[Optimization of neonatal hospital care for very preterm babies while supporting early parent-child relationships]

Research shows that not only medical but also psychological factors such as parents' emotional state, their parenting skills, quality of very early relationships with the infant influence child's physical and mental health and development. The support of good infant-mother relationships is an essential part of early family-centered help to premature babies. The article reviews existing evidence-based programs of neonatal care and support of early mother-child relationships for preterm babies at the hospital. It covers three main directions: discussing with parents prognosis of a child's health and development; supporting natural conditions of child development, and including parents into child early care and observation. Data presented in the article shows that if using each of the mentioned above directions that are important for quality early care and interaction, positive dynamics is seen both on parents' and preterm infant's side. Designated programs can be widely implemented in neonatal intensive care units for children born before term, including those with extremely low body weight when they achieve clinical stabilization. The material presented in the article may be used as the scientific base for implementing in Russian Federation early care system both at the hospital level and, later, in the family environment. It also constitutes new directions for research of preterm babies and their parents.

[Mothers' emotional states and characteristics of early interaction with their prematurely born babies]

Advanced technologies of neonatal reanimation and intensive care have led to the increase in the number of children with the extremely low and low birth weight. These children constitute a risk group often having severe development complications and disabilities. This article provides a review of the existing research literature on emotional states of mothers of prematurely born infants' and characteristics of their early interaction. The data on the influence of the mother's emotional state on her interaction with her prematurely born infant and its impact on the child's long-term development are presented. The authors present directions of studying development of prematurely born infants, which are not fully reflected in the literature, regarding infants with structural intracranial changes (intraventricular hemorrhages) and associated hydrocephalus and posthemorrhagic hydrocephaly. New targets of practical work have been developed to improve the family-centered interdisciplinary support for children at infancy and early age.

[Intraventricular thrombolysis and liquor filtration in treatment of newborns with severe intraventricular hemorrhages]

The authors have analyzed 32 cases of complex treatment of severe forms of neonatal intraventricular hemorrhages and proved high clinical efficiency of complex treatment. The stage-by-stage application of tissue plasminogen activator and operation of extracorporeal cerebrospinal fluid filtration resulted in decreased mortality, reduced duration of the cerebrospinal fluid sanitation period, reduced number of shunting-dependent children. One year follow-up showed an improvement of the patients' quality of life.

[25 years' experience in surgically treatment of the epilepsy]

Progress in surgical treatment for unifocal epilepsy is evident. The efficiency of surgical treatment for multifocal epilepsy in cases when pathology of the brain is not seen on MRI remains to be inadequate and by large and large the problem is to be solved.

MATERIALS AND METHODS

In 1978 to 2004, the epilepsy center of the Republic of Moldova performed 258 operations in 215 patients with drug-resistant epilepsy. These included 28 temporal lobectomies, 46 cortical resections, 151 stereotactic operations, 6 resection-and-stereotactic operations, and 27 implantations of diagnostic intracerebral electrodes (SICE). The operations were performed in a specialized operating suite. The authors developed stereotactic apparatuses, intracranial electrodes, and chemoelectrodes. Intraoperative diagnosis included video monitoring, echography, stereotactic electroencephalography (SEEG), electric studies, drug induction of a seizure, cortical anatomic and functional mapping, and determination of resection boundaries. Stereotactic destructions were made by diathermo- and cryotechniques.

RESULTS

In temporal epilepsy, stereotactic hippocampotomy yielded good, satisfactory, and poor results in 23, 44, and 33% of cases, respectively. Amygdalohippocampotomy did these results in 33, 39, and 28%, respectively. Excellent and good results of open operations amounted to 42%. These of anterior temporal lobectomy were observed in 69%.

CONCLUSIONS

1. Stereotactic hippocampotomy is most effective in unifocal temporal epilepsy. Bilateral amygdalohippocampotomy has a marked psychosedative effect. 2. In 65%, the site of an epileptic focus failed to enable its resection to be radically made. 3. Temporal lobectomy is most beneficial in temporal epilepsy. 4. Intraoperative Talairach's SEEG, followed by resection is most effective in nontemporal epilepsy. 5. SICEs enhance the efficiency of resections by 2 times, stereotactic operations by 15%, without affecting the results of temporal lobectomy.

