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CME Sites and Cases of the Week

(listed in reverse chronological order)

Sites chosen in 1996

December 22-28, 1996
Healthlink Natural Resources Forum. This is a frustrating site to use because of its rather complex setup and use of frames. It requires registration, but there is no clear path to the registration area, or once registered, no clear path to continue. Anyway, if you get through it all, the site has a wonderful and free MEDLINE interface. I put the words "hemodialysis hypotension" into this search engine for 94-96 and got 90 results. Healthgate ( returned only 34 for the last two years. I was initially, and still am, enthusiastic about Healthgate's medline interface, but Healthlink now provides a very useful and possibly superior alternative. Both the Healthlink and Healthgate sites offer reliable access to the MEDLINE database.

December 15-21, 1996
Osler Medical Journal. This is a new journal, but one that, with its premier issue, leapfrogs to near the top of what is available on the internet in terms of useful medical content. The journal is run by residents at Johns Hopkins, who, after cutting the call schedules back a few years ago, now appear to have time for other useful activities. In the journal, which is devoted to Oslerian principles of medical education, there are sections on case reports, topic reviews, images in medicine, and on clinical and basic science reports (usually projects run by residents). For cardiovascular and nephrology devotees, there is a discussion of bolus vs. continuous administration of diuretics to treat refractory CHF along with a description of a prospective study designed by the housestaff and apparently in progress. In a section called "Osler at the Bedside" there is a discussion of Cervical Bruits. A third section called "Images of Osler" (actually images in medicine) presents photos of purpural fulminans and Osborne waves (for those of you who forgot, J- type waves in the QT interval on the EKG found in patients with severe hypothermia. Quite an effort, of interest to medical residents and those who teach them.

December 8-14, 1996
Community of Science Web Server. It's not clear to me exactly what this organization is or does. It has members from most major drug companies and claims to have representations from major universities as well. In any case, it's a nice information server. It has a WONDERFUL Medline access module, which unfortunately is free only until December 31, 1996. This is not only better designed than that at, but also much faster. Also available is the full text of the Federal Register, Commerce Business Daily, and the U.S. Patent Citation Database. The catch is, of course, that these resources are not open to you and me, but only to member institutions. Some of the areas are open if you come in with a .edu browser, but not with a .com browser extension. A Funding Opportunities Database is accessible to all and has good disease specific information regarding grant opportunities. There is also a list of federally funded research in the U.S.

December 1 - 7, 1996
Transplant Pathology Internet Services. Specifically, this is the page on the server dealing with renal allograft pathology, created by Drs. Parmjeet Randhawa, Lorraine Racusen, and Kim Solez. Excellent discussions are found re grading of acute and chronic allograft rejection, and differential diagnostic considerations in the allograft biopsy. This page is part of the larger TPIS server, which deals with transplantation of many organs and which is sponsored by the University of Pittsburgh Pathology Department.

November 24 - 30,. 1996
United States Renal Data Systems. Although this site has been up for more than a year, it was upgraded last month, and its utility has increased greatly. It now contains a full version of the 1996 Annual Data Report, complete with full color slides. You can also download each chapter in Microsoft Word format, and each chapter's slides in Power Point format.

November 17 - 23, 1996
American Heart Association CME Page. So far only two programs are up, only one of which (Implications of the Treatment of Mild Hypertension Study [TOMHS]) , can be accessed. The other concerns angina and CAD. The TOMHS-inspired program is quite well done. This study compared nutritional therapy alone with nutritional plus drug therapy, randomizing to 5 drug classes. It turned out that drug therapy was superior to nutritional therapy, and all drugs were comparable, with a slight edge to amlodipine in terms of numbers of patients still on therapy after 4-5 years. This CME program develops the arguments and rationale for the study, with many nice tables and figures showing the results. Another new addition at the AHA site, is a nascent list of scientific guidelines. Only one up at the moment: Prevention of Bacterial Endocarditis. Unfortunately, I was hoping that the AHA would have a nice summary of key presentations at its 69th Scientific Sessions which took place this month at New Orleans. They have this huge Scientific Sessions On-Line Program, but there is no meat in that large refrigerator.

November 10 - 16, 1996
Endocrinology Database. Compiled by Dr. A.G. Amador of Southern Illinois University, and hosted by the Illinois State Academy of Science site. The database has a list of the normal values for almost every conceivably measured hormone in both men and animals, a list of chemical names for common steroid hormone derivatives, and conversion factors to go from SI units to common units and vice versa. Where else could one find what normal serum prolactin levels are in black bears? Also useful is a series of acid-base formulas.

