Unusual medical cases. Longest use of the iron lung device

Casuistic cases in forensic practice, due to the contamination nature of the studied ANC

Ph.D. E. Yu. Zemskova, Doctor of Biological Sciences, Prof. P. L. Ivanov

Federal State Budgetary Institution "Russian Center for Forensic Medical Examination" of the Ministry of Health of the Russian Federation Abstract: The report examines a number of remarkable artifacts from the practice of forensic molecular genetic examination, the reason for which is the casuistic circumstance that the DNA examined during the examination turned out to be of a contaminated nature. The purpose of this review is to illustrate the feasibility of an integrated approach to assessing the results obtained during the examination, and the importance of an objective and responsible attitude to the interpretation of these results as a means of proof.

Key words: forensic molecular genetic examination, DNA contamination

Casuistic cases in forensic practice caused by the mixed nature of the investigation DMA

E. Yu. Zemskova, P. L. Ivanov

Abstract: The article reviews a number of remarkable artifacts from the practice of forensic molecular and genetic examination caused by the casuistic fact that the investigative DNA was mixed nature. The goal of this review is to illustrate the advisability of an integrated approach to the assessment of the results obtained in the examination, and the importance of objective and responsible attitude to the interpretation of these results as a means of proof. Keywords: forensic molecular and genetic examination, DNA contamination

In forensic practice, DNA analysis is used to obtain information that is significant for the investigation and the court in cases related to civil legal relations, criminal offenses, and identifying victims of emergency situations (natural, man-made or other nature). The objective value of molecular genetic data and the increasing complexity of expert tasks stimulate the dynamic growth of specialized high technologies, which, in turn, are designed to satisfy the desire of experts to extract the required amount of genetic information from the smallest possible initial amount of DNA.

Indeed, the introduction of new high-tech solutions into expert practice objectively increases the information content of molecular genetic analysis and generally ensures a tendency towards a significant increase in the evidentiary value of the results obtained.

However, we must be aware that situations where expert problems are solved at the limit of sensitivity of the analytical methods used pose a certain danger.

research of ultra-small quantities of biological material - down to a single cell.

In the process of developing the LCM laser dissection technology (Laser Capture Microdissection - laser microdissection with subsequent capture of dissected samples), we showed that one of the fundamental issues in the study of biological objects that require the analysis of minimal amounts of DNA is the issue of reliability and the relevance of the obtained result to the studied object. We are talking about the possibility of contamination (contamination is interpreted as contamination of the biological object under study with foreign DNA). In this context, contamination is essentially an artifact, a false result.

Therefore, with the development of molecular genetic expert technologies, the topic of contamination danger is becoming increasingly important.

In this regard, I would like to note that, while welcoming modern high-tech research into “high achievements,” one should understand: in many cases, these achievements are of a demonstration nature and are carried out in pre-prepared model conditions. In real practice, in order to work at the limit of sensitivity of the analytical methods used, strict adherence to a number of additional control measures is required in order to avoid the cases described in this work of obtaining false, artifactual results due to the contaminating nature of the examined DNA.

Molecular genetic study of abortive material - a case study

A. A. Komarova, M. A. Ignashkin, S. A. Frolova, Ph.D. A. S. Abramov

Department of Medical and Biological Research of the Directorate for Organization of Expert and Forensic Activities of the Main Directorate of Forensic Science of the Investigative Committee of the Russian Federation. Abstract: The article is devoted to the practical case of conducting an examination of rape. As comparative materials, biomaterials were received after a medical abortion, the established gestational age was 5 weeks. Key words: rape, molecular genetic research, abortive material

Molecular genetic study of abortive material - practical case

A. A. Komarova, M. A. Ignashkin, S. A. Frolova, A. S. Abramov

Abstract: The article is dedicated to a practical case of rape examination. For examination biomaterial after medical abortion of 5 week pregnancy was received. Keywords: rape, molecular genetic study, abortive material

INTRODUCTION

The molecular genetic research method today is one of the most effective in cases of identifying individuals involved in committing violent acts of a sexual nature.

MATERIAL AND METHODS

To conduct a molecular genetic examination on the fact of rape, the laboratory received biomaterials from a medical abortion, the established gestational age was 5 weeks, as well as samples of the buccal epithelium of the victim and the suspect. The paternity analysis was complicated by the fact that, according to the investigative version, the suspect was the biological father of the victim. The genetic profile of the embryo in this case suggests the presence of a large number of homozygous allelic combinations. Heterozygous allelic combinations that match the allelic combinations of the mother or father are also possible.

