Return to HDCN
HDCN's CME Site or Case of the Week
(listed in reverse chronological order)
(chosen by JT Daugirdas MD, Editor HDCN)
1997 CME Sites
December 28, 1997 - January 3, 1998
When do we begin dialysis therapy? This was the topic of a Satellite Symposium
organized at the San Antonio American Society of Nephrology Meeting in November of this year.
The two speakers were Brian Pereira, M.D. from Tufts University School of Medicine, and Norbert
Lameire, M.D., University of Gent, Belgium. The talks were recorded and are
recreated on HDCN in synchronized slide/audio format.
December 21 - 27, 1997
inScight. This on-line news journal by Academic Press and AAAS is sort of an offshoot of
Science NOW news magazine also run by the same publisher. What has become irritating
with Science NOW is, that paid subscription is now required, and so when you click on an item, more
often than not you will be blocked. Thus far, inScight remains free of charge. Most useful is the
searchable archive section, where you can enter a key word such as hypertension, and get
summaries of many important papers published in the last 6 months in this area. Another interesting
area is a discussion forum, where a discussion of nitric oxide is ongoing (about 20 entries).
For more on-line science and medical news sources, see the
HDCN News Page.
December 14 - 20, 1997
If you're like me, you sort of use PubMed and Grateful Med (see the home page of HDCN
for hyperlinks), but only for simple
searches. The true power of these search tools can only be realized after some training.
Now training manuals for both internet search tools are available on the Web
at the NLM site:
Internet Grateful Med Training Manual (rev. 11/97)
These files are available in Word Perfect 6.1 format. After you open the files, which are 1092 and
1354 K in size, respectively, you will see a lot of funny characters in your browser. Once the file
is opened, use File-Save on your computer to save it to disk, and open it with either Word Perfect
6.1, or with Word (which generally knows how to open WP files also), and then you can print out your
manuals. Mac Users can convert these documents to Mac format using MacLink Plus 9.7.
Pubmed Training Manual (rev. 11/97)
December 7 - 13, 1997
Full text articles from Nephrol Dial Transplant.
NDT is becoming a very useful and interesting journal. It is unique among the nephrology journals
in its collection of about 5 editorial vignettes in each issue, each dealing
with a current topical area in the field. Also, NDT includes many short
articles in case report format, designed to illustrate teaching points, etc. Much of this sort
of material cannot be captured well by reading an abstract off PubMed, and in fact, much of this
material does not have abstracts. NDT now has put all of its material on the Web in full
text format. One can now access all of this useful short text material (plus the full text
of the articles), for free (until the end of 1997 only!), and all you need to do is to
download acrobat reader from the www.adobe.com website (the full text material is in .pdf format).
After 1998, you'll have to pay (otherwise, why would anyone buy the journal?), but enjoy the
freebie while it lasts.
November 30 - December 6, 1997
The glomerulopathies: clinico-pathological correlations. This is a set of digitalized
images of kidney biopsy slides from 37 patients with various glomerular disease. The collection
was put together by Helmut G. Rennke, MD, from Harvard Medical School and the Brigham and Women's
Hospital. The slide collection was put up in internet format by Dr. Kim Solez from the University
of Alberta as part of the National Kidney Foundation's CyberNephrology Program and also in
collaboration with the International Society of Nephrology Informatics effort.
It would help if the 37 cases were listed separately instead of in groups of 10 to permit quick
access to a given pathologic entity. However, the collection is still somewhat a work in progress.
More clinical information will be added, along with more disease-specific information to enhance
the educational value of this excellent collection even further.
November 23 - 29, 1997
PubMed Journal Browser. This is a very interesting feature of the PubMed Site. Many of
you will regularly browse current contents to search through new and intersting titles that you may
be interested in. PubMed now provides for an alternative approach. You can enter a journal name or
keyword into this browser, and get a list of journals with this key word. This will give you a
hyperlink to a PubMed search where all articles published in this journal are listed, starting with
the most recent one. For example, if you want to find out what's in November Kidney International,
you enter Kidney, get a listing of journals with the word kidney in it, and then click on the
hyperlink at the right-side table entry to go to the search. You will see a listing of articles,
beginning with a paper by Dr. Massari, in the November issue of Kidney International.
