No abstract

Of 98 consecutive patients with neuroblastoma, 54 could be separated into survivor and non‐survivor groups on the basis of an opportunity for a 2 year minimum period of observation. Their excretions of the catecholamine metabolites, vanillylmandelic acid (VMA), homovanillic acid (HVA), 3‐methoxy‐4‐hydroxyphenylethyleneglycol (MHPG), and total metanephrines (TM) were assayed at the moment of their initial diagnosis as well as following therapy. Histologic specimens were evaluated independently by two pathologists at different institutions. Age‐at‐diagnosis, sex, catecholamine catabolite excretion pattern before and following therapy, histology, and prognosis were subjected to a statistical study of association probability. A better prognosis was associated with an age‐at‐onset of less than two years, greater histologic differentiation, lower initial HVA excretion, and a rapid return of catecholamine metabolism to normal following therapy. These data suggest the availability of criteria by which a prognostically useful classification of neuroblastoma may be established.

Neuroblastoma, one of the most common solid malignant tumors of childhood, has been frequently confused with other malignancies as well as nonneoplastic diseases. The observation that neural crest tumors resulted in excretion of elevated quantities of the catecholamines and their by‐products opened the way for development of biochemical techniques for their detection. Vanillylmandelic acid, metanephrines, homovanillic acid, and 3‐methoxy‐4‐hydroxy‐phenylethyleneglycol excretions of 180 normal children were compared with those of 62 subjects suffering from illnesses commonly confused with neuroblastoma as well as 41 patients with neural crest lesions. A simple, bedside chemical technique for detecting a neuroblastoma resulted in no false positive and 91% reliability among those patients with this tumor. Although quantitative assay for 3‐methoxy‐4‐hydroxyphenylethyleneglycol appeared to offer the greatest reliability for biochemical diagnosis of neuroblastoma, broad application of the screening test might significantly improve the ease of detection and differential diagnosis of neuroblastoma.

Relations among plasma epinephrine, norepinephrine and renin activity and systolic pressure, diastolic pressure, heart rate and the product of heart rate and systolic pressure (rate-pressure product) were evaluated in 31 healthy men whose arterial pressure spanned the range from normal to mildly elevated. Measurements were made during 60 minutes with the patient in the supine position and during 10 minutes of quiet standing. In the supine position, highly significant regressions were found between systolic pressure or rate-pressure product and plasma epinephrine, but not between these variables and norepinephrine or renin activity. A weakly significant correlation was also found between heart rate and norepinephrine. On standing, norepinephrine and epinephrine increased significantly. In this position, rate-pressure product was significantly related by regression analysis only with plasma epinephrine. Weakly significant correlations between systolic pressure and epinephrine and between heart rate and norepinephrine and epinephrine were also found. Plasma renin activity was not significantly correlated with arterial pressure, heart rate or rate-pressure product in either position. These results suggest that plasma epinephrine is a determinant of systolic pressure when postural reflexes are minimized and that epinephrine may participate in control of cardiac work load, as reflected by rate-pressure product in the absence of exercise or definable stress.