November 3 - 9, 1996
Morning Report by Theodore Moon, M.D., a second year resident in internal medicine at Los Angeles County Hospital. Dr. Moon states that he sees many interesting cases at LA County, and has put up one so far, a patient who has been treated for transitional CA of the bladder and who now presents with nausea, vomiting, abdominal pain and hyperkalemia. It's up to the viewer to make the diagnosis of this interesting electrolyte problem. (Note, this case is no longer available -- update 12/26/97).

October 27 - November 2, 1996
Clinical Guidelines from the American Association of Clinical Endocrinologists. This site has both a public and a "members only" section. The latter I couldn't visit as I am not an endocrinologist. What hormonal hors d'oeuvres are hidden there beyond one's grasp are left to the imagination. The useful info on the public site is a series of guidelines, five posted so far (not of direct use to nephrologists, however). Guidelines include those pertaining to diabetes, osteoporosis, hyper- and hypothyroidism, and management of thyroid nodules.

October 20-26, 1996
American Diabetes Association On-Line Site. This site hyperlinks to the primary ADA journals, namely Diabetes and Diabetes Care. Particularly useful is the entire January 1996 Diabetes Care Supplement on-line . This contains the full text of 23 position statements, 8 consensus statements, and one standard, from everything ranging from diabetic foot care, food labeling, bedside blood glucose monitoring, to the treatment of hypertension in diabetes and the diagnosis and management of nephropathy in diabetes.

October 13-19, 1996
University of Pittsburgh Department of Pathology Case Database. This includes 81 cases at this time, indexed either by diagnosis or by patient history. The first 50 or so are quite skimpy, and include only a 1-2 line history. The last 30, however, include a more detailed history and microscopic pathology description. A detailed discussion of the disease in question and differential diagnosis, however, are lacking for most cases. Of particular interest to nephrologists are:
* Pregnancy-induced hypertension and antiphospholipid antibody syndrome
* Immunotactoid glomerulonephritis
* Wegener's Granulomatosis
Two cases (renal artery stenosis #48, and fibrillary glomerulophathy #78) are under construction. The first group of 50 cases (pathology only), include post-transplant lymphoproliferative disorder (#41), renal cell carcinoma (#35,29), renal allograft rejection (#20), and polycystic disease (#2). On the home page there is a link to the First Annual Conference for Anatomic Pathology Informatics, Imaging, and the Internet, which will take place in Pittsburgh on November 8-9, 1996.

October 6-12, 1996
Cyberounds. This site, with executive editor Harry Levy, M.D., and the product of interMDnet Corporation, is a collection of essays more than rounds, in several subspecialty areas of medicine, including cardiovascular medicine, nephrology, geriatrics, and hematology. A new essay/rounds is posted each month, hosted by a moderator who is a physician with academic credentials. The site has been going just two months now. You will need to register before you can access any material, and apparently you MUST be a physician or medical student to get a password.

In nephrology, Eli Friedman M.D. is the host/editor. Last month there was a discussion of - diabetes management: preventing protein denaturation, basically a discussion of use of aminoguanidines to block formation of advanced glycosylation end products. This month's topic is replacing renal function with GI nitrogen extraction, which contains a reference to a paper in Nature Medicine by TMS Chang describing the use of genetically engineered E. Coli which eat urea and make amino acids to reverse experimental uremia in rats! Both topics are "vanguard" topics, with little present clinical application. A more practical rounds is in the hematology section by Dr. Robert G. Lerner on heparin induced thrombocytopenia. Although the rounds are generally of high quality, the use of hyperlinks and hypertext is not very functional. In particular, the rounds are presented on a page with both a horizontal and vertical frame which have minimal functional utility and make the text area annoyingly small. I suggest printing out the rounds first before trying to read them. All in all, however, this may very soon turn out to be one of the premier sites on the internet for physicians.

