О. Мнушкин1 1ФГБОУ ВО МГМСУ им. А. И. Евдокимова Минздрава России, Москва 2ГБУЗ «НИИ скорой помощи им. Н. В. Склифосовского» ДЗ г. Москвы В работе освещаются современные представления о патогенезе смерти мозга, диагностике этого состояния, юридически приравненного к смерти человека. Проводится сопоставление между клинико-инструментальными и паталогоанатомическими признаками.
Ключевые слова: смерть мозга, кома, респираторный мозг, церебральная ангиография, электроэнцефалография, ультразвуковая допплерография Смерть мозга - это полная и необратимая утрата всех функций головного мозга, регистрируемая при работающем сердце и продолжающейся искусственной вентиляции легких (ИВЛ). Согласно российскому законодательству (Приказ Минздрава РФ от 25.12.2014 № 908н «О порядке установления диагноза смерти мозга»; Федеральный закон от 21.11.2011 № 323-ф3 «Об основах охраны здоровья граждан в Российской Федерации»), смерть мозга приравнивается к смерти человека.
Смерть мозга развивается при первичном или вторичном повреждении мозга, когда вследствие массивного его повреждения и развивающегося отека мозга внутричерепное давление становится выше артериального, что приводит к прекращению и невозобновлению поступления артериальной крови в полость черепа и развитию тотального некроза мозгового вещества, включая верхние шейные сегменты спинного мозга. Следует отметить, что при прекращении мозгового кровотока скорость необратимой гибели разных участков мозга различна. Наиболее чувствительными к недостатку поступления крови являются нейроны гиппокампа, клетки Пуркинье, нейроны зубчатого ядра мозжечка, большие нейроны неокортекса, базальных ганглиев. В то же время клетки спинного мозга, малые нейроны коры, основная часть таламуса значительно менее чувствительны к аноксии. При прогредиентном течении церебральной комы, переходящей в смерть мозга, нередко наблюдается клиническая и биоэлектрическая активность некоторых участков, тогда как исследование функций других частей показывает их гибель. Отмечено, что скорость развития тотального некроза мозга различна в случаях острого (ЧМТ, гематома и т.п.) и хронического (анокси-ишемические поражения) повреждения. Установлено, что полное непоступление крови в полость черепа в течение 30 минут ведет к полному и необратимому разрушению структурной целостности основных отделов ЦНС. У больных, соответствующих критериям смерти мозга, по мере проведения ИВЛ мозг постепенно некроти-зируется, появляются характерные изменения, напрямую зависящие от длительности респираторной поддержки.
