[Prophylaxis and treatment of hemorrhagic complications of operative interventions in patients with hemophilia A and Villebrand's disease].

Hemophilia A and Villebrand's disease owe similar clinical features, for their treatment the preparations, containing factor VIII and Villebrand's factor are used. Preoperatively it is necessary, first of all, to establish the disease diagnosis and its form definitely and then an optimal scheme of hemostatic therapy must be selected with its intraoperative and postoperative correction under control of laboratory monitoring. It is important to reveal timely a hemostasis disorders and a hemophilia of inhibitory form occurrence. Modern rational methods of prophylaxis and treatment of hemorrhage, using desmopresin (for mild forms of hemophilia A and Villebrand's disease type III) as well as preparations of restoration therapy, containing factor VIII and Villebrand's factor, are recommended. Preparations of auxiliary therapy are applied according to certain indications present for elimination of vascular-thrombocytic disorders, fibrinolysis activation, hemophilia of inhibitory form and hormonal disorders occurrence. It is also stressed, that, while these diseases are present, it is necessary to follow direct indications for the operations performance and guaranteeing a reserve of sufficient quantity of corresponding hemostatic preparations.

[Nonspecific hemostatic therapy for dysfunctional uterine hemorrhages in patients with mild forms of von Willebrand's disease].

Main coagulation parameters against a background of nonspecific haemostatic therapy use (NHT) in women with mild forms of von Willebrand's disease have positive dynamics with coagulation test indices normalized on 5-6 and 10-14 days. Menses length under NHT use is significantly shorter and amounts 6-7 days in 19 (79,2%) patients, 8 days--in 5 (20,8%) women compared to 11-14 days in women without NHT.

[Prophylaxis and treatment of complications after splenectomy performed for various diseases and trauma of the organ].

Analytic digest of the literature data and observations of their own were adduced, concerning the results of splenectomy (CE), performed for various indications. SE was performed in 2059 patients, including 1656--suffering the blood system diseases. After SE performance the occurrence of speciphic (the splenic fuction loss) and other severe postoperative complications is possible, severity of which depends on the main disease severity and the operation traumaticity. The conduction of dynamic preoperative and postoperative examination of patients, using clinical and laboratory methods, prophylaxis and timely treatment of the immunodeficiency signs (general septic diseases), coagulopathy, hemodynamic disorders, anemia, an acute suprarenal gland insufficiency, and miniinvasive operative technique application secure the significant lowering of postoperative complications rate.

[Mild and latent forms of coagulopathy and thrombocytopathy in surgical practice]. / Legkie i latentnye formy koagulopatii i trombotsitopatii v khirurgicheskoi praktike.

The most characteristic hemorrhagic signs and frequency of their occurrence in mild and latent forms of coagulopathy and thrombocytopathy were analyzed. Recommendations were formulated on the diagnosis, treatment and prophylaxis of hemorrhagic syndrome during and after operation conduction.

[Expert evaluation of aftereffects of migration of catheters in the vessels during subclavian vein catheterization]. / Ekspertnaia otsenka posledstvii migratsii kateterov po sosudistomu ruslu pri kateterizatsii podkliuchichnykh ven.

Eleven cases with migration (escape) of catheters, inserted into subclavian veins, into the vascular bed, are analyzed by the results of forensic medical evaluations. Expert evaluation of aftereffects of the complications caused by flaws in medical care is made. Suggestions are made on evaluation of the severity of harm inflicted to health in such cases and the criteria of such evaluations are offered.

[Utilization of complex technologies of molecular genetics for forensic expert identification of unidentified remains of victims of terrorist acts in Moscow in 1999]. / Kompleksnoe primenenie tekhnologii molekuliarno-geneticheskoi individualizatsii biologicheskikh ob''ektov dlia sudebno-ékspertnoi identifikatsii neopoznannykh ostankov zhertv terroristicheskikh aktov v Moskve v 1999g.

This paper presents the first experience gained in Russia in expert identification practice with complex utilization of technologies of molecular genetic individualization of biological objects for solving identification tasks requiring the maximum complete armory of mutually supplementing means. This is particularly important for forensic expert personality identification in cases with many deaths, when indirect identification has to be resorted to, consisting in the use of biological samples from relatives of the victims as the identifying objects. Methodological approaches and concepts of expert studies, used for identification of the remains of people who died in terroristic acts committed in Moscow in September, 1999, are discussed. The results of this study and methodological experience notably extend the potentialities of expert evaluation as regards forensic medical identification of victims of overall disasters, terroristic acts, and war conflicts.

[Diagnosing death from burn shock]. / Diagnostika smerti ot ozhogovogo shoka.