For convenience, we have reconfigured the
HDCN journals page into a two-column listing. In the left column are the hyperlinks to
on-line journal site. In the right column are hyperlinks directly to the appropriate PubMed
Journals browser search for that journal. The HDCN journals page can be reached directly from the
home page of HDCN by clicking on "journals online" in the main category table (third or bottom row,
November 16 - 22, 1997
Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure -- JNC VI . This is a follow-up to JNC V, and contains a very
detailed treatise on recommendations pertaining to diagnosis and treatment of hypertension. (By the
way, the document departs from JNC V in recommending calcium channel blockers, much to the chagrin
of conservative "evidence based" hypertensologists such as Dr. Curt Furberg. See his
editorial in the Lancet
where he expresses his misgivings. You need to register with the Lancet first to access this
editorial). In any case, the
base JNC VI document is available as a
.pdf file. To read such files, you need to install software called
Acrobat Reader (free) from www.adobe.com. Another report of interest also posted on the
NHLBI site is the results of an NHLBI Workshop from 1994 on
Implementing Recommendations for Dietary Salt Reduction. Again, this document is
available only as a
.pdf file. Both of these documents can be found on links from the
National Heart, Lung, and Blood Institute Home Page, which is now being regularly
updated, and contains a wealth of useful information pertaining to cardiovascular disease. The
NHLBI home page (Government Sites) and JNC VI and Salt Recommendations (Clinical Practice
Guidelines) are now linked directly off the home page of HDCN.
November 9 - 15, 1997
Clinical Debate: Thrombolytics for Stroke -- New Engl J Med. Part of the many full text
offerings from the New England Journal. Drs. Caplan and colleagues vs. Dr. Grotta present opposing
points of view.
November 2 - 8, 1997
DOQI Guidelines. The initial guidelines in four areas, hemodialysis, peritoneal
dialysis, vascular access, and anemia, are now up on the National Kidney Foundation site. Carefully crafted and
evidence-based, these guidelines will be updated as new research appears. The Web is an ideal place
for such an evolving document.
October 26 - November 1, 1997
University of British Columbia's Therapeutics Initiative. This is a program at the UBC
that has a laudable goal of providing unbiased, evidence-based guidelines about the uses of
therapeutic agents. The initiative sponsors a number of teleconferences, but also an electronic
Therapeutics Letter. Now up to volume 20, the Therapeutics Letter covers the
thorny area of choice of hypertensive agent and other issues listed below. There is a cost
perspective that HMOs would love. However, there are opposing viewpoints to the maxim that all HTN
should be treated with beta-blockers and thiazides, and these are not presented. Nevertheless, for
recommendations that are not biased by a given manufacturer, and for a good insight into cost of
antihypertensives, this sort of analysis is quite useful. Some of the letters are already a bit
dated (e.g., 1995), and should be read from that perspective.
Drugs of Choice for Hypertension (Part 1; June, 1995)
Drugs of Choice for Hypertension (Part 2; August, 1995)
Drugs of Choice for Hypertension (Update, September, 1995)
New Drug Review: Losartan (Cozaar) -- March/April, 1996
Hypertension and Angina Pectoris -- November/December, 1996
New Drugs: Torsemide (Demadex) -- January, 1997
October 19 - 25, 1997
New Engl J Med Collections: KIDNEY DISEASE.
NEJM now has four of these up on its
Kidney Disease, Breast Cancer,
Molecular Medicine, and Asthma. The Kidney Disease collection was just posted, and
consists of the full text (figures and tables included) of 12 original articles published since
1991, 4 editorials, 3 review articles, and 8 letters to the editor. CPCs are unfortunately not
included, although 2 of these (one on hemolytic uremic syndrome and one on post-transplant
lymphoproliferative disorder) published since 1996 are already on the NEJM website (search
"renal rounds by diagnosis" on HDCN or search the NEJM website for the hyperlinks to these).
