The purpose of the study was to identify the patterns of changes in the state of the parenchyma of the pancreas in patients with complicated forms of chronic pancreatitis with evaluation of the diagnostic effectiveness of shear wave elastometry (graphy). Materials and methods. For the period from 2006 to 2018 58 patients with complicated forms of chronic pancreatitis were examined. The average age of patients is (47.1±3.2) years old. The medical history ranged from 3 to 15 years. The basis of morphological studies were biopsies of the pancreas obtained during surgery. Ultrasound elastometry and pancreatic parenchymal elastography were performed by transcutaneous shear wave approach in Shear Wave Elastography. Software consistency was assessed by the nature of the color mapping. Results and discussion. The morphometry of the volume parts of the structural components of the pancreas showed that with the development of complicated chronic pancreatitis there is an increase in the area of fibrous tissue and a decrease in the area of acinar components. The proof of this is the strong inverse relationship between the degree of fibrosis and the volume fraction of acinar tissue (r= -0.83; р <0.05), as well as the direct relationship between the degree of fibrosis and the volume fraction of connective tissue (r=0.61; р <0.05). If at a fibrosis of the III degree acinar tissue occupied (25.39±2.01)%, connective – (64.33±3.85)%, fatty – (6.42±4.48)%, at a fibrosis of the IV degree noted the following: the proportion of acinar tissue was only (2.86±0.76)%, connective – (74.11±4.17)%, and (20.14±4.29)% was adipose tissue. Such manifestations indicated severe irreversible changes in the external secretory function of the pancreas. When assessing changes in the stiffness of the pancreatic parenchyma with the deepening of fibrosis processes and data from transcutaneous shear wave elastography, it was found that the degree of fibrosis according to morphological data correlated with the degree of fibrosis according to shear wave elastography, r = 0.71; p <0.05. The following patterns were noted. Grade II pancreatic fibrosis was characterized by intralobular fibrosis, which covered 26-50% of the gland area, which corresponded to the shear wave elastography data in green-blue color (5.98-7.05 kPa). Grade III pancreatic fibrosis corresponded to intralobular fibrosis, which covered 51-75% of the gland area in shear wave elastography in green-yellow color (7.06-9.06 kPa). Grade IV pancreatic fibrosis was characterized by intralobular fibrosis, which covered 76-100% of the gland area, which corresponded to shear wave elastography data in yellow-red color (> 9.07 kPa). Conclusion. Thus, the objectification of shear wave elastography indicators of the pancreas based on the correlation of histological evaluation and morphometric indicators of structural changes in the pathological process allows to consider transcutaneous shear wave elastography as a promising and reliable method of non-invasive diagnosis of fibrosis in chronic pancreatitis
The article examines separate sexual problems of psychosomatic disorders of persons who have become victims of sexual criminal offenses; issues related to behavioral analysis, the state of health, physical and moral balance, the internal complex of unrealized anger, social dissatisfaction, models of unresolved conflict in Ukrainian society. Proposals for reforming outdated legal norms and social practices, expanding the range of understanding of social space, victims of sexual criminal offenses of a sexual nature and refugees, of which there are many, are significant for the constitutional values of our citizens. As a result of post-traumatic stress disorder, the lives of victims of sexual violence by the Russian military have drastically changed in their families and in society. The consequences form the victims individually specific and distorted experience, peculiarities of sexual relations, degree and state of deprivation. In cases where the victim was intimidated, forced to engage in sexual relations in childhood and adolescence, raped several times, the symptoms are complicated by the formation of persistent post-traumatic stress disorder. Legal guarantees are the decisive legal means of ensuring, implementing, protecting human and citizen rights in Ukraine. Realization and guarantee of the rights, especially with various types of deprivations, of the citizens of our country, is one of the most important factors of the proper development of Ukraine, the formation of civil society, a convincing evidence of democracy for joining the EU. The anti-social, criminal behavior of Russians, during the military aggression against Ukraine, uncontrolled aggressiveness, murders, mutilations, torture of civilians, rape of women, girls and children require legal assessment, particularly at the international level. Key words: criminal offenses of a sexual nature, mental disorders, psychosomatics, criminology, verification, mental deprivation.
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