Morphological changes were studied in the organs of 28 victims dead from burn shock at the age of 20-65 years and in rabbits in which burn shock was induced. Histological sections were stained with hematoxylin and eosin, Sudan III, by Regaud's method; brain sections were stained by Nissl's and Brachet's methods and examined by electron microscopy. Morphological criteria of burn shock were determined, underlying the specific features of thermal injury.

[Current status and prospects for developing chemical-toxicological (forensic chemical) studies in the Russian Federation]. / Sovremennoe sostoianie i perspektivy razvitiia khimiko-toksikologicheskikh (sudebno-khimicheskikh) issledovanii v Rossiiskoi Federatsii.

The authors discuss modern state and prospects of planning and carrying out research in forensic (toxicological) chemistry within the framework of practical forensic medical expert evaluation, state of forensic medical expert evaluation of alcohol and narcotic intoxication, and other pressing problems of forensic medical expert practice.

[Defects in medical care rendered by private practitioners (or institutions)]. / Defekty meditsinskoi pomoshchi, dopuskaemye chastnopraktikuiushchimi vrachami (predpriiatiiami).

Fifty-one conclusions of forensic expert medical committees on criminal and civil cases instituted against private medical institutions and physicians are analyzed. Sixteen expert evaluations concerned dental care, 15 were on cosmetic operations, etc. Flaws in medical care, their causes and consequences are analyzed. Tentative expert evaluation of similar cases is made.

[Biomechanical conditions of developing injuries sustained from falling from a height]. / O biomekhanicheskikh usloviiakh formirovaniia povrezhdenii tela pri padenii s vysoty.

Evaluation of the height from which human fell from his/her tissue and organ injuries is discussed. The authors of available publications paid the principal attention to estimation of the height from which the victim fell without consideration for the kinetic energy of the body, which depends not only on the height from which the victim fell, but on his/her body weight as well. Primary external and primary internal injuries are distinguished, which are determined by the area of contusion during landing; secondary contact injuries which form during inertial movement of the body after the first contusion, and injuries due to negative acceleration during contusion when landing (so-called signs of total body concussion) are also distinguished. The totality of all listed injuries helps estimate the total kinetic energy at the moment of contusion and determine the height of falling, with due consideration for anthropometric characteristics of the victim.

[Clinical criteria in the diagnosis of mild and occult forms of coagulopathy and thrombocytopathy]. / Klinicheskie kriterii diagnostiki legkikh i skrytykh form koagulopatii i trombotsitopatii.

Clinical criteria of diagnosis of mild and occult forms of coagulopathy and thrombocytopathy were discerned. It was established, that in such diseases the mixed type of hemorrhagic diathesis predominates. There were analyzed the most characteristic hemorrhagic signs and frequency of their occurrence in these forms of hemostasis pathology.

[Forensic medical evaluation of professional working capacity in victims, who needs additional care]. / Ob ustanovlenii nuzhdaemosti poterpevshikh v dopolnitel'nykh vidakh pomoshchi pri sudebno-meditsinskoi ekspertize stepeni utraty professional'noi trudosposobnosti.

The philosophy of evaluating the need of a victim in extra care is discussed. The method for evaluating the need in transport vehicles for the victim is described in detail. Legislative documents which help solve such problems are cited, including those used by committees of forensic medical evaluations.

[Organization and methodological activities of Russian Center for Forensic Medical Expert Evaluations Ministry of Health of the Russian Federation]. / Ob organizatsionno-metodicheskoi rabote Rossiiskogo tsentra sudebno-meditsinskoi ékspertizy Ministerstva zdravookhraneniia Rossiiskoi Federatsii.

Analyzes the organization and methodological activities of Russian Center for Forensic Medical Expert Evaluations in 1996-1998. Informs about the federal law on forensic medical expert evaluations and norm-setting acts aimed at improvement of forensic medical service in the Russian Federation, which have been developed at the Center. Offers recommendations on improving the quality control of expert evaluations at territorial centers and continuous education of experts. Formulates the main tasks of the Center fort the nearest future.

[Organization and procedure of forensic medical expert evaluation of professional working capacity loss]. / O poriadke organizatsii i proizvodstva sudebno-meditsinskoi ékspertizy ustanovleniia stepeni utraty professional'noi trudosposobnosti.

Sixty-one forensic medical expert conclusions on the loss of professional working capacity are analyzed and typical errors are characterized. The procedure of forensic medical expert evaluation of the degree of loss of professional working capacity in accordance with the Civil Code and Civil Judicial Procedure Code of the Russian Federation and the actual norm-setting documents is described.