[The role of the Department of Forensic Medicine of the Military Medical Academy in the study of gunshot and blast trauma].
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Biomedical subjects
Publications and source records attributed to E A Dyskin.
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Gunshot disturbances of different severeness were induced in rabbit brain by means of specifically worked out experimental model. Cerebral cortex was studied using light and electron microscopy in severe gunshot craniocerebral trauma (SGCT), accompanied with cranial bones and cerebral disorders, plentiful external and internal hemorrhages and death of the animals 1-5 minutes after the shot. Peculiarities of responsiveness to trauma were demonstrated in microcirculatory bed elements, neurons and glial cells. SGCT causes rapid appearance of destructive changes in cerebral cortex with degenerative processes not following hemomicrocirculatory bed disturbances, but developing simultaneously with them.
Cerebral cortex was studied morphologically in rabbits with concussion of brain induced by gunshot injury. The extent of severity was modelled by the bullet rate. No significant bleeding followed the injury allowing to observe the animals during the necessary terms (7-14 d.) Morphological study included light optical and electron microscopy. In neurons, glial cells and synapses a series of essential destructive changes in shown detectable predominantly on ultrastructural level that might be the base of psychoneurological complications of a distant period. Ballistic properties of a bullet were obviously fundamental to pathogenesis of brain concussion in these experiments as kinetic energy of the bullet was only sufficient for non significant damage of the skull soft tissue. But in contrast to the dull trauma, the blow was of a high speed and despite mild clinical characteristics caused essential diffuse structural disturbances in brain tissues.
The character of contusive changes has been determined in the skin and sciatic nerve after lesion of soft tissues of the extremity with a high-speed small-bore bullet. A high-speed filming, tensiometry have been used. They allow to observe and measure processes of formation of the temporal pulsating cavity appearing at the moment of injury in the block of 20% gelatin and its influence on the imitator of the vascular-neural bundle. In the investigation performed on test-animals by means of neuromorphological, histological and histochemical techniques certain contusive changes are stated in the skin and sciatic nerve at various distances from the edge of the entrance and axis of the wound canal. The investigation of the material in 1, 3, 5 days after the lesion makes it possible to differentiate initial changes connected mainly with the effect of contusion from the secondary ones.
The article cites the concept, basic standards and principles of international humane law concerning the banning or restriction of some types of conventional weapons. The authors describe international methods for appreciation of destructive effects of wounding missiles. On the basis of literature and their own experiments the authors make a conclusion that actually it would be impossible to formulate a straight definition between "human" and "inhumane" bullets, as well as to establish a criterion which could determine the admissible or inadmissible limits for gunshot injuries.
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Clinical observations were performed in 104 patients with intrahepatic blockade and 32 patients with subhepatic blockade of portal bloodflow and experimental studies in 24 mongrel dogs with the model of dosed stenosis of the portal vein. It was found that microcirculation bed of hollow organs of the gastrointestinal tract is also involved into the circle of pathological disorders in portal hypertension. Alterations of the microcirculation bed consist in the appearance of destructive lesions of the microvessel walls, disturbance of their permeability and hemodynamics. Undoubtedly, genesis of functional disturbances is based on structural alterations.
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At portal hypertension, produced by means of experimental stenosis of the portal vein in the hemomicrocirculatory bed of hollow organs of the gastrointestinal tract, congestive phenomena and edema of walls in the organs are observed. Manifested dilatation is noted in the lumen of arterioles, venules, postcapillary venules and capillaries. At early stages after the operation average diameters of these vessels in the submucosal base of the small intestine become increased 3-7 times and they do not return to the initial size even at late stages. The precapillary sphincters are in the state of spasm. Overdistention of walls in microvessels of the venular part of the functional module results in their increased permeability, that is demonstrated as diapedesic hemorrhages. During formation of intraorganic and extraorganic peripheral pathways of the circulation, the congestive phenomena in the hemomicrocirculatory bed disappear gradually.
The neurohistological data on the nonspecific reactive phenomenon the dendrite neuroplasm excrescences were compared with intravital data on reactive mobility of the processes of the surviving neurons and nerve cells in tissue cultures. It was demonstrated that static pictures on histological preparations correspond to the stages of reactive reconstruction of live dendrites, such as retraction, extrusion and autotomy. The neuroplasmic excrescences reflect the reverse displacement of the neuroplasm associated with the process retraction rather than enhancement of its proximodistal flow.
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In 21 mongrel dogs changes in the intraorganic arterial and microcirculatory bed of the cervical muscles have been studied after a simultaneous ligation of the common carotid and vertebral arteries. The most pronounced changes of rearrangement are observed during early periods after the operation (up to two months). The form, size of the arterial loops and direction of the blood stream change in them. On the base of the arterio-arterial anastomoses collateralies are formed, their degree of development is progressing with the increase of the postoperative time. The arteriolo-arteriolar anastomoses in small loops convert into microvascular collateralies that are of importance only during early postoperative stages. The new conditions of hemodynamics at the arteriolar level result in a dependent rearrangement in other links of the microcirculatory bed, where a number of compensatory-adaptive mechanisms are revealed. After the magistral by-pass ways are completely formed, the changes observed disappear and the microcirculatory network acquires the features specific for intact animals.
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In 20 mongrel dogs by means of four methods (injection of Indian ink and gelatin, impregnation after Bielschowsky--Gros, injection of 1% colloid silver solution and erythrocytes staining with benzidine) capillaries in the musculus sternomastoideus have been revealed. The capillary diameters are measured with a screw ocular micrometer and treated by means of variational statistics methods, three-factor dispersion analysis including. The role of the factors affecting the capillary diameters in the process of their revealing is defined. The controlled factors determine 81% of total variation, out of them the investigation methods--70%, individual variability of the animals--1.2%, conditions for making preparations--0.1% and 2.9% are connected with the interrelations of the factors mentioned. Each method makes certain distortions in the measurements, but, at the same time, is specific for revealing various structural details. Therefore, in order to study the capillaries, it is necessary to apply their combinations.
Microcirculatory bed in some organs of a normal brown frog Rana temporaria has been studied at vital observation by means of the luminescent photomicroscope LIUMAM K-1. Elements of the microcirculatory bed have been determined according to the direction of blood stream and the diameter of its separate links. Certain peculiar features of the blood stream have been studied in the dark field in the organs such as: the skin, the tongue, the gastric wall, the intestinal wall, the lungs and others. The range of morpho-functional lability in the microvessels and structural organization of the bed in question depend on the structure of certain organs. A close connection between the microvascular wall and melanocytes has been revealed.