This is an amazing amount of information for a publisher to post for free on the web. Somehow
I don't think this sort of thing will last. Enjoy it while you can!
October 12 - 18, 1997
Canadian Medical Association Online. This is a rich site. It includes no fewer
11 journals and a large selection of
clinical practice guidelines, including a recently
published set of recommendations regarding Hypertensive Disorders in Pregnancy: Part One deals
with diagnosis and classification;
Part Two describes
non-pharmacologic management and prevention, and Part Three, available in November of 1997,
will discuss drug treatment.
October 5 - 11, 1997
Nordiska Njurdagar (Nordic Nephrology Days): Selected lectures on HDCN.
In May of this year, the Nordic Countries, at their annual nephrology meetings, celebrated the
50th anniversary of the first dialysis in Lund under the direction of Dr. Nils Alwall. The
symposium lasted 3 days and had many excellent speakers. We reproduce five of the excellent
talks on HDCN in slide/audio format (using Real Audio). It is regrettable that only a minority
of the many fantastic talks could be reproduced here. The talk subjects include a primer on
vasculitis by Dr. Charles Jennette, basic and more advanced urea kinetics by Dr. John Daugirdas,
cardiovascular disease in ESRD by Dr. Rob Foley, the history of dialysis until Dr. Alwall's period
by Dr. Carl Kjellstrand, and the contributions of Dr. Nils Alwall to dialysis, by Dr. Horst
Klinkmann. Download the Real Player and listen to these presentations as the slides change; you
won't be disappointed.
September 28 - October 4, 1997
American Society of Transplant Physicians 16th Annual Meeting Abstracts. This
is the second year that the ASTP has put all of the abstracts of its annual meeting on-
line. The meeting took place in May of this year in Chicago. The abstracts are organized
by topic area, although the topic areas are quite broad. What would be nice in the future
is a highlights or press release area to help identify which work represented major
advances in the field.
September 21 - 27, 1997
Internet Grateful Med V2.3. The US National Library of Medicine performed a
tremendous service on June 26, 1997, when it made both PubMed and Grateful Med available
for free through its website. PubMed has been on HDCN for sometime now (linked via HDCN's
home page). Although PubMed is enough for me and is my preferred browser, it accesses
only MEDLINE (to my knowledge). Grateful Med also allows access to other databases,
including OLDMEDLINE (you need to change the default medline setting in the search
Search Screen for Grateful Med will now be linked to the home page of HDCN,
just beside the link for PubMed.
September 14 - 20, 1997
Rocky Mountain Poison and Drug Center's Toxicology Case of the Month: A Little Dab
will Dew Ya!. by Kennon Heard, MD, on the Medconnect site (primarily an ER
medicine/pediatric site that also has internal medicine board review offerings). This
set of toxicology cases, complete with interactive questions and nice graphics,
forms one of the very best collections of clinical teaching material on the internet. The
rest of the site is fine, also. It has been selected several times in the past as CME
site of the week. I won't give the diagnosis of this month's toxicology case away, but it
has to do with ingestion of a substance causing metabolic acidosis...
September 7 - 13, 1997
Selected lectures from the 1997 US National Kidney Foundation Spring Clinical
Nephrology Meetings. These lectures are being posted as a joint project between
National Kidney Foundation as part of its
CyberNephrology program and HDCN.
Four talks are presented, (a) plasmapheresis and use of IVIg, (b) new indications for ACE
inhibitors, (c) hypokalemia in hypertension, and (d) glomerulonephritis associated with
hepatitis C virus infection. You will need to have downloaded the Real Player from http://www.real.com, and have at least a 28.8
kbps modem to listen to the talks, which are presented as synchronized slide/audio
presentations. Each page has 15-30 slides, so pleaase download the whole page before
starting up the audio.
