[Clinical and anatomical analysis of mortality from COVID-19 in sudden death and in those who died in health care facilities]. / Kliniko-anatomicheskii analiz letal'nosti ot COVID-19 pri skoropostizhnoi smerti i u umershikh v lechebno-profilakticheskikh uchrezhdeniyakh.

OBJECTIVE: Assessment of pathological and morphological changes in those who died from COVID-19 including persons received therapy in medical and preventive institutions (LPI) and who died suddenly from this pathology at home. The analysis data of the pathological and anatomical changes in 57 deaths from COVID-19 in hospitals and 74 forensic medical examinations where infectious pathology was established as the main cause of death are presented. For microscopy the sections were stained with hemotoxylin and eosin, OCG, immunohistochemical study with markers for CD3, CD 4, CD 20, SK-7. The mixed viral and bacterial lesions of the lungs were detected more often than pure viral infection in those who died suddenly from COVID-19 compared with people whose death occurred in medical facilities. This allows speaking about the lack of adequate antibiotic therapy out-patiently. Features of mononuclear lung infiltration in COVID-19 with a predominance of a moderately pronounced reaction of T-lymphocytes and a mild B-lymphocytic reaction indicate a decrease in immunological reactivity. Conducting clinical and anatomical analysis allows determining the features of pathogenesis and morphogenesis in each specific fatal case and informing the clinicians of health facilities (clinics and hospitals) allows the autopsy doctor (pathologist, forensic physician) to provide significant assistance in improving the quality of diagnosis and treatment of patients with this highly contagious severe viral disease.

[Morphological diagnosis of obstetric pulmonary embolism]. / Morfologicheskaya diagnostika akusherskoi tromboembolii legochnoi arterii.

Pulmonary embolism (PE) is one of the most common fatal complications in a wide variety of pathologies along the most common death causes of the population - diseases of the circulatory system and oncology. The development of PE in the postoperative and postpartum periods can also be fatal. The diagnosis of PE is very difficult and in 50-80% of cases it is not diagnosed at all. During autopsies it is important not only to diagnose PE but also to establish the source of its origin. An example of PE in a 34-year-old pregnant woman is given; the PE source was thrombosis of the right deep femoral vein facilitated by varicose veins of the lower extremities and severe preeclampsia. The presence of severe preeclampsia in a pregnant woman caused the development of venous sinus thrombosis accompanied by bilateral exophthalmos, necrosis of a pituitary gland part and progressive cerebral edema.

Ultrastructure of Cardiomyocytes and Blood Capillary Endotheliocytes in the Myocardium under Conditions of Experimental Mechanical Injury to the Heart.

We studied ultrastructural changes in cardiomyocytes and blood capillary endotheliocytes in the ventricular myocardium in response to mechanical injury of the heart of varying severity in Wistar rats. Acute alterative changes in cardiomyocyte and endotheliocyte ultrastructure indicate impairment of the energy-producing, contractile, and protein-synthesizing functions of the cells after mechanical injury. These disorders play the key role in the development of acute contractile insufficiency of the myocardium in mechanical injury to the heart.

[The expert observation of myocardial contusion in a child].

A case of the myocardial contusion associated with the closed blunt chest injury in the girl aged 1 year 7 months is presented. The autopsy revealed hemorrhage of an irregular oval shape, coloured dark-red, and confined to the region with the area of 4.0 x 3.5 cm. It penetrated throughout the entire thickness of the lower part of the left atrial myocardium and the upper and middle parts of the left ventricle. No other changes were found in the heart, nor were congenital cardiac and vascular malformations documented. The main factors playing an important role in the formation of the myocardium contusion are discussed. The authors emphasize that it is the children having the narrow chest with the pliable wall who constitute the group at the highest risk of accidents resulting in the chest injury and myocardial contusion.