A bottle containing a mushy substrate of blood with fragments of soft tissue was presented for the study. The contents of the jar were filtered, washed with distilled water and placed in a Petri dish. Given the small physical size of the embryo in the early stages of intrauterine development, a visual inspection of the contents of the vial was carried out to look for fragments of the umbilical cord or embryonic membranes. As a result of a visual examination, two fragments of a red, unevenly colored tissue structure were identified, in the form of exfoliating strands about 2 mm in diameter, up to 3-4 mm long, which could be fragments of the umbilical cord (objects No. 1, 2), and one fragment , having the appearance of a translucent film 4x5 mm, which may be a fragment of the embryonic membrane of the embryo (object No. 3). Cuttings were made from the discovered fragments. The remaining fragments, in appearance and structure, were probably blood clots and endometrial fragments.

DNA from objects was isolated using the PrepFiler TM Automated Forensic DNA Extraction Kit (Applied Biosystems, USA), on an automatic station for DNA extraction “AutoMate Express™ Forensic DNA Extraction System” (Applied Biosystems, USA).

Analysis of DNA template activity from objects was carried out using polymerase chain reaction using the Quantifiler® Human DNA Quantification Kit (Applied Biosystems, USA) quantitative enzymatic amplification system.

The productivity of the polymerase chain reaction was recorded in real time using an ABI PRISM 7500 Sequence Detection System amplifier and SDS software v.1.1 (Applied Biosystems, USA).

The DNA concentration in preparations from objects No. 1 and 2 was 82.8 and 46.6 ng/µl, in the preparation from object No. 3 - 92.5 ng/µl. DNA preparations were diluted to a “working” concentration of 0.1 ng/μl.

Typing of polymorphic STR loci of nuclear DNA from objects was carried out using a polymerase chain reaction using the AmpFlSTR Identifiler Plus and Globalfiler reagent kits, produced by Applied Biosystems, USA, in accordance with the instructions supplied with the kits. The amplification reaction was carried out with using the GeneAmp PCR system 9700 device from Applied Biosystems, USA. Separation and detection of fluorescently labeled amplified fragments was carried out using the ABI PRISM 3500 Genetic Analyzer device and software from Applied Biosystems. Determination of the lengths of amplified fragments and determination of allele numbers were carried out on the basis of internal length standards (Size Standard GeneScan-600 LIZ) and

adding allelic ledgers into the reagent kit using the GeneMapper ID-X software package.

In DNA preparations from objects No. 1, 2, the genetic characteristics of the victim were established.

The DNA sample from object No. 3 revealed a mixed genetic profile with a predominance of the victim’s genetic characteristics. The minor genetic component was represented by the genetic profile of a male embryo.

Non-maternal alleles in the total DNA profile coincided with the alleles of the corresponding loci in the suspect’s genotype. The presence of non-maternal alleles in only 4 out of 21 loci is associated with the presence in the genotype of the embryo of homozygous allelic combinations and heterozygous allelic combinations that coincide with the allelic combinations of the mother. Such data confirm the investigative version of the relationship at the parent-child level between the victim and the suspect.

To confirm the identified relationship, an analysis of STR markers of the Y chromosome was carried out (AmpFISTR Y-Filer PCR AmplificationKit reagent kit, manufactured by Applied Biosystems, USA).

The Y-chromosome haplotype identified in the DNA sample from object No. 3 completely coincides with the Y-chromosome haplotype of the suspect.

Thus, conducting a molecular genetic examination of abortive material obtained in the early stages of pregnancy (5 weeks) is possible, although it is associated with certain difficulties (complexity of storing biological material, the need for differential morphological analysis of abortive material, taking a large number of samples, analysis of mixed genetic profiles).

Possibility of using laser microdissection technology of biological preparations for molecular genetic analysis of chromosomal DNA using electrophoresis in polyacrylamide gel plates

V. V. Ryndin1, T. A. Smagina1, Ph.D. A. G. Kobylyansky2, D. D. Markov2, Doctor of Medical Sciences, Prof. V. A. Klevno1

TBUZ MO "Bureau of SME" (head - doctor of medical sciences, prof. V. A. Klevno)

2Center for Cellular and Gene Technologies of the Federal State Budgetary Institution of Science, Institute of Molecular Genetics of the Russian Academy (CCGT IMG RAS)

Abstract: The article is devoted to studying the possibility of typing chromosomal DNA using the maximum number of STR loci in a certain number of cells isolated from biological preparations using laser microdissection. The possibility of using this method for electrophoresis in polyacrylamide gel plates was determined. It was established that due to the insufficient sensitivity of the method used, it cannot be recommended for use in molecular genetic laboratories of forensic institutions.