September 29-October 5, 1996
Medconnect Board Reviews in Primary Care. This is the fourth time this site has been chosen. This month's board review, by Dr. Ajay Singh from RWJ Medical School in New Jersey, focuses on both acid-base and on glomerulonephritis. It includes:
Acid-Base Presentation
Acid-Base Challenge
Glomerular Disease Challenge
Glomerular Disease Perls
Acid-Base Pearls

September 22-28, 1996
The Nephrology Exchange. This is a review journal edited by Francisco Llach, M.D., with a focus on bone disease sponsored by Abbott Laboratories, makers of IV calcitriol. Most nephrologists get this newsletter in print form in the mail. Abbott Labs has put Vol.3 No.1 on the internet. The material posted, unfortunately, dates back to November, 1993. Nevertheless, it contains three nice reviews, all relating to hyperparathyroid bone disease, one by Jill S. Lindberg, one by Robert L. Benz, and one by John R. Valdin (all M.D.s). One wonders why Abbott Laboratories did not put the entire series of these lectures on the net. The lectures posted have the most to do with control of hyperparathyroidism and indications for calcitriol, and it is understandable why Abbott would focus on this topic, but the other lectures in the series are equally valuable. (Update 12/16/97: Link no longer available)

September 15-21, 1996
The Lancet. The Lancet has always been one of my favorite journals. The online site is very well done, although only a portion of the article abstracts in each issue are linked. Check out the paper on white-coat hypertension by Glen et al in the September 7 issue , for example, along with an accompanying editorial by McGrath. Before you can get to the goodies, however, you must first register (open to all) at the Lancet site. The Lancet hyperlink is available on the journals page of HDCN (see Journal tables of contents/abstracts).

September 8-14, 1996
(Update 12/16/97: Links no longer available) Reuters - The Internist's Casebook. We reviewed the Reuters site in early February 1996. The site continues to grow, providing searchable up to date medical news. It's "clinical challenge" section has now undergone a mitosis, into the internist case files, linked above, and also to The Dermatology Files. Two relatively recent casebook files are:
70 year old diabetic Chinese male with severe acidosis.
Hyperkalemia in an AIDS patient.
These cases are really vignettes, but they are growing in length and detail, and have several intermediate steps where the reader is prompted for input and a diagnosis.

September 1-7, 1996
Clinical Reviews in Depth. This is a subsite located on the EMBBS Emergency Medicine and Primary Care Homepage. It was not clear to me who runs the EMBBS site, save that many of the participants are from the Morristown Memorial Hospital in Morristown, New Jerey. The Clinical Reviews in Depth subsite is run by Dr. Robin Hemphill from the Brooks Army Medical Center. To-date three reviews are posted, all of interest to nephrologists:
* Toxic Alcohols
* Acute Renal Failure
* Diabetic Ketoacidosis and Nonketotic Hyperosmolarity
Each review beings with a case presentation, a list of identified goals of the teaching module, and then the teaching module itself. There are some gaps. The actual diagnosis of the first case is not specifically discussed. The text is broken up into pages requiring successive hyperlinking without rhyme or reason; it would be easier to download the entire discussion as one long page to make printing out easier. Also, the review is similar to one long book chapter; creative use of hyperlinking or graphics is absent. However, the material is excellent and well written.

The EMBBS home page also has one of the nicest interfaces that I've seen regarding a case presentation: it is the EMBBS ACLS Megacode Simulator. Two cases are presented, a patient with severe bradycardia, and one with acute chest pain. The text is updated in a column flanked by two imagemaps, one showing options such as "IV Line", "Begin CPR", etc., and the other a drug cabinet with drugs and doses. You proceed to treat the patient and the middle text column is updated based on the results of your actions. The case presentation is then extended by an in-depth discussion of bradycardia, various drugs which can be used, pacemakers, etc. This is a wonderfully creative and interesting way to teach ACLS, and could be adapted to other types of cases as well. I finally saved patient #1. I can't wait to go back and see how case #2 will turn out.

August 25-31, 1996
Virtual Anaesthesia Textbook: Water and Electrolyte Homeostasis; Renal and Acid-Base Physiology. Remember in the film "Witness", when the Amish get together to build a barn? Well this is a neat idea by a group of anesthesiologists to parcel out and write an on-line virtual textbook of anesthesiology, except that each piece of the barn is on a different computer! The link above is to a chapter (by Dr. Ken Pauker, from Laguna Beach, California) on acid-base, which is still in progress (internet "books" should be continually in progress, I suppose). The chapter represents one of those Russian dolls, as it includes a collection of hyperlinks to other on-line books and lectures across the internet. Perhaps most notable among these links is to a chapter in another internet book, the Global Textbook of Anesthesiology, by Dr. Alan Grogono of Tulane entitled The Fundamentals of Acid-Base Balance. Dr. Grogono's book contains many of the basic acid base equations and nomograms and is quite extensive in its treatment of common acid-base disorders.

