The authors analyzed foreign experience in the training of forensic experts. This experience is compared with the corresponding training system for forensic doctors that existed in Ukraine until 2022. A comparative analysis of the working curricula of pathologists and forensic doctors was carried out. It is shown that the proposed system of training forensic medical experts based on a three- month specialization of pathologists can potentially lead to a decrease in the qualifi cation level of forensic medical examination in Ukraine, since such a training period is not enough. It is proposed to adjust the training program for pathologists from this year by combining the educational material of pathological anatomy, clinical pathophysiology and certain sections of forensic medicine, with the expansion of the competencies of a pathologist. The authors also propose to change the name of the specialty from «Pathological Anatomy» to «Pathology». The teaching of forensic medical examination during the postgraduate training of pathologists should be carried out by highly qualifi ed teachers in the specialty «Forensic Мedicine».
In relation with the development of clinical endovasive surgery, neurosurgery, maxillofacial surgery there is an urgent need for their improvement. Recent year's osteological and orthopedic areas of medicine have been rapidly developed; it requires an additional data on the age-related and individual anatomical variability. The purpose of the study -is to establish the range of anatomical variability of facial skull in adulthood taking in account the extreme forms, sizes and relations according to skull shapes. The research was conducted on a study of 100 bone samples of coherent and fragmented skulls from the collections of anatomy department of Kharkiv National Medical University. It was investigated 58 male skulls and 42 female skulls in 25-60 years old age. To establish an individual anatomical variability of the bone structures, was determined a number of main indices using the well-known craniodivider. All calculations performed by computer program "SPSS Statistics 17.0" using the digital standard package of the tables and initial data. It is proved that the highest range of the arithmetic average of zygomatic sizes (zy-zy) related with representatives of brachycephalic type of the skull, in adulthoods with mesocephalic type it decreases, the minimal range has been found in dolichocephalic type of the head and skull. The lower zygomatic diameter -the size between points go-go, also decreases in the arithmetic average from brachycephalic to dolichocephalic types that is associated with the gradual narrowing and lengthening of the visceral skull in adulthood. More stable results were found determining the forehead width (ft-ft). This parameter tends to decrease from brachycephalic to dolichocephalic. More advanced type of facial structure is defined in brachycephalic adulthoods, the narrowed forehead shape related with dolichocephalic type. For modern craniological estimation of the visceral skull, the size n-pr used to calculate special indices. According to our data, in brachycephalic males this parameter varies from 5.0 to 6.9 cm; females -between 4.8-6.6 cm. In representatives of mesocephalic type, the n-pr ranges in 10.0-11.6 cm. In people with dolichocephalic type, this altitude parameter increased in males from 5.7 to 7.9 cm, females -from 5.5 to 7.6 cm. It was also established that Ind1 has a wide range of variability, especially in brachycephalic males -83.50 ± 9.70 and in females -87.00 ±7.80, which includes a variety of visceral skull structure in people of different age. The range of this index in mesocephalic people is less -86.00 ± 3.20 (males) and 85.30 ± 3.40 (females). Accordingly, in dolichocephalic type complete visceral index is observed in range -91.20 ± 4.40 (males) and 91.10 ± 2.90 (females). Thus, it is proved that the specific type of visceral skull -europrosopic is specific for the people of Kharkiv region. It is characterized by increased latitudinal sizes: zy-zy, po-po and go-go, with a slight decrease in altitude parameters of the visceral skull n-gn and n-pr. Depending on the ra...
The purpose of the study was to determine the craniotopographic (craniometric) indicators of sinuous-liquor relationships in the horizontal plane in people of the first and second periods of mature age, based on the maximum permissible depth of its introduction. Materials and methods. The object of the study was the dura mater of the brain with its sinuses, the ventricles of the brain and the vault of the skull of mature people. The study was performed on 100 corpses of people of different ages and gender with the manufacturing of native preparations of the brain with membranes and liquor structures. Of the indicated number of morphological objects, 70 preparations of veins and sinuses of the dura mater of the brain and 30 preparations of the cerebrospinal fluid system of the brain of mature people were made. The study used such research methods as: macro- and micropreparation of anatomical objects of the brain; cranio- and morphometry of veins, sinuses of the dura mater of the brain and liquor structures of the brain; manufacturing of corrosive (acrylic) casts – preparations of veins, sinuses of the dura mater of the brain and liquor formations of the brain; injection technique; variational-statistical analysis of morphometric data; computer-graphic analysis. Results and discussion. As a result of the study, it was found that the puncture of the central part of the lateral ventricle is better to be performed at the level of the bregma point, or between this point and the vertex (v). The puncture needle penetrates to a depth of 6.0–7.0 cm through the milling hole, which is displaced by 3.0–4.0 cm from the arrow line at an angle of 70–75°. The obtained data make it possible to determine the most optimal craniometric puncture points of the cerebrospinal fluid system of the brain. To penetrate into the cavity of the anterior horn of the lateral ventricle, the metopion point is proposed, which