August 31 - September 6, 1997
European Society of Cardiology. The best thing about this website is a series of
Abstract Press Releases and
Press Conferences Releases
from the 19th Congress of the Society that was held August 24-28, 1997 in Stockholm. Two
key large trial results that were presented, both of which contradict much of the recent
bad press received by calcium-channel blockers, are results from the STEPHY trial by
Trenkwalder et al ,
showing that calcium channel blockers do NOT increase the risk of cancer in an elderly
European population, and results from the
presented by Robert Fagard, which show that nitrendipine reduces the risk of stroke by
42%, and the risk of other cardiac endpoints by 26%, vs. placebo in elderly patients with
isolated systolic hypertension. This is the first outcomes trial that shows reduction in
the incidence of a hard clinical end-point with a drug other than a diuretic or beta-
August 24 - 30, 1997
Journal of Urology. This site was chosen before, but it was a while ago, but
it deserves re-emphasis. Of especial utility is "This Month in Clinical Urology", which
summarizes the papers of the month in the clinical field. There are papers here of
interest to nephrologists, such as one this month by
Janetscheck et al (J Urol 1997; 158:346-451) suggesting that
extracorporeal shock wave lithotripsy is followed by hypertension in a substantial portion
of elderly patients. There will now be a hyperlink to this site from the home page of
HDCN in the "journals" section.
August 17-23, 1997
16th International Diabetes Federation (IDF) Congress Press Releases. This
important congress, held in Helsinki, just concluded (July 21-25, 1997). The most useful
part of the on-line site for the congress is a collection of very extensive and detailed
press releases, which describe newsworthy presentations on each of the four
congress days. Some of these are almost collection of mini editorial reviews and are well
worth looking at.
August 10 - 16, 1997
Lancet Supplement: Diabetes and the Heart . Seven full text reviews can be
found here pertaining to cardiovascular effects of diabetes. You must first
register with the Lancet before you can access this material. It's worth it
(registration is free)!
August 3 - 9, 1997
Scientific American Online. This is not a renal site, of course, but the journal
is colorful and deals often in relevant medical topics. For example in the July 28 issue,
there is a paper called:
"Critters on a chip", that describes new approaches to designing biosensors,
including one using luminescent bacteria (are you in-line diagnosticians from Utah
listening?) recently published in Nature. The site is a bit heavy on large file-
size graphics, so persons with slower connections may want to initially turn auto-load
images in their browser options section to Off.
July 27 - August 2, 1997
Vasculitis Pathology Image Catalogue from the ECSYSVASTRIAL Pathology Group.
The ECSYSVAS trial is the Multicenter European Study on Renal Vasculitis. The Pathology
Goup is coordinated by Dr. Franco Ferrario from Milan, Italy. The pathologists involved
in the trial have posted an interesting catalogue of
Renal Morphological Lesions in ANCA-Associated Vasculitis. There are three
"pages" of annotated figures, 21 in all, taken from actual patients in the trial. Each
image is accompanied by a very brief commentary. Unfortunately, the home page for the
ECSYSVAS trial as a whole is nothing to write home about, and could be much more
July 20 - 26, 1997
Urinary sediments at the Italian Society of Nephrology On-Line Site. This is
an ambitious effort to prepare an on-line "book" with text and graphics covering common
urinary sediments encountered in clinical nephrology. The layout is clean and attractive,
if not very practical. The "book" is not yet finished, and I am violating an internal
prime directive by reviewing an "under construction" site. Still what is up is quite
interesting. My own bias is, that such use of frames is more annoying than helpful. You
feel that you are looking through a keyhole at the text, and one wishes for a full screen
For related topics, see also urinary sediment slides on HDCN from
Dr. George deVeber's collection, and a previously reviewed commercial product:
University of Washington's
LAB-MED Urinalysis Tutor. You can download a demonstration disk for this
product. I did and was quite impressed. The collection on HDCN is not yet posted. We
are looking for someone to write an erudite, accompanying commentary to each slide. Any
July 13 - 19, 1997
FDA Center for Drug Evaluation and Research (CDER). This site is a
useful source of information on drug regulation from the FDA. The site is divided into
four parts: (1) About CDER, (2) Drug Information, (3) Regulatory
Guidance, and (4) "What's happening". Interesting draft guidance documents for
comment include "Pharmacokinetics and pharmacodynamics in patients with impaired renal
function: Study design, Data analysis, and impact on dosing and labeling.". Another
draft guidance document is titled, "Computerized systems used in clinical trials".