August 18-24, 1996
Dr. Deloughery's Famous Handouts. These are present at the CLINIWEB site from Oregon Health Sciences University. These are actually more than simple handouts, and are similar to the topic cards presented in Dr. Burton Rose's Up to Date in Medicine series. There are 14 handouts posted to-date, four of which have to do with cardiovascular disease: Antithrombotic therapy, antiphospholipid antibody syndrome, atherosclerosis, and strokes and myocardial infarction in the young patient. All are very well done. It is not clear how current they are, however, as among the numerous references, I could not find a reference cited later than 1993.

August 11-17, 1996
Bandolier. This is an evidence-based journal from the National Health Service Oxford Anglia Region in the UK. The journal is published monthly, and summaries of articles including figures and references are on the Website. Articles are conveniently grouped on a major topics page, where one can find a discussion under "Cardiac" of ACE inhibitors in CHF, Calcium channel blockers (the figures from the Furberg and Psaty papers are reproduced) and cholesterol lowering in CHD. Under "Trial Methods and Reporting" one can find succinct discussions of many statistical tests such as use of meta-analysis, odds ratios, risk ratios, etc., to the point that this section comprises a useful statistical primer. A list of evidence-based medicine links rounds out the usefulness of this fine site.

August 4 - 10, 1996
Rockefeller University Press. Something for the basic scientists this week. RU Press is the outfit that publishes JCI: the Journal of Clinical Investigation , and also the Journal of General Physiology , the Journal of Experimental Medicine , and the Journal of Cell Biology. Each is now on-line with tables of contents and abstracts. Abstracts are not yet searchable, although a major transformation is promised for October of this year. Links to these journals have now been added to the home page of HDCN.

July 28 - August 3, 1996
Medconnect Board Reviews in Primary Care: Three Hypercalcemia Cases. There are three of these, each in the style of a board exam presentation with intermediate break points and questions. I don't quite agree with the management chosen for the first case (saline diuresis in an 81 year old lady with hypercalcemia and ARF and a creatinine of 5.3 mg/dl), but I think the three cases are quite instructive and generally the discussion is of high caliber. We have reviewed the Medconnect site before. It continues to be the best site that I know of on the internet regarding content and CME, although it's main emphasis continues to be pediatrics, toxicology, and emergency medicine.

July 21-27, 1996
Radiology Society of North America. At a time when the ASN is planning its internet presence, it is nice to examine a few models of those who have gone before. The RSNA has a wonderful internet site, providing easy access to information about its publications, learning and practice resources, and most useful, its annual meeting. ALL of the abstracts of the October 1995 annual meeting are online in a searchable database (Update 12/16/97: link to 1995 abstracts no longer available). For useful info pertaining to dialysis, link up to this page and put in dialysis access in as key words. You will come up with the texts of relevant abstracts presented at the meeting. Hopefully ASN might eventually provide such a service.

July 14 - 20, 1996
Nephrology Dialysis Transplantation. For those of you not subscribing to this journal, you are missing something! NDT has become increasingly relevant and interesting, and particularly strong in publishing excellent clinical material, including a series of short editorials in each issue, teaching cases, etc. Now NDT is on-line, and includes abstracts of most of its articles. HDCN is now linking up to these abstracts texts whenever it reviews an interesting paper, and the NDT site is hyperlinked on the home page of HDCN (under "journals tables of contents"). In the June issue, the EDTA abstracts are also printed. These have a wealth of clinical information, and a selection will be reviewed on HDCN in the next two months. The on-line site also has a valuable search tool, where one can search back issues of the journal by key word.

July 7 - 13, 1996
TRANSWEB. This is a transplantation information server run out of the University of Michigan. The site has excellent graphics, which are small and don't impede downloading, organization, and is regularly maintained. It has an excellent calendar of events. A feature found on few other sites is "Ask TRANSWEB", run by Jeff Punch, a local transplant surgeon. Most of the questions are from patients, but they come at a rate of about 20/month, and are answered competently and archived nicely.

June 30 - July 6, 1966
Journal of the American College of Cardiology. Although this journal has few articles on hypertension, it is within the sphere of interest of HDCN readers. Abstracts of all original articles are given on the site, along with the full text of featured articles (this month's feature article is on Chlamydia and atherosclerosis). There is no searchable index. We have added the JACC to the home page of HDCN.

June 23-29, 1996
American Society of Transplant Physicians (ASTP) 15th Annual Meeting Abstracts. The ASTP has hit a home run with its internet site. ALL of the abstracts from the May 26- 30, 1996 Annual Meeting are listed here, and there is a search engine to help find abstracts on a given topic. For future reference, we added a hyperlink to this page on the homepage of HDCN.

