Background– An agent that many pregnant women may be exposed to is opium or one of its alkaloids such as morphine and heroin. Recent observations of central nervous system (CNS) defects such as cyclopia among the infants of addicted mothers have suggested that opiate agents might be a cause of neural tube defects. The purpose of this study was to test morphine for CNS teratogenicity in mice and to identify the primordial structures affected. Methods– Timed pregnant BALB/c mice were intraperitoneally injected with 10 mg/kg morphine given in the early morning on days 10 and 11 of gestation. After dissection of fetuses and fixation in Bouin’s or 10% formalin solution, CNS abnormalities were evaluated using a dissecting microscope. Data were analyzed using Fisher’s exact test. Results– There was a higher incidence of CNS fetal malformations including exencephaly and spina bifida in fetuses whose mothers were exposed to morphine than in control fetuses exposed to NaCl. There were defects in 33% of fetuses from mothers who received morphine on both days 10 and 11 of gestation. Conclusion– Critical morphine injection times were determined to be days 10 to 11 of gestation. Our results indicate that morphine can be embryopathic during critical stages of CNS development.

Background/Objectives: Of congenital malformations of the central nervous system 46% are abnormalities of the spinal cord, which includes spina bifida occulta (SBO). The occurrence and significance of spina bifida occulta in patients with persistent primary nocturnal enuresis (PPNE) were evaluated. Materials and Methods: Between January 2000 and February 2001, 109 consecutive children who had nocturnal enuresis more than once a week after the age of 7 years for an uninterrupted period of at least 3 months, with less than 50% reduction in wet nights despite different treatments for at least 6 months, were prospectively evaluated for the presence of associated spina bifida occulta. The results were com-pared with data from a group of 40 normal children.Results: The mean age was 9.9 years in PPNE patients and 7.5 years in normal group. SBO was present in 86 (78.9%) of PPNE patients and 10 (25%) of normal children. This difference was statistically significant using chi-square test. (P-value < 0.001)Conclusion: Spina bifida occulta was thought to have no clinical significance but our results showed its significant higher rate among PPNE patients. There is no direct causal relation between spina bifida occulta and enuresis, apparently, but the findings suggest a common developmental etiology.

Background: Spina bifida aperta is a lesion that communicates with the external environment; and includes meningomyelocele and meningocele. We investigated all clinical presentations in meningomyelocele and meningocele patients in Shiraz, southern Iran. Methods: Patients’ files of spina bifida aperta who were admitted from 1989 through 2005 to Nemazee Hospital were reviewed for meningomyelocele and meningocele in Shiraz, southern Iran. CSF shunting by ventriculoperitoneal (VP) shunt was also performed. Results: Out of 580000 patients, 100 cases of spina bifida aperta were registered. In 67 patients with meningomyelocele and 33 with meningocele with male and lumbar and lumbosacral areas predominance, cystic mass was more common. 35% of patients showed congenital anomalies including talipes equinovarus and congenital hip dislocation that were more in meningomyelocele patients. 10% of the patients were operated in the first 72 hours and the others 1 month to 1 year after birth. CSF shunt insertion was more in meningomyelocele patients. Among meningomyelocele patients, mortality occurred in 3 patients (meningitis in 2 and post-operative pneumonia in one case). Conclusion: It seems that water-thigh dural closure and use of dural patch could decrease the rate of postoperative CSF leakage. Our results resembled the pattern in other series, except the low prevalence of hydrocephalus and a male predominance. Earlier referral of spina bifida aperta patients should be encouraged, because it could lower the complications and lead to better outcomes.