RU2292547C1 - Express-diagnosis method for determining massive blunt body injury in carrying out forensic medical examination - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves taking blood serum from dead body blood vessels for making analysis. Muscle hemoglobin content is quantitatively determined in blood serum after centrifuging using special-purpose ScreenMyo-N collections. Muscle hemoglobin content being less than 1600 ng/ml with no myocardial infarction signs or other pathological muscle tissue states being observed in post-mortem examination, injury age is evaluated not exceeding 7 days. The value going to 3200 ng/ml, 7-14 days old injury is considered to be the case. The value being equal to or greater than 6400 mg/ml, the injury age is considered to be greater than 14 days.

EFFECT: low cost, simplified method.

Description

The invention relates to medicine, namely to forensic medicine, and can be used in determining the timing of a massive blunt body injury.

Not in all cases, at the time of admission to the forensic medical examination, law enforcement agencies have information about the time of causing mechanical damage. Often injuries on a corpse are the result of unlawful acts committed in the absence of eyewitnesses. In addition, criminals can distort the picture of what happened, deliberately distorting the timing of the injury.

There is a method of visually determining the limitation of mechanical damage to soft tissues by the presence of swelling and redness in the area of damage, the presence of purulent exudate, granulation, scar. In cases of assessing the limitation of soft tissue damage, the color of the bruise, the nature of the healing of the surface of abrasions and wounds are examined (1). However, these methods have significant drawbacks: it is difficult to carry out any quantitative assessment of a symptom when assessing lesions visually; the vast majority of diagnostic signs relate to external injuries; however, a forensic expert often encounters massive damage to internal organs. In addition, a whole complex of factors can affect the color of bruising or the healing stage of abrasions and wounds - the localization of injuries, age, gender, the presence of concomitant diseases, etc.

Laboratory histological examination - a method traditionally used to determine the duration of injury, in turn, makes it possible to study the histological picture of cellular reactions in the lesion zone (2). However, it is also not without significant drawbacks, including the length of preparation of the object for research, the need for expensive equipment and supplies (microscope, microtome, thermostat, reagents), as well as specially trained personnel.

The well-known "Method for the rapid assessment of the prescription of bruising" RF patent No. 2177252 from 12.27.2001, the authors Edelev N.S., Vorobyov V.G., Opurin M.A. This method is based on the study of optical damage parameters. This method is the closest to the proposed one, since its task is to diagnose the timing of occurrence of damage to integumentary tissues, carried out by express methods. The disadvantage of this method is that it allows you to determine the period of surface damage, but is not suitable for assessing the limitation of massive internal damage.

The task of the invention is the possibility of rapid diagnosis of the limitation of extensive mechanical, including internal damage during the examination of corpses, carried out at the stage of sectional examination of the corpse in the morgue.

The removal of a blood sample from the corpse allows us to diagnose the period of occurrence of damage both at the initial stages of the forensic medical examination and in the future, since it is possible to store the prepared serum for a long time after freezing it. Accordingly, if during the investigation of a crime the law enforcement authorities need to determine the limitation of damage to a corpse, this method may be useful.

The problem is solved by the fact that blood is taken from a blood vessel of a corpse, 10-fold diluted blood serum is prepared and myoglobin content is determined in it, and with an increase in myoglobin level of 1600 ng / ml or more, the injury duration in the range of 1-7 days, 3200 ng is judged / ml and more - about the prescription of the injury within 7-14 days, 6400 ng / ml and more - about the prescription of the injury over 14 days; in this case, an autopsy is performed and, if there is no detection of myocardial infarction and / or other painful changes in muscle tissue during autopsy, the myoglobin content is determined with subsequent rapid diagnosis of the statute of limitations. At the same time, the content of myoglobin is determined using a set of erythrocyte reagent "Skrinmyo-N", revealed at autopsy.

The proposed method is simple to implement, does not interfere with other laboratory tests. A feature of this method is that the study does not require long-term preparation of the material, the result can be obtained within 1 hour from the start of the study, which allows us to judge the prescription of mechanical damage found on the corpse already at the stage of sectional research.

The method is as follows. In accordance with Order No. 161 of April 24, 2003, "On Approving the Instructions for the Organization and Production of Expert Studies in the Bureau of Forensic Medical Examination," a forensic medical examination of the corpse is being carried out. In this case, the state of skeletal muscles and myocardium is examined. In the absence of painful changes in the muscle tissue (inflammatory processes of various nature, areas of ischemia, sclerotic changes), blood is removed from the corpse to determine the amount of myoglobin. From the vessels of the corpse, blood is taken for examination in a volume of up to 10 ml. After centrifugation of the blood with the help of the "Screenio-N" kits, a quantitative determination of the serum myoglobin content is carried out. To do this, the test serum is diluted 10 times with buffered physiological saline (PBS) (0.1 ml of serum is added to 0.4 ml of PBS), after which a series of serial two-fold dilutions of 0.025 ml of PBS in the wells of the plate are made according to the standard method. Dilution of serum by 10 times is necessary, since it was experimentally found that with smaller dilutions of cadaveric blood serum, the determination of myoglobin is impossible. 0.025 ml of PBS are added to all wells of the row, then 0.025 ml of test serum and standard are added to the first well of the row. The contents of the first well are mixed and transferred using automatic booties to the second well of 0.025 ml of the mixture, then from the second to the third, etc.

0.025 ml of the mixture is poured from the last well. Thus, in the first wells, the studied and standard sera are diluted 10 times, in the second holes 20 times, in the third 40 times, etc.

To identify possible spontaneous agglutination, 0.025 ml of PBS are added to two wells of a plate, after which 0.025 ml of erythrocyte reagent is added to all wells.