June 16-22, 1996
Case of the Quaker. This is another toxicology case presentation by the Rocky Mountain Poison Control Center. It has nephrologic aspecs to it. The format is wonderful! This is the third time we've selected something on Unfortunately, this is primarily a pediatrics/ER site.

June 9-15, 1996
The "other" HDCN. My sons and I enjoy playing "Zelda", where objects in "Light World" have their counterparts in "Dark World". While surfing the net, I found HDCN's alter ego, although both HDCNs are most assuredly in "Light World". I even suspect that the other HDCN'ers are having a lot more fun!

June 2-8, 1996
Free Medline Access via HealthGate. This is the site I've been waiting for! It offers completely, absolutely, free, unlimited MEDLINE searching (registration is required); and the search engine is fast, clean, and works wonderfully well (some more instructions could be provided on how to do complex searches). HealthGate offers a subscription based search service with access to other databases, and also access to newswire services. It also is aiming toward patients, with a complete online manual of medical tests and procedures. For now, HealthGate is the only service, other than Physicians On-Line, that offers free MEDLINE access, and with HealthGate, access is not limited to physicians. Access is limited to US residents, although it is not clear if the latter stipulation is being enforced. There is now a link to HEALTHGATE from the home page of HDCN for easy access to MEDLINE.

May 26-June 1, 1996
American Medical Association Weekly Press Releases. This site has also been linked on HDCN for quite awhile, but it is not getting the traffic it deserves. Every week, selected press releases feature an article published in an issue of JAMA or the Archives of Internal Medicine. There is a direct link from the press release, which gives a lay description ot the article, to the original abstract. See the May 22/29 press release which focuses on hypertension. The AMA press release site, the selected releases, as well as the AHA Media News Release site are conveniently linked from the home page of HDCN.

May 19-25, 1996
American Heart Association News Releases. This site has actually been linked on HDCN for the past 6 months. However, it has been a slow week and this site fully deserves CME site of the week status. It lists press releases organized by date, usually describing a key article published in Circulation, Circulation Research, Hypertension, or one of the other AHA scientific journals. By browsing this site you can find summaries of key articles in these journals going back from the present to June of 1995.

May 12-18, 1996
The American Society of Hypertension. This site has the program for the 1996 Annual Meeting of the ASH. As the meeting (May 15-18, 1996) will progress, highlights will be made available. You can subscribe by email by sending the message:
SUBSCRIBE ASH-EHLB firstname lastname in the body of an email sent to

May 5-11, 1996
Renal Pathology Tutorial. This is a unique event on the internet. It appears to be the beginnings of a full fledged book on introductory renal pathology by J. Charles Jennetee, MD, from the University of North Carolina at Chapel Hill. Sections on normal kidney histology, clinical presentation of glomerular disease, nephrotic syndrome, minimal change disease, membranous nephropathy, focal GN, and Type I and II membranoproliferative GN are ready now, complete with teaching slides.

April 28 - May 4, 1996
This Month (March, 1996) in Urology. This will be a regular feature offered at the Journal of Urology home page. "This Month in Urology" offers a 4 line synopsis of the major articles in the Journal, plus a featured commentary (about 2 pages with references) on a selected topic. This month it is a discussion of the testicular microenvironment by Dr. Harris Nagler. The home page also lists tables of contents.

April 21-27, 1996
New England Journal of Medicine On-Line. This excellent site includes abstracts of all articles starting 1996. Full text is also presented of the following features, including figures and tables: Images in Clinical Medicine, Case Records of the Mass General Hospital, Molecular Medicine, Editorials, Sounding Board articles, Correspondence, and Book Reviews. You can search for these full text offerings by category in the "recent issues" link from the home page. This is a very generous and brave move on the part the of the Mass Medical Society, to put so much of the content of the journal on-line for free.

April 14-20, 1996
Americal College of Cardiology on the Net. This site, certain areas of which require registration, has excellent information about the ACC Meeting which just took place in late March. One can search for any presentation by keyword. Also there are pages where various press releases and news alerts regarding the clinical trials are presented. These include Real Audio interviews with some of the presenters.

April 7-13, 1996
CME at the University of Laval Faculty of Medicine. This is a new site, still largely under construction. The authors have ambitions to provide CME courses and tutorials in all medical specialties. Both (Update 12/27/97: Many of the previous links are gone. CME courses no longer appear to be present.)