[Assessment of implication of transcranial ultrasonography in the diagnostics of acute disturbances of cerebral blood circulation in adults]

Implication of transcranial ultrasonography (TUS) in diagnostics of acute disturbances of cerebral blood circulation (ADCBC) was studied in 324 subjects, aged from 20 to 83 years, including group I (208 subjects without neurological disturbances), group II (56 subjects without the structural intracranial changes which, along with TUS, underwent MRT), group III (60 patients with diagnosis of ADCBC which underwent TUS and then CT of the brain). The brain areas where intracranial hemorrhages (ICH) were most often localized in hemorrhage stroke (HS) were found in 166 subjects (80%) of group I. The second and third cerebral ventricles were seen in 187 (90%) people. The third ventricular was seen in 19 patients (the effectiveness was corresponded to Echo-EG). The comparison of US-, CT- and MRT-images did not reveal significant differences as in the total assessment of the intracranial structural state of the brain as well in the most relevant measurements. TUS revealed no significant changes in 40 patients from group III but the diagnosis of infarction was confirmed by CT. The specific US signs of ICH were found in HS. In 19 patients the CT revealed and verified the ICH of supratentorial localization. In conclusion, TUS with using portative US equipment provides the possibility of screening-diagnostics and monitoring of ICH in strokes.

[Influence of smoking on the cerebral hemodynamics and biochemical blood indices in chronic insufficiency of brain circulation]

The influence of smoking on cerebral hemodynamics and biochemical blood indices has been studied in 50 male patients with chronic insufficiency of brain circulation (CIBC), aged 40-50 years, divided into 2 groups: smoking (n=26) and nonsmoking (n=24). Smoking was shown to play a substantial role in the development of discirculatory encephalopathy with atrophic brain changes, causing metabolic disturbances (a shift of acid-basic balance towards acidosis) and microcirculation disorders due to altered cerebrovascular reactivity. These alterations develop previously to hemodynamically significant atherosclerotic arteries lesion and emerge irrespective of the presence of atherosclerotic vascular changes, atherogenic shifts of lipid metabolism, disturbances of free-radical processes and platelet aggregation.

[Intracranial endoscopic operations with ultrasonographic support in pediatric neurosurgery (the potentials and outlook)]

The outcomes of intracranial endoscopic operations for occlusive hydrocephalus (65 interventions in 60 children) and intracranial hematomas (11 operations in 10 children) are analyzed. Indications and contraindications for intracranial endoscopic operations, equipment supply, specific features of their performance, and outcomes are discussed. In occlusive hydrocephalus, the outcomes were as follows: hydrocephalus stabilization (38%), complications (15%), mortality (3%), the follow-up lasting as long as 8 years. The dynamic evaluation of the intracranial status (clinical and sound monitoring) is the obligatory condition of intracranial endoscopic operations made for intracranial hematomas. There were no complications in children with intracranial hematomas after planned intracranial endoscopic operations. The application of flexible distal end-controlled endoscopic, ultrasound-stereotactically aimed, and double-maneuver-controlled systems (visual examination through the optic system of an endoscope in combination with intraoperative ultrasonographic monitoring) was shown to be optimal during intracranial endoscopic operations.

[Combined electroanesthesia: a nontraditional method of anesthesia in pediatric neurosurgery]

A combination of electrical anesthesia with calypsol and nitrous oxide has been developed and used in neurosurgical operations performed to 142 children aged 8 days to 15 years, who were divided into two groups. Group 1 included 89 children administered electrical anesthesia in combination with calypsol and nitrous oxide, Group 2 consisted of 53 children, to whom only routine calypsol and nitrous oxide anesthesia was administered. The Lennar apparatus was used to administer electrical anesthesia. The adequacy of anesthesia was estimated on the basis of the clinical data and laboratory findings. The results have shown that a combination of electrical analgesia with calypsol and nitrous oxide provided sufficient protection of a child from surgical stress, was not associated with significant changes of the hypothalamo-hypophyseo-adrenal and thyroid functions and permitted a significant reduction (by 80.8%) of the drug load.