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MEDICO-LEGAL ANALYSIS OF BLOOD LOSS-INDUCED
DAMAGE TO SOFT TISSUES AND KIDNEYS
Rakhmanova Mubarak
English teacher at Urgent Technical School Of
Public Health named After Abu Ali Ibn Sino
Abstract.
The article discusses the results of an experimental study on modeling
mechanical trauma accompanied by damage to soft tissues and the kidney under
conditions of blood loss and without it. A certain dynamics of pathomorphological
changes was revealed both in soft tissues and in the kidney, depending on the duration
of the damage.
Kеywоrds:
experimental modeling, kidney, damage, pathomorphology.
INTRОDUСTIОN
In the course of forensic medical research in various types of mechanical trauma,
one of the most important issues is to establish signs of intravital formation of injuries
and the age of their occurrence [1]. Resolution of these issues becomes possible as a
result of morphological analysis of reactive changes in various tissues and organs that
are characteristic of certain periods of the post-traumatic process, as well as the
identification of acute circulatory disorders in the area of injury [3].
MАTЕRIАLS АND MЕTHОDS
The literature contains information that reflects the patterns of development of
responses occurring in the div after injury, both in soft tissues and in internal organs
[2]. However, according to the authors, the dynamics of the development of reactive
changes in the post-traumatic period, in different organs and tissues, proceeds
differently, which is associated with their morpho-functional characteristics [1].
Considering that severe blunt trauma is often accompanied by the development of
blood loss and complicated by hemorrhagic shock, when planning this study, the
possibility of the influence of hemorrhagic shock on the nature of reactive changes in
injured tissues and organs was taken into account [5].
In connection with the above, it seemed appropriate to us to evaluate
pathomorphological changes in blunt trauma accompanied by damage to soft tissues
and kidneys against the background of hemorrhagic shock in the experiment.
RЕSULTS АND DISСUSSIОN
The first group consisted of animals that were anesthetized using diethyl ether and
fixed on an operating machine. Modeling of hemorrhagic shock was carried out by
collecting blood from the tail vein. Using a measuring tube, blood loss was monitored,
which was 3.5–4 ml, which corresponded to 30–40% of the circulating blood volume
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of an animal weighing 180–200 g [1].
After simulating hemorrhagic shock, the animals underwent a dissection of the
anterior abdominal wall 1.5 cm to the right of the midline. Using anatomical tweezers,
mechanical damage was performed by local compression of the lower pole of the right
kidney. The formation of damage was monitored visually by the resulting hemorrhage.
Injury to soft tissues was carried out by applying a Hegar needle holder for 10 s to a
folded area of the anterior abdominal wall, after which a hemorrhage also formed under
the parietal peritoneum in the area of impact. After simulating a blunt injury to the
kidney and soft tissues, the anterior abdominal incision was sutured in layers.
In order to identify pathomorphological changes in soft tissues and the kidney
during mechanical trauma against the background of developing hemorrhagic shock,
depending on the age of formation of the damage, the animals were divided into 7
groups of 11 animals each: Group 1 - 1 hour after modeling injuries, 2nd group – 6
hours, 3rd group – 12 hours, 4th group – 24 hours, 5th group 72 hours (3 days), 6th
group – 5 days, 7th group – control (samples of organs and tissues were taken
immediately after modeling injuries to soft tissues and the kidney). In the experiment,
soft tissues and kidneys from 77 animals were examined.
When microscopying specimens from animals from the 7th control group in the
soft tissues and kidney, uneven blood filling of vessels of all calibers was noted; focal
hemorrhages were represented by clusters of loose and compact masses of erythrocytes
located perivascularly and in the intermuscular spaces of soft tissues .
In animals of group 1, 1 hour after injury during hemorrhagic shock, the
appearance of neutrophilic leukocytes was observed in the soft tissue vessels, some of
which migrated outside the vascular bed and were located perivascularly. The
appearance of neutrophilic leukocytes in the area of the resulting hemorrhage was also
noted.
When examining the kidneys, the microvasculature vessels were anemic and the
arteries were spasmodic. The glomerular capillaries were unevenly filled with blood or
empty. In the area of damage, hemorrhages were represented by loose masses of red
blood cells with an admixture of single neutrophilic leukocytes. The epithelium of the
proximal tubules was high, somewhat swollen, in a state of dystrophy, which was
accompanied by a narrowing of the lumen of the tubules. In some areas, the tubular
epithelium was “swollen,” eosinophilic clumps were observed in the cytoplasm of
these cells, and the nuclei were also swollen.
In animals of the 2nd study group (6 hours after injury), increasing swelling was
noted in the soft tissues, the connective tissue fibers were swollen, and the distances
between them were increased. In foci of hemorrhages formed in places of traumatic
impact, diffuse polymorphocellular infiltration was detected, characterized by the
presence of neutrophils and the appearance of macrophages. Microscopic examination
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of the kidneys 6 hours after the formation of damage in animals with hemorrhagic
shock revealed a diffuse leukocyte reaction in subcapsular hemorrhages with the
appearance of single macrophages.
СОNСLUSIОN
Thus, the results of the study indicate that in the post-traumatic period after blunt
mechanical trauma caused by hemorrhagic shock, there is a more active development
of reactive changes in the damaged soft tissues compared to the injured kidney. The
identified differences in the dynamics of the development of reactive changes in soft
tissues and in the kidney are likely associated with the characteristic features of the
course of tissue and organ metabolism. The data obtained can be useful when
conducting expert studies to establish the age of damage.
RЕFЕRЕNСЕS:
1. Astashkina O.G., Stolyarova E.P., Poltarev S.V. and others. Establishment of
the lifetime of mechanical injury based on biochemical parameters // Medical
examination and law. – 2010. – No. 3. – P. 43–45.
2. Davydovsky I.V. General human pathology. – M.: Medicine, 2018.
3. Naumenko V.G., Mityaeva N.A. Histological and cytological research methods
in forensic medicine. – M.: Medicine, 2020.
4. Permyakov N.K., Zimina L.N. Acute renal failure. – M.: Medicine, 2020. – 235
p.
5. Sapozhnikova M.A. Morphology of trauma to the chest and abdomen. – M.:
Medicine, 2018. – 187 p.