March 31 - April 6, 1996
American College of Physicians On-Line. The long- awaited ACP site is finally active. It includes tables of contents, abstracts, and selected articles from Annals of Internal Medicine, Evidence Based Medicine, and the ACP Journal Club. One also can find news stories from the ACP Observer.

March 24-30, 1996
Renal Pathology Society Conference Page: Biopsy Cases. As part of the upcoming Renal Pathology Society (RPS) meeting, five renal cases have been posted as unknowns. They include a history of present illness, physical examination, lab values, and pathology slides. It is up to the audience to make the diagnosis. The correct diagnoses will be unveiled at the RPS meeting this week and posted. If you look at the pictures, remember to click on the smaller images to see enlarged slides; otherwise the detail is hard to discern. You can check the Renal Pathology Society Home Page for more info on this society.

March 17-23, 1996
French Language Peritoneal Dialysis Registry. This primarily European registry and its accompanying journal, the Bulletin de Dialyse Peritoneale (BDP) are run by Dr. Christian Verger and Dr. Jean Phillippe Ryckelynck. Dr. Verger is one of the "gurus" of peritoneal dialysis permeability testing, and has devised the APEX test as an alternative to the standard PET to assess peritoneal function. This site includes a status of the PD Registry. It also includes titles from the last two issues of "Bulletin de Dialyse Peritoneale" (one may request reprints of individual titles from Dr. Verger).

PD Calculators: The most interesting feature of this site is the availability of 3 PD calculators, written in JavaScript by dr. Jacques Chanliau: One calculator computes body surface area and total body water (similar to the calculator available on HDCN). The other two pertain directly to PD kinetics. One computes the APEX time as an index of peritoneal permeability, and the other PCR, Kt/V, and various clearances based on a 24 hour collection of urine and dialysate. You need Netscape 2.0 or better to use these calculators.

March 2-16, 1996
Kidney Patients' Resources. This is a site organized by Curtis L. Atkin, a medical researcher with renal disease. It is one of the largest compendiums available on the Internet of sites related to renal disease. The information is useful not only to patients but to medical professionals as well.

February 25-March 2, 1996
Primary Care Board Reviews on the Net. We chose as Site of the Week only 3 weeks ago. Now they've gone and done it again! This is an absolutely wonderful review of a classical case of gout. It must be viewed with Netscape Navigator 2.0! It involves a wonderful series of discussions each preceded by a set of multiple choice questions about the disease, complete with a wonderful graphic of a neutrophil engulfing a uric acid crystal.

February 18-24, 1996
"Dr. Web" at the Section of Electrophysiology and Pacing at the Cleveland Clinic Heart Center. (Update 12/27/97: This section is no longer available.)

February 11-17, 1996
Reuters Health Information Services. This is a professional news site run by Reuters, which is free for the moment, but which will probably be subscription only very soon. You can get the week's top health stories here, or use the news search tool to find news relevant to hypertension, dialysis, renal or any other topic. Try putting in the above key words. You will not be disappointed. Enjoy this free site while you still can.

February 4-10, 1996
Medconnect. This is the best site which we have found so far on the internet that provides CME and patient case summaries. The site is focused on Emergency Medicine and Toxicology, but has a growing collection of material in primary care. In addition to a series of case studies such as a patient with theophylline toxicity or digoxin toxicity, there is an excellent collection of CME essays, seven posted so far, including an in-depth review of the management of acute pulmonary edema.

January 28-February 3, 1996
Medical News from DOCTOR'S GUIDE TO THE INTERNET. This is a commercial site which aims very broadly at all physicians, and the site even has patient information material. Much of the site is under development. Most useful right now is the Medical News page to which the hyperlink above travels. Here one can find a collection of news releases, mostly from pharmaceutical firms and medical device manufacturers, but sometimes from universities, highlighting recent discoveries or approvals of new indications for various drugs. It would be better if each news release title were dated and the releases should be sorted by category, as under the present organization schema their sheer number becomes daunting. However, this is the only place on the internet we know of that such news releases are collected. We have placed a direct link to this site on our "NEWS ALERTS" page.

