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Renal arteriography remains the only study to identify and define correctly both location and extent of renal artery stenosis. Because other studies do not adequately identify all children who have renal artery disease, it is reasonable to perform renal arteriography in those children with severe hypertension who do not have another readily identifiable cause for their hypertension. On the other hand, in children with less profound elevation of blood pressure in whom there is no other definable cause, it is possible to defer renal angiography. In these children with mild or moderate hypertension, studies such as the captopril 99mTc-DTPA scan or intravenous digital subtraction angiography may identify those for whom arteriography is more likely to have abnormal results.

A controlled clinical trial was performed using two dosage regimens of chlorambucil to treat childrenwith frequently relapsing nephrotic syndrome. All children concurrently received prednisone (60 mg/m 2 on alternate days). Ten children (Group I) were given chlorambucil as a stable dose (0.2 mg/kg/day) for 56 to 60 days, and 11 children (Group II) received increasing doses (0.2 to 0.63 mg/kg/day) for 42 to 77 days. Two children in each group subsequently relapsed. Follow-up averaged 28.6 and 27.2 months in Groups I and II, respectively. Three children in Group II developed infectious complications. The data indicate that a stable dosage regimen for chlorambucil is as effective as an increasing dose regimen in achieving long-term remission of frequently relapsing nephrotic syndrome.

Four preadolescent children had paroxysms of intractable sneezing. After days of hospitalization and numerous local and systemic drug treatments had failed, a psychogenic cause of their problem was entertained. This uncommon form of conversion reaction most often occurs between the ages of 9 and 15 years, and prognosis is good if the appropriate interventions are undertaken.

The incidence of neonatal HSV infection is approximately one case per 7,500 del iveries: The occurrence o f HSV infections in two infants born within a one-month period to mothers who had been living together in the same commune is highly unlikely to be fortuitous. HSV viruses were cultured from both infants and serotyping proved that they were of the genital type II. There is substantial evidence that this type is transmitted exclusively in adults through sexual contact? A likely explanation for our case would involve a common male source o f the virus, venereal transmission to the mothers in the third trimester near term, and the subsequent infection of the infants during parturition. Neither infant manifested signs or symptoms of a prenatal infection. There is reasonable clinical evidence o f in one mother (No. 1) a localized genital viral infection and in another mother (No. 2) a systemic viral illness presumably both from HSV within one month prior to the births of their children. The acquisition of HSV infection by the mothers must have occurred late in gestation, since infectious virus persists in the urogenital canal for on the average only 27 days in primary infection and for only 16 days in nonprimary infections. If the mothers shed viruses in their urogenital tracts at delivery, the infants had at least a 40% risk of becoming infected. ' The risks are significantly less if the mothers were infected earlier in gestation. Overall, only one in 28 infants born to mothers who have had HSV genital infection at some point in gestation will acquire neonatal disease? Thus, it is likely that our infants acquired their infection during parturit ion passing through an infected canal.