This article presents an analytical material on the relationship of alcohol consumption and mortality in St. Petersburg for the period 2015-2017 years, which is based on the data of the city Bureau of forensic medical examination. The analysis of deaths found that the problem of abuse of alcoholic beverages (including ethanol containing) remains relevant, as indicated by the high (up to 30%) frequency of detection of acute ethanol poisoning in forensic examination of corpses. We found that ethanol poisoning in the structure of poisoning occupy the second place, while drug poisoning (opiates, cannabioids, cocaine) confidently and by a large margin occupy the first place. However, more than 75% of those who died from acute drug poisoning had alcohol in their blood. In cases where the death was violent, alcohol was found in the blood of more than 60% of the victims. High rates of alcohol intoxication were found in cases of death from low temperatures and mechanical asphyxia (hanging). About 25% of the victims of road accidents (pedestrians, drivers, passengers) were intoxicated. Our study showed no dynamics of reducing the frequency of alcohol intoxication and in cases where death occurs from diseases. When comparing certain types of non-violent death, it was found that most often the state of alcoholic intoxication accompanied (was the background) in cases of death from diseases of the digestive system: hemorrhagic pancreatitis, cirrhosis, gastric ulcer and duodenal ulcer, varicose veins of the esophagus (in 24-53% of cases), somewhat less – in diseases of the cardiovascular system (in 25-29% of cases).

One of the most serious complications of modern anesthesia is malignant hyperthermia, which is a pharmacogenetic disease, phenotypically manifested by skeletal muscle hypermetabolism and rhabdomyolysis during or after general anesthesia with the use of inhalation anesthetics. In Russia, the problem of malignant hyperthermia currently remains unresolved. We present a case of malignant hyperthermia in a 19-year-old girl who was operated on for nasal breathing disorders and received Sevoran anesthesia as support. The patient died 1 hour and 25 minutes later. after the end of the operation during withdrawal from anesthesia due to the development of a clinically confirmed syndrome of malignant hyperthermia. At the forensic autopsy, this diagnosis was confirmed. A description of the morphological changes in the skeletal muscles using both plain and elective histological stains is given.

The article presents modern data on pathomorphological changesin lung tissue formed under the influence of acute and chronic intoxication with ethanol and its metabolites. At autopsy of the persons abusing alcohol, along with defeat ofabrain, heart, a liver note considerable changes in lungs. It was found that ethanol is excreted by the lungs and kidneys unchanged. The lungs are actively involved in the conversion of ethanol into carbon dioxide. The toxic effect ofethanol and its metabolites increases the permeability of the vascular wall, which leads to the accumulation of protein in the lung tissue with the development of pronounced dystrophic and destructive changes with the formation ofsubsequent pneumosclerosis. Alcohol negatively affects the function of alveolar macrophages, which have an important role inprotecting the lungs. Under the influence of ethanol in macrophages, biochemical processes are slowed down, expressed in a sharp decrease in their phagocytic activity and ability to move. In turn, it is necessary to note the studies that reflect the data on the influence of alcohol on the lung surfactant, which stabilizes the surface tension in the alveoli and counteracts the transudation of fluid into the alveoli. Alcohol adversely affects the phospholipids included in the surfactant and disrupts the process of its formation. Alcohol intoxication is the cause of 60% of comatose States, and obturation-aspiration complications are the leading form of respiratory disorders. Alcohol-induced disorders of the mucociliary apparatus contribute to the ingress of foreign particles into the respiratory tract. The defeat of these protective mechanisms in combination with a decrease in the overall immune reactivity of the body cause the development of anumber of pathological changes in the lungs. Thus, the study of morphological features of lung injuries in acute ethanol poisoning is of fundamental importance in elucidating the links of pathogenesis ofterminal States, their justified therapy.

The article is dedicated to Ekaterina Tikhonovna Bokova, who left a bright trace in the memory and hearts of people who connected their lives with forensic medicine. After graduating from the 1st Leningrad Medical Institute and graduate studies at the Department of Forensic Medicine. Ekaterina Tikhonovna was appointed head of the Forensic Medical Examination of the LHE. When appointing, Bokovas business qualities were taken into account: her high efficiency, directness, determination, modesty, as well as successful work in the Komsomol and the recommendations of Professor M.I. Raysky. Since 1940, she began to combine as an assistant of the Department of Forensic Medicine of the Leningrad Pediatric Medical Institute (LPMI). The whole period of the Great Patriotic E.T. The lateral war remained in Leningrad, led the forensic medical expert service of the city, and from March 1942 until June 1944 she also temporarily acted as head of the department of forensic medicine at the LPMI. Thanks to the courage and selfless work of the Leningrad forensic doctors, led by Ekaterina Tikhonovna, it was possible not only to maintain expert research in the besieged city at the required level, but also to return to the pre-war organization of work as soon as possible. Ekaterina Tikhonovna was awarded the medals For the Defense of Leningrad and For Valiant Labor in the Great Patriotic War. In the postwar years, E.T. Bokova continued to lead, actively engaged in research and teaching work. In 1952, E.T. Bokova defended her thesis Morphological features of damage to the soft integument of the head and bones of the skull with chopping weapons. In addition to scientific and teaching work, Ekaterina Tikhonovna was an active social activist, was elected as a deputy of the Vyborg District Council of Leningrad, a member of the Vyborg District CPSU Committee. February 24, 1965 Ekaterina Tikhonovna suddenly died.

The analysis of expert practice and scientific research conducted during the last decade show that the greatest number of claims to the correctness of the provision of medical care are made by doctors of surgical specialties, including obstetrician-gynecologists, and, at the same time, inspections for “medical cases”, including profile “obstetrics and gynecology” are complex and time-consuming. The article considers the problem of the unfavorable outcome of medical care in obstetric practice. The questions of etiology, pathogenesis, diagnosis of intrauterine infection (VUI), which largely determines the frequency of perinatal morbidity and mortality, are also analyzed and analyzed questions of the prescription of the pathological process in the amniotic membranes, its role in the formation of fetal death. On a concrete example, expert practice shows how the forensic medical commission, taking into account the data of medical documents, as well as the results of macroscopic and microscopic studies, solves the problem of the immediate cause of antenatal death and establishes the role of intrauterine infection in the death of the fetus, the timing and causes of its formation. The information that is relevant to the practice of forensic medical examinations is presented, which allows us to formulate objective and scientifically substantiated conclusions about the existence of cause-effect relationships between the defects in the provision of medical care and the onset of an unfavorable outcome of medical care in similar cases.