Labeling guidelines for atenolol, captopril, and quinidine may be of interest to
nephrologists. Under Drug Information one can find the text of recent advisories
concerning hyperglycemia with protease inhibitors, and
reports of valvular heart disease in patients receiving 'fenphen'
fenfluramine and phentermine). The latter report will be published in the New
Engl J Med in late August.
One can find instructions here to subscribe to an FDA listserv for daily or weekly email
notification of new material on the CDER website.
July 6 - 12, 1997
Opthalmology Grand Rounds by Diagnosis. This is part of the Digital Journal of
Ophthalmology site sponsored by the Massachusetts Eye and Ear Infirmary, and is one of the
few exclusively electronic journals accepting original papers. The grand rounds portion
is edited by Drs. Yichieh Shiuey and Peter Kaiser. A new rounds is posted every two
weeks. As this feature started in May of 1995, there are now more than 70 such rounds
posted, including several cases which may be of interest to nephrologists and internists,
such as sarcoidosis (May 20, 1995), cocaine retinopathy (Dec 18, 1995),
multiple myeloma with hyperviscosity syndrome (Mar 26, 1996), ocular ischemic
syndrome (Mar 4, 1996), and cytomegalovirus retinitis (June 25, 1997).
June 29 - July 5, 1997
Still more Cyberounds. This site has been chosen many times before.
(June, February and
January, 1997 and October 6-12, 1996). The material is password protected, and you need
to register if you want to access the site. Recently, two new
cyberounds have been added of interest to nephrologists and specialists in
cardiovascular medicine. One is a discussion of
the ANA test for lupus and related connective tissue diseases
by Dr. Peter Barland. The other is a discussion of
folate supplementation, homocysteine metabolism and vascular disease
by Drs. Robert Russell and Joel Mason.
June 22 - 28, 1997
University of Pittsburgh Department of Pathology CME Case Database.
This innovative university department has had well over 100 pathology cases on the Web now
for more than one year, but the quality of the material was limited, in that there was
little discussion of the diagnosis, and there was no opportunity for self-assessment.
This has now changed with a new section on this website where 5 cases are presented,
including one clearly renal case, of a
68 year old male with chronic renal insufficiency. In addition to the case
presentation and light, immunofluorescence, and EM pathology, there is a
series of self-assessment questions, which can be taken for fun or for CME
Category I credit. The questions are nicely phrased, and one is forced to go back for
wrong answers (not that I answered any wrongly, so how would I know?).
June 15 - 21, 1997
University of Iowa Virtual Hospital: Radiology Resident Case of the Week (Renal
Subset). Here you can find 7 short case vignettes (expansively titled "multimedia
teaching files") with X-rays, ultrasounds, or CT scans. Cases posted so far include:
Cystic teratoma, urachal carcinoma, bladder exstrophy, renal angiomyolipoma,
vesicoureteral reflux, ureteral obstruction, and emphysematous pyelonephritis. The
discussion is Spartan, followed by 1-10 references or selected readings. There also is a
"multimedia textbook" on glomerulonephritis. It has 1-page descriptions of the major
categories of GN, with several slides. The discussion of each entity is cursory, even at
a medical student level.
June 8 - 14, 1997
3rd International Home Hemodialysis Symposium Audio/Slide Presentations. HDCN
is the site again this week. These talks were recorded at the 1997 Denver PD meetings,
and include talks by Dr. John Woods, Dr. Fritz Port, Dr. John Daugirdas, Dr. Zbylut
Twardowski and Mr. George Harper. It's really worth your while to get an audio card and
download the Real Audio Player (it's free!) to experience the full benefits of
June 1 - 7, 1997
More Cyberounds. This site has been chosen before (February and
January, 1997 and October 6-12, 1996). The material is password protected, and you need
to register if you want to access the site. Recently, two new
cyberounds have been added of interest to nephrologists and specialists in
cardiovascular medicine. One is a discussion of the measurement of
creatinine clearance and of comorbidity index in diabetes
by Dr. Eli Friedman. The other is a discussion of
fat distribution of obesity and syndrome X
by Dr. Eli Ipp. See the listing below for February 9-15 CME site of the week for listing
of previous cyberounds of interest to nephrologists.
