VITAL TESTS

From Big Medical Encyclopedia

VITAL TESTS — the methods of definition of a zhivorozhdennost establishing presence of air at lungs or digestive tract.

Conducting two hydrostatic tests agrees § 79 of «Rules of a medicolegal research of corpses» surely: pulmonary and gastrointestinal. For establishment of the fact zhivorozhdennost (see) also radiographic test of Dillon, test on passability of vessels of an umbilical cord, optical and ear tests are offered.

Pulmonary test it is based on the physical law on specific weight. After the first breath lungs of the newborn are filled with air and their specific weight becomes lowered in a vessel with water, emerge and float on a surface.

Lungs of not breathing baby represent airless plotnovaty fabric, specific weight cover more unit; they plunge on a bottom of the vessel filled with water. By production of pulmonary test before opening of a chest cavity otseparovyvat soft tissues of a neck and tie up a trachea in its upper third. After survey of bodies of a chest cavity they are taken in a uniform complex (before section of a gullet it is necessary to tie up it at an entrance to a stomach). The taken complex is carefully lowered in a wide vessel with transparent cool water. If the complex sinks, then, having replaced water in a vessel, separate lungs from bronchial tubes and lower in a vessel each lung separately. Test is repeated with each lung lobe, and then with the certain sites of pulmonary fabric which are allocated with lighter coloring. Ability of lungs or their parts to float indicates contents in alveoluses of the air which arrived at the first respiratory movements of the baby and is estimated as a positive take of pulmonary test. It must be kept in mind, however, that at putrefactive change of a corpse, freezing of lungs with formation in them of ice, holding various actions for the purpose of revival of the newborn lungs of not breathing baby can float.

Gastrointestinal test it is based on the fact of penetration of air in went. - kish. a path along with the beginning of independent lung respiration as a result of swallowing air by the baby. For carrying out it is tied up a stomach at an entrance and an exit two ligatures before extraction of a cervicothoracic complex, by large and small bowels in several places, especially where there is accumulation of gases. Further all intestines are carefully separated from a mesentery and together with a stomach lowered in a vessel with cool water and tested for swimming similar to lungs. It is important to note partial immersion of a complex i.e. what departments went. - kish. a path were emerged and on what extent since at an extrauterine life of the baby this or that part went. - kish. a path it is filled with air and the longer life proceeded, the more deeply on went. - kish. to a path air gets. Then the stomach and intestines consistently open with a scalpel under water, noting absence or existence of air traps. The positive take went. - kish. tests are estimated as well as pulmonary. Reliability of results went. - kish. tests sharply decreases or it is completely lost if there are signs of putrefactive decomposition of a corpse. It is necessary to remember also that air can fill a stomach and guts at resuscitation of the newborn. Content of air in went. - kish. a path not always corresponds to force and duration of breath: in case lungs remain in a condition of an atelectasis, went. - kish. the path is filled with air quicker, than at free breath. A positive take of this test, matching the same result of pulmonary, confirms life of the child after the birth. If went. - kish. test is positive, and lungs are airless, she on herself can be a sign to an extrauterine life. Quite often lungs contain air, and in went. - kish. a path it is absent. This phenomenon becomes clear and does not contradict the fact of an extrauterine life of the newborn if to take into account that penetration of air into a stomach requires more time, than in lungs.

Dillon's test it is offered in 1937. On Ya. G. Dillon's observations, even in the absence of air the child lives in lungs a nek-swarm time if air gets into his stomach immediately after the birth; this air is soaked up and supports life. By a radiographic research it is possible to find even insignificant amount of air (to 0,2 cm 3 ) in lungs and a stomach of newborns.

Optical test it is based on existence of a characteristic marble surface appearance of lungs of the breathing baby. At survey of a surface of lungs with the naked eye or by means of a magnifying glass it is possible to find the light sites consisting of a set of the brilliant bubbles representing the alveoluses straightened by air. They are located under a pleura, are surrounded with the capillaries stretched by blood and are considered as a sign of the having place of breath. However the alveoluses straightened by air are available also at an artificial respiration and at putrefactive decomposition of pulmonary fabric; in such cases establishment of a zhivorozhdennost on optical test becomes impossible.

Test on passability of vessels of an umbilical cord proceeds from ability of an umbilical cord at mortinatus babies to pass water, and at live-born to detain her passing. Test has no scientific justification, its results are contradictory therefore it is the proof of a zhivorozhdennost only in combination with positive takes of other tests.

Ear test, connected with the fact of penetration of air into an acoustical (evstakhiyeva) pipe and a drum cavity, did not receive practical application owing to complexity of performance.

See also Viability , Mertvorozhdennost .



Bibliography: Rozenblyum E. E., Serdyukov M. G. and Smolyaninov V. M. Medicolegal obstetric and gynecologic examination, M., 1935; Serdyukov M. G. Judicial gynecology and judicial obstetrics, M., 1964, bibliogr.; Smolyaninov V. M., Shirinsky P. P. and Pashinyan G. A. Medicolegal diagnosis of a zhivorozhdennost, M., 1974, bibliogr.

P. P. Shirinsky, G. A. Pashinyan.

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