morphine and Neuroblastoma

Neuroblastoma, Hirschsprung's disease, and central hypoventilation (Ondine's curse) are considered aberrations of neural crest cell growth, migration, or differentiation, and as such are considered to be under the general heading of neurocristopathy. Their combined occurrence in a newborn infant presenting with total colonic aganglionosis, central hypoventilation, and multifocal neuroblastoma had not been reported previously. A 2.3-kg white full-term girl required endotracheal intubation because of persistent apnea in the first hours of life. She had progressive abdominal distension and failure to pass meconium; a barium enema was performed, which showed microcolon with meconium pellets at the distal ileum. During laparotomy the distal ileum was found to be obstructed with inspissated meconium; an ileostomy and appendectomy were performed. The resected specimens were aganglionic. An additional 20 cm of aganglionic ileum was removed, and a normally innervated ileostomy was constructed. Numerous attempts at extubation failed because of apnea. The results of an extensive apnea workup, including electroencephalogram, magnetic resonance imaging (MRI), bronchoscopy, and pH probe study, were normal. Sleep studies showed congenital central hypoventilation syndrome, and the patient underwent a tracheostomy. At 3 months, an abdominal ultrasound examination performed within a septic workup showed a right suprarenal mass extending across the midline. Thoracic and abdominal MRI scans showed large bilateral adrenal and posterior mediastinal masses. The serum catecholamines and ferritin level were markedly elevated, suggestive of neuroblastoma. In light of the child's multiple problems, the family chose to forgo further workup (including a tissue biopsy) and therapy. In the following 2 months her tumor load rapidly progressed, and she died of respiratory insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenal Gland Neoplasms; Colonic Diseases; Female; Follow-Up Studies; Hirschsprung Disease; Humans; Ileal Diseases; Infant, Newborn; Intestinal Obstruction; Meconium; Mediastinal Neoplasms; Neural Crest; Neuroblastoma; Sleep Apnea Syndromes; Tracheostomy

The reaction of N-2,4,5-tribenzyloxyphenyl)ethyl methanesulfonate, prepared in a seven-step sequence, with normetazocine followed by hydrogenolysis of the benzyloxy-protecting groups, gave N-(2,4,5-trihydroxyphenethyl)normetazocine. This compound was prepared to study the effect of a narcotic analgesic containing a functional group which could be activated in situ to a moiety potentially capable of reacting irreversibly with the narcotic receptor. This 6-hydroxydopamin derivative of normetazocine did not prove to be a useful affinity label. Its low toxicity could indicate the necessity for the formation of an aminochrome system for the expression of toxicity by 6-hydroxydopamine.

Topics: Adenylyl Cyclases; Analgesics, Opioid; Animals; Benzomorphans; Brain; Cyclazocine; Depression, Chemical; In Vitro Techniques; Male; Mice; Morphinans; Neoplasms, Experimental; Neuroblastoma; Norepinephrine; Protein Binding; Rats; Receptors, Opioid

Topics: Abdomen, Acute; Cysts; Diagnosis, Differential; Digestive System Abnormalities; Female; Follow-Up Studies; Hemangioma; Humans; Hydronephrosis; Infant, Newborn; Infant, Newborn, Diseases; Kidney Diseases; Kidney Neoplasms; Liver Neoplasms; Male; Meconium; Neuroblastoma; Ovarian Cysts; Peritonitis; Polycystic Kidney Diseases; Renal Veins; Retroperitoneal Neoplasms; Stomach Neoplasms; Teratoma; Thrombophlebitis; Uterine Diseases; Vaginal Diseases