May 25 - 31, 1997
Selected nutrition and iron talks from the Denver PD meetings (on HDCN).
Sorry, but who are we to be so humble? The site of the week is again HDCN,
this time for another first: fully synchronized audio/slide presentations of selected
medical talks from the Denver PD meetings (another batch will be posted in the next 2
weeks). This new feature allows one to hear the talk with slides popping up in a
synchronized fashion, as if one were actually at the lecture. The experience should
be doable even for subscribers with only 14.4 modem access. Be sure you download the
entire talk (which may contain up to 20 slides) before starting the Real Audio
player. There are 3 talks in this batch: (1) Dr. Allen Nissenson talking about an
update on iron therapy, (2) Dr. Michael Jones talking about protein/calorie
requirements in PD patients, and (3) Dr. Rhoda Makoff speaking about micronutrient
and mineral requirements in ESRD.
May 18 - 24, 1997
National Center for Infectious Diseases On-Line Site. This branch of the
US CDC has many useful files and
electronic publications. Among the latter is a long treatise on the
prevention of intravascular device-related infections, and a series of annotated
slides sets on the
slide sets on the epidemiology and prevention of viral hepatitis A to E.
This makes for a nice audiovisual presentation. The slidesets are organized as one
slide per page. The thumbnail slide is too small, whereas the full slide is too
large, filling up more than the entire monitor screen at standard video resolution.
Nevertheless, this site makes very creative use of the audiovisual potential of the
Web, and by a government agency, yet! For a better way to do this, stay tuned to
HDCN; new audiovisual material will be added in the coming week.
May 11 - 17, 1998
Nephrology News and Issues On-Line. This site was actually on the Web for
over a year, but has only recently begun posting the full text of its news stories.
The news stories from each month's issue are posted as one very long file. The cover
picture takes up 130K, and you may want to set the download images option on your
browser to OFF if you have a slow connection. For political/financial news in the
nephrology field, this site is one of the best. This site is now hyperlinked from
the "News Alerts and Press Releases" section of the HDCN home page.
May 4 - 10, 1997
Science NOW news magazine. This is an offshoot of Science magazine that
each week describes the newsiest of the papers published in its full text parent.
For example, one of the papers chosen for review by HDCN this week, by
Update 12/97: Science Now Magazine can only be accessed on a subscription basis.
April 27 - May 3, 1997
National Library of Medicine's PubMed.
Lately, I have become very happy. Why? Because something I have
been waiting for a long time has finally arrived on the net: fast,
reliable, public access to MEDLINE. The site is PubMed, an
experimental service of the National Library of Medicine.
I have used it extensively in preparing a recent talk and found
PubMed to be consistently fast, and the search results appear very
reliable. I think the NLM has just put a lot of other providers of
internet MEDLINE access out of business. What's more, I think there
is some sort of arrangement between publishers and the NLM that
gets articles posted before they are actually indexed. The
eventual goal is to have links to full text articles via the
publishers. Try it. You'll love it! PubMed will now be available
as a hyperlink from the home page of HDCN. To see how PubMed can be used, see the
review of the NKF Spring Clinical Meeting abstract by
Dheenan et al. (jtd).
April 20 - 26, 1997
HDCN Urea Kinetics Calculators. In a frenzy of immodesty ("Who are we to
be so humble?") we choose HDCN for this week's best site. Why? Because we have
completely redone several of our urea kinetic modeling (UKM) calculators and added
two new ones. The
old calculator has been reprogrammed to now do formal 2-BUN single-pool
UKM to get V, Kt/V, PCRn, and TAC urea. It also continues to compute double-pool
values using the rate equation, and also calculates double-pool PCRn using
modifications of the Daugirdas/Depner equations for PCRn. We also have added a
batch mode calculator, which will give single-pool UKM outputs for up to
150 patients at a time. You can prepare your inputs as a comma-delimited file using
a spreadsheet or database, and using the Windows Edit-Copy and Edit-Pase functions,
you can put this table of values into the calculator and get values for all the
patients in your unit. Output is either as an HTML table or as a comma-delimited
file. The latter you can grab using Edit-Copy and put back into your spreadsheet.
