[Forensic, clinical and anatomical aspects of diagnosising diaphragmatic injuries in stab wounds]. / Sudebno-meditsinskie i kliniko-anatomicheskie aspekty diagnostiki koloto-rezanykh povrezhdenii diafragmy.

AIM: To improve the quality of clinical and forensic examination and diagnosis of diaphragmatic injury (DI) from stab wounds by defining the boundaries of the thoraco-abdominal region and the topographic and anatomical characteristics of thoracoabdominal stab wounds. MATERIAL AND METHODS: Based on the results of forensic medical examinations of 81 corpses with stab wounds, the clinical and anatomical characteristics of thoraco-abdominal stab wounds were noted; and in anatomical dissections of 90 cadavers, the boundaries of the intercostal spaces and costophrenic recess were modeled. RESULT: The boundaries of the thoraco-abdominal region, and the location of stab wounds that make the probability of DI particularly high (10-50%) were clarified. A method for diagnosing DI was developed. The method was used to identify DI in 81 out of 411 victims with penetrating stab wounds to the chest and abdomen. The results of the study prove the feasibility of using computed tomography in the examination of living persons with a wound in the thoracoabdominal region. This study can assist in determining the features of a wound channel, in providing a correct assessment of the damage, and in the identification of undiagnosed DI.

[Conventional and minimally invasive surgery in diagnosis and treatment of thoracoabdominal wounds]. / Optimal'noe sochetanie otkrytykh i miniinvazivnykh operatsii v diagnostike i lechenii torakoabdominal'nykh ranenii.

AIM: To develop the algorithm of optimal combination of conventional and minimally invasive procedures for surgical diagnosis and treatment of thoracoabdominal wounds (TAW). MATERIAL AND METHODS: The most common borders of TAW were analyzed in 81 bodies of victims. Typical borders of costodiaphragmatic pleural sinus were assessed in 90 male cadavers. There were 81 victims with TAW who were divided into two groups. The first group included 40 patients who underwent newly developed methods of treatment. Group II consisted of 41 patients who were treated earlier. RESULTS: The algorithm of invasive diagnosis of diaphragm wounds and the method of sequential determination of indications for conventional or endoscopic procedures were developed and applied in the first group. Minimally invasive operations alone or in combination with open surgery were applied in 80% of patients in group I and in 53.66% of patients in group II. Thirty-eight (97.5%) and 35 (85.37%) patients convalesced in groups I and II, respectively. CONCLUSION: Thoracotomy was required in 34.29% of cases for TAW correction, laparotomy - in 71.43% of cases. Minimally invasive operations were sufficient in other cases.

[Morphological features of structural organization of cerebellar cortex in old age].

In this science work there were conducted such researches as organometric, histological, immunomorphologic and morphometric of cerebellar cortex of 219 corpses of people (108 man and 111 woman) of young and old age. A comparative analysis of the parameters of bulb-shaped neurons in these ages revealed decrease of their height and width. It is found that distance between interval nerve cell bodies of ganglionic layer increases with age that obviously associated with progressing disorganization and death of bulb-shaped neurons. It is marked an increment in the number of immunopositive for glial fibrillary acidic protein, protide S-100 and vimentin astrocytes in granular layer and molecular layer of cerebellar cortex, and decline in the number of immunopositive for neuron-specific enolase and immunonegative for protide S-100 and vimentin bulb-shaped neurons that can be regarded as manifestation of neurodegeneration. Using immunohistochemical methods in research allows approaching more differentially to the issues of morphological assessment cerebellar cortex of elderly people and gives an opportunity to receive more objective and full information of postnatal morphogenesis.

[Comparative organometric characteristic of cerebellum of the young and old age].

The science work is based on morphological research of cerebellums of 219 corpses of people (108 man and 111 woman) of young and old age. There were used such research methods as organometric, histological and morphometric. During study a comparative analysis of the mass, linear dimensions, thickness of cerebellar cortex of young and old age was conducted. The regularities of age variability of organometric characteristic of cerebellum were revealed and they are found in the reduction of mass and linear dimensions of the people of senile age in comparison with younger people. It was determined that thickness of molecular and granular layers of cerebellum was characterized by aging changing parameters. The results of the morphological study can serve as a basis for the identification of certain regularities of age anatomy of the cerebellum and have practical significance as indicators of the norm that allows using these data in diagnostic and therapeutic work.

[Pleural drainage for the treatment of the acute empyema].

Treatment of 675 patients with the acute pleural empyema was analyzed and supplemented with anatomometric investigations of costophrenic sinus in 60 male corpses. Technical features of effective pleural drainage were fundamentally substantiated and depicted in pictures and schemes. The original method of the retrograde thoracoscopic drainage with the original device were suggested.