is located at the intersection of the median plane of the head with the line connecting the most convex areas of the frontal humps. The upper puncture of the lateral ventricle is better to be performed by puncturing at the bregma point (the point of connection of the sagittal and coronal sutures) 2.0 cm from the midline (sagittal plane); the needle is directed down and backwards and at a depth of 5–6 cm (taking into account that it is enlarged and stretched) it enters the ventricular cavity. The suboccipital puncture or a puncture of the cerebellar-cerebral cistern must be performed between the opisthocranion and lambda points. The puncture needle is inserted to a depth of 6.0–7.5 cm, and the end of the needle is gradually lowered to the base of the skull. Conclusion. The most optimal puncture points of the constituent parts of the cerebrospinal fluid system of the brain – the cavity of the anterior horn and the central part of the lateral ventricle, the cavity of the cerebellar-cerebral cistern – were determined using craniometric analysis
The purpose of the work was to study the microscopic structure of the mucous membrane of all the walls of the frontal sinus of a person in order to obtain morphometric data on its structural components – glands and the submucosal base. Materials and methods. The material for the study was the mucous membrane of the frontal sinus of 110 people who died at the age of 22–86 years from causes not related to the pathology of the paranasal sinuses. Results and discussion. The results of the study showed that the glands in the mucous membranes of all the walls of the frontal sinus are alveolar-tubular in structure. In a morphometric study of such a structural component of the mucous membrane of all the walls of the frontal sinus, as the thickness of the submucosal base, it was shown that the thickest submucosal base is located on the inferior wall (on the left – 423.67 ± 21.33 μm; on the right – 426.45 ± 16.77 μm (p<0.05)) and is four times higher than the average values of thickness on the posterior wall and septum. The outer diameter of the end sections of the glands of septum of the human frontal sinus in a morphometric study averaged 25.42 ± 1.68 μm on the left and 25.89 ± 1.38 μm on the right (p<0.05), that is, the smallest compared to other walls. The values of the average diameter of the end sections of the glands of the mucous membranes of the anterior, inferior, and posterior walls of the frontal sinus probably did not differ between themselves. Conclusion. From the obtained data, it can be clearly seen that the mucous membrane of the inferior wall of the frontal sinus has the greatest functional load, since it has a connection with the nasal cavity in the middle nasal passage. The information obtained in the course of the study significantly expands knowledge about the structure of the human frontal sinus. Digital morphometric (metric) material with statistical processing confirms and complements the differences in the microstructure of the glands of the mucous membrane of the human frontal sinus in general, and separately on each wall, and in comparison with other paranasal sinuses. This is of great importance for modern otorhinolaryngology, since the glands of the mucous membranes of the paranasal sinuses are links of the mucociliary system, and such a process as mucociliary clearance depends on their quality work.
Аutoinflammatory diseases or syndromes (HAIDS) have attracted practical and scientific interest. This group of pathologies is united by similar clinical symptoms in the form of periodic fever, systemic inflammation and other clinical syndromes. PFAPA — syndrome or Marshall's syndrome is one of the most common representatives of this group of diseases. РFАРА syndrome (Marshall's syndrome) is considered an autoinflammatory disease of unknown etiology and not fully studied pathogenesis. Gene mutations, family inheritance and the modifying role of persistent intracellular infections are considered as the causes of development. Genetically determined immune responses and neutrophilic inflammation, the presence of immune dysregulation play a role in the pathogenesis of Marshall's syndrome. The incidence and prevalence of this condition in the pediatric population are unknown. The pathology is characteristic of early childhood, the syndrome is characterized periodic fever, aphthous stomatitis, pharyngitis or tonsillitis and cervical adenitis. Patients do not have disturbances in well-being between episodes, pathognomonic laboratory changes, have normal growth and development indicators. The syndrome occurs in children under 5 years, disappears in adolescence, has good+quality current, the treatment of which is the administration of corticosteroids. The pathology has no specific biological markers, so the diagnosis is made on the basis of clinical manifestations, a thorough analysis of the history and the exclusion of other possible causes of recurrence fever. Purpose: to highlight the complexity of the diagnosis of PFAPA–syndrome. Clinical case. The article describes own clinical case of a child with Marshall's syndrome. Recurrent attacks of fever with a specific frequency in combination with aphthous stomatitis, pharyngitis and cervical lymphadenitis, the absence of specific laboratory changes and the positive effect of the corticosteroids treatment it possible to diagnose the above diagnosis. Conclusion. Literature data and the above clinical case indicate the difficulty of diagnosing this syndrome, long-term irrational drug treatment without clinical effect. So physicians in many specialties need to remember the need for a detailed survey of patients and parents, pay attention to the time and frequency of symptoms described above, and their combinations, if Marshall's syndrome is suspected do not be afraid to prescribe glucocorticosteroids for therapeutic and prophylactic purposes. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Keywords: Marshall's syndrome, children, periodic fever, corticosteroids.
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