January 21-27, 1996
Tokai University Department of Radiology Cases. This site is the brainchild of Prof. Yutaka Suzuki. Sixteen radiology cases are presented as unknowns, with various imaging test results. In some cases the diagnosis is obtained by a hypertext link; in others the diagnosis becomes obvious from viewing the images. The presentations are short, as is information pertaining to the diagnosis. The images are of good quality, although in the case of chest X-rays and some of the scans, some of the image files are not fine enough to appreciate the pathology. Two cases pertaining to HDCN are among the 16:
60 year old male with hypertension, throbbing headaches, and palpitation
Pulmonary calcifications in an ESRD patient

January 14-20, 1996
Unit II Pathology Course at the Bowman Gray School of Medicine of Wake Forest University. This site, created by Dr. Robert Rainer, is designed for medical students and contains about 50 case presentations with pathology slides, disease information, and review questions. The question answers are not provided, and there is no interactive component, however. Renal cases include:
Acute cell mediated and vascular allograft rejection.
Churg-Strauss syndrome (allergic granulomatosis and angiitis).
SLE with crescentic glomerulonephritis.
Renal infarct, coagulative necrosis.

January 7-13, 1996
Year two medical school learning programs at USC. This is a medical student site developed by the University of Southern California. The renal sections include some simple cases and discussion pertaining to inherited renal diseases, glomerulonephritis, and causes of nephrotic syndrome. The inherited renal disease section, by Dr. Miroslaw Smogorzewski, includes a brief overview of Alport Syndrome, autosomal dominant polycystic kidney disease, medullary sponge kidney, and medullary cystic disease. Two case summaries are presented with branching questions, similar to the old US ACP internal medicine board examination. Case 1 is a 25 year old male with gross hematuria after exercise, with a family history of renal disease, and Case 2 is a patient with Alport syndrome. In the second case, pathology slides of both Alport syndrome and medullary sponge kidney are presented.

In another page on the site, Dr. Michael Koss presents an overview of the pathology of glomerulonephritis, with hyperlinks to pathology slides of membranous GN, MPGN, Lupus, IgA, post-infectious, and crescentic GN. A related page summarizes the pathology of the nephrotic syndrome, including MCD, FSGS, diabetes, and amyloidosis. The nephrotic syndrome page has no hyperlinks and only text. Six cases are presented, with very brief histories. Only the first case in the series has been developed.

December 31-January 6, 1996, 1996
Emory University's "MEDWEB" list of medical electronic newsletters and journals.
This excellent and current list has been compiled by the Woodruff Health Sciences Library staff at Emory University in Atlanta, GA. The list is now 10 pages long, single-spaced, and there are separate groupings of journals which provide tables of contents, and of journals which include full text articles. (Happy New Year!)

December 24-30, 1995
Case Studies in Toxicology.
This is a site maintained by Mark Crockett, M.D., a senior resident in Emergency Medicine at the University of Illinois at Chicago. Ten interesting case studies are listed, several of which have renal involvement. Some examples are:
Vomiting 3 year old child with anion gap acidosis who ingested radio-opaque pills
68 year old woman with dizziness,hyperkalemia, bradycardia, and heart block
Alcoholic with renal failure after ingestion of mystery substance
The layout is very stylish, and cases are followed by self-assessment questions and summaries. Overall an extremely well done site. See also the related Toxikon site, from the UIC department of Emergency Medicine, with a Poison Review section as well as a Poison of the Week.

December 17-23, 1995
Hot topics from the November 1995 ASN Meeting (on HDCN). This week we looked for a site of the week and, as Lancelot sings in "Camelot", we're forced to disclose that this week's best site is us! Specifically, we list for emphasis the "hot topics" section, where key new clinical findings at ASN have been reviewed. Topics listed include:
ACE gene polymorphism and renal disease (David Leehey)
Urea kinetics (James Tattersall)
Inflammatory mediators, albumin, and mortality (Tom Depner)
New methods of measuring access flow and recirculation (John Daugirdas)
Cholesterol and progression of renal disease (Vardaman Buckalew)
HIV in Nephrology (Stephen Pastan)
New techniques for dry weight assessment (Ravi Mehta)

December 10-16, 1995
Recurrent CMV viremia after renal transplantation (NEPHROL thread).
This is a discussion of a patient in whom ganciclovir therapy apparently failed to control symptomatic CMV viremia soon after an episode of graft rejection. Contributors include Dr. Alessandro Bellucci (Manhasset, NY), Dr. Paul B. Lim (Sacramento, CA), Dr. Thomas Gonwa (Dallas, TX), Dr. Daniel C. Brennan (St. Louis, MO), Dr. Daniel M. Canafax (Minneapolis, MN), and Dr. Daniel R. Salomon (La Jolla, CA). Your additional comments are welcome and can be added at the bottom of the thread.