Key words: biological preparation, laser microdissection, chromosomal analysis

Highest body temperature

July 10, 1980 at Grady Memorial Hospital in Atlanta, NY. Georgia, USA, 52-year-old Willie Jones was admitted with heatstroke. His temperature turned out to be 46.5 C. The patient was discharged from the hospital after 24 days.

Lowest body temperature

The lowest documented human body temperature was recorded on February 23, 1994 in Regina, Saskatchewan, Canada, by 2-year-old Carly Kozolofsky. After the door of her house was accidentally locked and the girl was left in the cold for 6 hours at a temperature of −22 C, her rectal temperature was 14.2 C.

Hiccups

Charles Osborne from Anton, PC. Iowa, USA, began hiccupping in 1922. He led a normal life, was married twice and had 8 children, and stopped hiccupping in 1990.

Sneeze

Doina Griffiths of Pershore, c. Hereford and Worcester, UK, began sneezing on January 13, 1981. After sneezing about a million times in the first 365 days, she sneezed for a further 614 days.

Snore

A snoring noise level of approximately 93 dB was recorded on 24 May 1993 by Kare Valkert from Kumala, Sweden, at Örebro District Hospital.

Swallowing objects

2,533 foreign bodies, including 947 safety pins, were found in June 1927 in the stomach of a 42-year-old woman who suffered from compulsive swallowing. She complained of mild abdominal pain.

Heaviest item

The heaviest object ever removed from a human stomach was a hairball weighing 2.35 kg. It was located in the stomach of a 20-year-old girl who suffered from compulsive swallowing and was removed on 30 March 1895 at the South Devon and East Cornwall Hospital, UK.

Human cells

40 years after Henriepa Lax's death, her body's cells are still alive. From these, a single cell was isolated that lacked chromosome 11; the latter, as is now known, suppresses the process of the appearance of neoplasms. As a result, this cell turns out to be immortal and serves as a valuable object for biomedical research.

Receiving the most blood

The largest amount of blood required during the operation was 50-year-old Warren Jirich, who suffered from hemophilia. In December 1970, during heart surgery at a hospital in Chicago, pc. Illinois, USA, 2400 donor units (1080 l) of blood were transfused to him.

Longest tracheotomy

Winifred Campbell of London had a silver tube inserted into her larynx in 1906, through which she breathed until her death at the age of 86 in 1992.

Oldest surgical patient

The oldest person to undergo surgery was James Henry Brett Jr. from Houston, pc. Texas, USA. On November 7, 1960, when he was 111 years and 105 days old, he underwent hip surgery.

Has undergone the most number of operations

Between 1954 and 1994, Charles Jensen of Chester, Co. South Dakota, USA, 970 operations were performed to remove tumors.

First general anesthesia

When removing a cyst from the neck of James Venables in 1842 in Jefferson, pc. Georgia, USA, Dr. Crawford Williamson Long used diethyl ether (C2H5)2O as an anesthetic.

Longest operation

The longest operation was to remove an ovarian cyst. It lasted 96 hours and was made to Gertrude Lewandowski from Chicago, PC. Illinois, USA, February 4-8, 1951. After the operation, the patient's weight dropped from 280 to 140 kg.

First heart transplant

The first heart transplant operation was performed on December 3, 1967 in Cape Town (South Africa) by Prof. Christian Neethling Barnard. His patient, 55-year-old Louis Washkansky, died 18 days after surgery.

Longest-living woman with a transplanted kidney

The record for survival after a kidney transplant belongs to Joanna Leanora Rempel from Red Deer, Alberta Ave., Canada. The kidney was transplanted to her on December 28, 1960 in Boston, PC. Massachusetts, USA.

Emergency medical care

Fisherman Jan Egil Revsdal's heart stopped for 4 hours after he fell overboard off the coast of Norway near Bergen in December 1987 and his body temperature dropped to 24 C. He recovered after being connected to a heart-lung machine at Heukeland Hospital .

Longest coma

Elaine Esposito from PC. Florida, USA, a 6-year-old girl became comatose on August 6, 1941, while undergoing appendicitis surgery. After being unconscious for 37 years 111 days, she died on November 25, 1978 at the age of 43 years 357 days.