The contents of the wells are thoroughly mixed by gentle shaking and left at room temperature for 60 minutes.

The reaction is considered positive if complete agglutination is observed in the wells with the test blood or serum, as well as in the well with the standard (containing myoglobin). erythrocytes are evenly distributed in a thin layer along the bottom of the hole.

Recalculation of myoglobin content is carried out in accordance with the instructions after determining the sensitivity of the diagnosticum.

In accordance with the applicable methodology for the determination of myoglobin, the following options for the detection of myoglobin are possible: 200; 400; 800; 1600; 3200; 6400; 12800 ng / ml, etc. depending on the number of holes in the tablet.

With a serum myoglobin content of 1600 ng / ml or more, taking into account the absence of signs of myocardial infarction and other painful changes in muscle tissue detected during autopsy, judge about the prescription of the injury in the interval up to 7 days, 3200 ng / ml or more - about the prescription of the injury in within 7-14 days, 6400 ng / ml or more - about the prescription of injury over 14 days.

The proposed method was used in the practice of the Nizhny Novgorod Regional Bureau of Forensic Medicine.

80 corpses of men and women aged 20 to 45 years were examined, of which 21 corpses with an isolated craniocerebral trauma, 59 corpses with a combined blunt body trauma were used. For the purposes of the studies, the erythrocyte reagent "Skrinmyo-N" manufactured by the immunochemistry laboratory was used Nizhny Novgorod Research Institute of Epidemiology and Microbiology.

Blood was taken from the corpses from the lumen of the vessels to exclude the ingress of myoglobin into the blood when the heart wall was cut or from other excised muscle tissue of the corpse.

The isolation of an isolated traumatic brain injury and a combined blunt body injury was due to the fact that in the first case (with a brain injury) the lesion was local, and therefore more susceptible to the restrictive properties of the inflammatory reaction on the absorption of myoglobin into the blood from the damage zone . In the second case (with a combined blunt trauma), the massiveness of the lesions did not allow the inflammatory reaction to delimit the damage zone from the surrounding tissues.

In cases of massive blunt trauma to the body, a close to linear dependence of the increase in myoglobin concentration was revealed in accordance with the duration of the injury. The change in the concentration of myoglobin in the blood in the post-traumatic period is presented in the graph. Apparently, in the subsequent, more distant period of the post-traumatic period, the level of myoglobin should return to the original level, however, this could not be confirmed in the experiment, due to the absence of corpses with injuries of the corresponding prescription.

With local damage to the soft tissues in cases of traumatic brain injury, the following was revealed. The level of myoglobin in the blood was more susceptible to individual fluctuations. During the first 7 days, the concentration of myoglobin did not actually change, then, within 7-14 days, a sharp jump in the content of myoglobin in the blood was determined, and in the interval of more than 14 days the content of myoglobin returned to its original level.

The data obtained in the experiment are due, in our opinion, to the fact that extensive trauma is accompanied by massive destruction of muscle fibers, which is accompanied by a gradual increase in the concentration of myoglobin in the blood. The lack of dynamics of the level of myoglobin at the initial stages in cases of local injuries due to traumatic brain injury is apparently due to the restrictive properties of the inflammatory reaction in the affected area, and the subsequent sharp jump is due to a decrease in inflammatory infiltration and tissue repair phenomena at the productive (proliferative) stage of inflammation.

Examples:

1. Research No. 6 (expert opinion No. 3064 for 2003) a corpse without visible signs of muscle tissue diseases. Death time was 3 days. The death of a man came as a result of a massive combined blunt trauma to the body, accompanied by the formation of hemorrhages in the soft tissues of the head, neck, abdominal wall, soft tissues of the lower extremities. The serum myoglobin content is 1600 ng / ml. Prescription injury - 4 days before death.

2. Research No. 43 (expert opinion No. 1221 for 2004) a corpse without visible signs of muscle tissue diseases. Death time was 2 days. The death of a man occurred as a result of a massive combined blunt trauma to the body, accompanied by the formation of hemorrhages in the soft tissues of the head, trunk, limbs. The serum myoglobin content is 3200 ng / ml. Prescription injury - 12 days before death.

3. Research No. 25 (expert opinion No. 394 for 2004) a corpse without visible signs of muscle tissue diseases. Death time was 2 days. The death of a man occurred as a result of a massive combined blunt trauma to the body, accompanied by the formation of hemorrhages in the soft tissues of the head, trunk, and upper limbs. The serum myoglobin content is 6400 ng / ml. Prescription injury - 14.5 days before death.

REFERENCES:

1. Pigolkin Yu.I., Barinov E.Kh., Bogomolov D.V., Bogomolova I.N. Forensic Medicine: Textbook. - M.: GEOTAR-MED, 2002, - pp. 102-104.

2. Pigolkin Yu.I., Barinov E.Kh., Bogomolov D.V., Bogomolova I.N. Forensic Medicine: Textbook. - M.: GEOTAR-MED, 2002, - p. 95-96.

3. Edelev N.S., Vorobev V.G., Opurin M.A. "Method for the rapid assessment of the duration of bruising" patent No. 2177252 from 12/27/2001

Claims (1)

A method for the rapid diagnosis of the timing of a massive blunt body injury in the absence of painful changes in muscle tissue during a forensic examination of a corpse, characterized in that they take blood from a corpse's blood vessel, prepare 10-fold diluted blood serum and determine the content of myoglobin in it and with an increase in serum myoglobin up to 1600 ng / ml inclusive, judge about the age of injury in the range up to 7 days, 3200 ng / ml - about the age of injury in the range of 7-14 days, 6400 ng / ml and more - about the prescription of herbs s more than 14 days.