A NEPHROL thread posted on HDCN earlier pertained to acute renal failure after eating mushrooms (for further information on NEPHROL click here).

December 3-9, 1995
RENAL CPCs at Emory University
This site offers three CPCs in the renal field prepared by Dr. Stephen Pastan:
A "middle aged" woman with rapidly progressive renal failure 1 month post cardiac cath
Progressive renal failure and severe worsening of longstanding hypertension
Acute complication of balloon angioplasty of the renal artery (same URL as above: scroll down to "patient 2".
November 26-December 2, 1995
AMERICAN HEART ASSOCIATION's "Journals at Home" page
This new site offers tables of contents and abstracts of current issues of the following AHA journals: (Click on the main site above for the current issue of each of these journals, or click on each individual journal title for an index by volume and number) "Hypertension","Stroke", "Circulation", "Circulation Research", and "Arteriosclerosis, Thrombosis, and Vascular Biology".

November 19-25, 1995
Abdominal pain, renal failure, and thrombocytopenia
This is a test case posted by Dr. Brian Levy of the University of Colorado, who is designing a series of interactive Medical Rounds. The patient history and findings are interesting in themselves, as is the novel use of e-mail by which viewers can pose questions to a "moderator" about various aspects of the case. One minor problem is that the laboratory data are expressed in tabular form. Those with earlier browser versions are left looking at a jumble of numbers.

November 12-18, 1995
Renal Biopsy Case Reviews by J.C. Jennette, MD
This is a wonderful collection of monthly case discussions including color slides of the biopsy findings created by Dr. Jennette from the University of North Carolina at Chapel Hill. We won't tell you what the September case had, (a 72 year old woman with a 1 month history of worsening nausea and vomiting), but there were kappa light chains in the urine. The site is located on RENALNET, a renal communications server with wide links to nephrology sites of interest and also containing several nascent discussion forums.

November 5-11, 1995
American College of Physicians (ACP) Journal Club On-Line
(Our apologies. The ACP Journal Club is a print journal summarizing evidence-based research papers (mostly randomized trials and some meta-analyses) in internal medicine. In addition to the summary, a commentary and further references are also provided. At this site all of the articles summarized in the ACP Journal Club since 1991 are listed, and you can search all of the summarized articles by title and by abstract section (e.g., you can put "lupus" in the title search and find all of the reviewed articles in ACP journal club pertaining to this disease).

October 29 - November 4, 1995
Stanford University -- UCSF Primary Care Teaching Modules
These teaching modules (there are about 17 of them and more on the way) were developed as a joint effort between the Divisions of General Internal Medicine at Stanford University and the University of California at San Francisco. They are targeted to medical students and residents in primary care specialties. The three modules of particular interest to HDCN readers are:
Hypertension - by Dr. Eliseo Pérez Stable.
Lipid Disorders - by Dr. Stephen Fortmann
Urinary Tract Infection - Dr. Douglas Bell and Dr. William Detmer
All are excellent and quite comprehensive! The Lipid Disorders and Urinary Tract Infection modules contain sample case reports and summaries. Other modules at the main site include hyperthyroidism, hypothyroidism, immunization, obesity, sinusitis, tuberculosis, COPD, and many more.

October 22-28, 1995
Late acute renal failure after mushroom poisoning
This case discussion thread (which we are posting with the express permission of all parties involved) actually began on Friday the 13th of October on the listserv called NEPHROL. NEPHROL is an unmoderated online discussion group and Internet resource for nephrology professionals and those in allied areas of medicine (for further information on NEPHROL click here). The discussion, which is typical of the fascinating interchanges that go on within NEPHROL, involve Dr. Joan Fort from Barcelona, Spain, Dr. Steven B. Tucker from Anchorage, Alaska, Dr. K.W. Rumpf from Goettingen, Germany, and Dr. Carl M. Kjellstrand from Alberta, Canada. The link includes comments from mycologist Dr. Tom Volk of the Forest Products Research Laboratory in Madison, Wisconsin, including a link to a site developed by Dr. Volk which includes pictures of Cortinarius mushrooms.

October 15-21, 1995
A 30-year old man with hypertension (Radiology Quiz)
The site location is the St. Francis Journal of Medicine, from the St. Francis Medical Center in Pittsburgh, PA., Volume 1, Number 1. There also is a very interesting CPC of a patient with headache, hyponatremia, and abnormal chest X-ray (wonder what that one could be?).

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