Longest posthumous birth

The fetus stayed the longest, namely 84 days, in the womb of the deceased mother. In this case, recorded on July 5, 1983 in Roanoke, pc. Virginia, USA, a girl was born to a woman who died of brain damage.

The biggest overloads

During the Silverstone Circuit Race in Northamptonshire, UK, in July 1977, a crash occurred and driver David Purley had to endure a speed reduction from 173 km/h to zero in a section of just 66 cm. He experienced the effects of a G-force of 179.8 dynes. , receiving 29 fractures and 3 dislocations. His heart stopped 6 times.

Longest use of the iron lung device

James Ferwell of Chichester, c. Hampshire, UK has been using negative pressure breathing apparatus since May 1946.

Largest number of injections

Since 1923, Samuel Davidson of Great Britain has received at least 78,900 insulin injections.

Most tablets

The largest number of pills, 565,939, are reported to have been taken by K. Kilner of Bindura, Zimbabwe, between 9 June 1967 and 19 June 1988.

Largest number of artificial joints

Norma Wickwire (USA), who suffered from rheumatoid arthritis, had 8 out of 10 large joints replaced with artificial ones. From 1979 to 1989, she had both hips, knees, shoulders, right elbow and left ankle replaced.

Longest beard

At the time of his burial in 1927, Hans N. Langseth, a native of Eidsroll, Norway, had a beard length of 5.33 m. In 1967, it was transferred to the Smithsonian Institution, Washington.

Phonagnosia

This is a very strange and very rare disease in which a person is unable to recognize the voices of people whom he cannot see. For such a person, all voices sound the same, and as a result, he is simply unable to communicate over the phone, since he cannot even recognize the voice of a person he knows very well. Until January 2009, doctors believed that such cases were only possible with patients who had suffered an apoplexy that affected the brain. But in January 2009, a woman was admitted to the hospital who was born with this disease.

It is interesting that such people recognize the tone of sound and the emotions of a speaking person well. But such patients are unable to find out who owns the voice they hear.

Twig in the lung

28-year-old Artem Sidorkin began to feel terrible pain in his chest for some time. After he went to the doctors, they decided that he had a malignant tumor, which was in one of the last stages. On the X-ray, doctors saw a 5-centimeter spot and decided to try to operate on the patient, without much hope of success, however.

And something incredible happened - when the doctors got to the patient’s chest, they saw... A spruce branch in the lung! No cancer - the lungs are pink and clean, and this is an incredible twig. It is quite difficult to explain the appearance of a twig in the lung - the only possible explanation is that the patient inhaled a vegetative bud while walking through a coniferous forest and decided to smell a spruce branch.

In general, everything ended well, and the patient is simply happy that he does not have cancer. By the way, a similar case occurred in 2007, when doctors operated on a 10-month-old Chinese woman who had breathing problems. Doctors discovered a small tuft of grass that had sprouted from a seed.

Child allergy

A 28-year-old English woman who gave birth to her baby discovered that every time she picked him up, painful sores would then form on her skin. After contacting doctors, she found out that she had a very rare skin disease, Pemphigoid Gestationis. This disease in this case manifested itself as an allergy to one’s own child.

At first, when the mother heard this diagnosis from the doctors, she thought it was a joke. But when she realized it was true, Joanne Mackie became upset. After all, you can imagine what difficulties she has with feeding the child, with games and other activities common to mothers.

She has to wrap towels around her hands when she picks him up. However, after a couple of months, doctors cured the disease using powerful steroids.

Changing your thinking

After brain surgery became common, doctors realized that even a minor operation could change a patient's personality. Thus, the operation performed on the brain of Sandy Allen led to the fact that the character and habits of this woman completely changed. Previously, she was a logical person who did not show artistic talent. After the operation, as a result of which a certain part of the left hemisphere was removed (it was removed due to a tumor), Sendy became an artistic person who began to draw, sing, and play music.

She transformed her apartment into a studio and began to exhibit various talents in the fields of fine art and music.

Face transplant

Isabelle Dinoire, France, was the first person to successfully undergo a partial face transplant. Her face was disfigured by a dog that attacked the woman, and on November 27, 2005, doctors decided to perform a partial face transplant. The surgery involved transferring the face from the top of the nose to the chin. The donor was a woman who had just been taken off life support and was brain dead.

In general, the operation was very successful, and after a couple of years the woman gained complete control over her new face, muscles and nerves became a single system.

Casuistry - what is it? It is this question that we will try to consider in this article. Here the definition of a terminological unit, the doctrine of casuistry and its place in various fields of activity will be touched upon. We will also focus on the concept of insinuation, which is associated with the term being studied.

Introduction

Casuistry - what is it?

Before getting acquainted with this concept in more detail, let us pay attention to the term “casuality” - the doctrine of chance. The theory of this doctrine was defended in ancient Greece, and this was done by the philosopher Epicurus and some of his followers, as well as by Lucretius, a poet originally from the Roman Empire. There were other individuals interested in the topic of casuistry.

General information

When answering the question of what casuistry is, it will be important to first become familiar with the commonly used meaning. This term refers to the ability to be resourceful when arguing or proving a number of ideas that are false or dubious.

Medieval scholastics, speaking of casuistry, had in mind a special dialectical form, a technique. Using this concept, they broke down various issues (religious, moral or legal) into a huge number of smaller components. For theologians and lawyers, this was a way of moving away from a general solution to the issue and moving to the most subtle and comprehensive characteristics and analysis of all possible options for the development of reality or pseudo-reality.

Theologians most often mean by this term a teaching according to which the degree of sin can be determined in relation to a variety of circumstances. Through casuistry, creationists distinguished and regulated conflict situations and disputes arising between human moral obligations.

Law and medicine

In jurisprudence, casuistry is the analysis of a specific case, case (case). Using casuistry techniques, a general set of certain fundamental facts was derived from the situation, which then supplemented the list of legislative normative guidelines. Judicial practice uses this concept to resolve many complex issues; Casual creativity is used in many countries, and it is determined by a set of issues that have not yet been reflected in the law.

What is casuistry in medicine? This term and its meaning are used by doctors and researchers to make “individual observations of injuries or diseases that are of considerable interest to mankind, both scientific and practical.” This is due to the rarity or unusualness of the phenomenon being studied.

Casuistry in judicial practice

As a rule, when we talk about casuistry, the term itself includes the concept of something unusual, atypical and rare. Forensic medical casuistry is a form of examination, which, in this case, is no exception.

The work of a forensic scientist often presents him with a number of demanding cases. Such situations are of great interest to specialists, since they include many atypicalities. The study of rare cases requires an extraordinary approach to finding an answer to a logically substantiated question.

Information about solving complex investigative issues using the specific capabilities of a forensic expert often becomes available to a wide range of different audiences. However, the publication of such data is often unable to satisfy discerning readers. This is due to late publications, incorrectly placed accents, or unclearly stated essence and content of the intrigue. In addition, it is extremely rare that all the details of the creative work of a laboratory specialist are revealed. The product of the thinking process of such a worker, with all his doubts, the birth of expert facts, etc., is especially not mentioned. And to better familiarize yourself with the answer to the question that this is casuistry, it would be very useful if the expert’s conclusions and reasoning were recorded and could be familiarized with. It is the direct analysis of such information that would enable people to better understand the research process and better understand casuistry itself.

Atypicality

The peculiarity of forensic medical examination and its relationship with casuistry is an extremely interesting phenomenon. Experts' research covers many different areas of research, ranging from traumatology to thanatology or personal identification. And although the set of research tools is generally the same for everyone and is limited, the number of cases studied is never identical. This is due to the individuality of the various subjects involved in a particular case or case. Therefore, it is important that the employee performing the analysis of all factors of the situation is extremely attentive and inquisitive. A comprehensive and complete examination of various research objects, their collection and analysis in parts, generalization and much more make it possible to create a clear picture of what happened, as well as find missing elements related to the case.

Concept of insinuation

When answering the question: “casuistry - what is it?”, it will be important to mention the concept of insinuation. These terms are interconnected and represent a kind of opposite to each other.

Insinuation is a malicious fictitious event or pseudo-fact, an attempt to instill negative thoughts, as well as hidden incitement and deliberate statement of false information. Also, this concept includes the desire and attempt to put the opponent’s thoughts in a bad light, which can cause him some damage or discredit him. Most often, insinuation is used secretly, for example, through hints or using psychological techniques.

Casuistry and insinuation lie on opposite sides of the law when it comes to judicial and legal practice. The purpose of insinuation is to undermine trust in listeners regarding the object of the insinuation. In other words, the person using it tries to prove the inconsistency of the opponent’s arguments and facts.