The third new calculator is for computing
dialyzer KoA from clearances you can find on any dialyzer spec sheet.
First find out if the clearances have been measured at a zero UF rate, or at a
particular TMP. Then you can put in the clearances at various blood and dialysate
flow rates, and get a print out of the KoA values for that particular artificial
April 13 - 19, 1997
E-Neph. This is the electronic journal counterpart of
Dialysis and Transplantation. Interestingly, "E-Neph" does not
highlight each issue of the journal separately, as is the practice with
most other journal sites. Rather, it is a separate, complementary entity.
D&T initially tried to launch this as a proprietary service using a non-Web
interface. Now it has been transferred to the world wide web, and so
debuts as a product that has already considerable development time behind
The most useful feature is a listing of recent nephrology news items.
Also well done is a full text archive of all D&T articles reaching back to
1994 (text only, no figures or tables), helpfully grouped by topic. The
archive area includes summaries of many of the same conferences covered by
HDCN such as ASN and the PD meetings. A meetings calendar is also on the
site. Although a bit Spartan with regard to layout, the simple pages are
quick to download. All in all, one of the few internet sites in
nephrology that are content-rich, and worth visiting for its
Renal Care News section on a regular basis.
April 6 - 12, 1997
Endovascular Forum. This highly interactive site designed for
interventional radiologists is organized by Dr. Barry Katzen of the Miami
Vascular Institute. The site is protected and designated for physicians
only. What's more, if you refuse to send a "cookie", you can't even get
in! Registration is required. The site has many valued sections; one of most interest to
"Ask the Expert Archive" , which includes a detailed discussion of
clotted or dysfunctional dialysis graft management by Dr. David Kumpe of
the University of Colorado Health Sciences Center. Included is a detailed
protocol for treatment of clotted hemodialytis access sites with UK/PTA.
Next month's topic of interest will be venous access, by Dr. Matthew Mauro
from University of North Carolina at Chapel Hill.
By the way, you may also be interested in the selected summaries of the
SCVIR '97 Annual
Scientific Meeting by Dr. Scott Trerotola on HDCN.
March 30 - April 5, 1997
Urology News On-Line. The Urology On-Line journal is content-
rich and graphically attractive. Each issue includes an editorial (Keith
Baxby FRCS, Dundee Royal Infirmary, editor), a lead article, a special
feature, and about a dozen reviews of recent papers in the literature.
There is also a "products" section and a searchable archive (although I
find the Excite search engine to be difficult to use).
March 23 - 29, 1997
Prostate Cancer Guidelines at the the American College of Physicians
These are in three parts:
Part 1: Prior Probability and Effectiveness of Tests,
Part 2: Early Detection Risks, Benefits, and Costs,
Part 3: Screening for Prostate Cancer. These will be linked on
the home page of HDCN under "Practice Guidelines".
March 16 - 22, 1997
Renal Pathology Society 1997 IAP Cases. The tradition of
case unknowns on the internet was begun last year. This year's cases are
at the University of Colorado Medical Rounds site. Use login ID IAP
password IAP to access the cases (posted with permission of Dr. Kim
Solez); they include:
Case #1: 3 year old child with anuria after ingesting acetaminophen elixir.
Case #2: 30 year old female with HIV, increasing creatinine and pyuria while
Case #3: Transplant rejection in a patient with CMV.
Case #4: Early transplant rejection.
Case #5: 79 year old woman with proteinuria and hypocomplementemia.
March 9 - 15, 1887
Magnesium-Deficiency Catastrophe Site. This site is run by a
non-physician (Mr. Paul Mason) who lives in the remote California
wilderness and who sells water that contains a high amount (110 mg/L) of
magnesium from a spring on his property. Mr. Mason firmly believes that
the change from well water to softened water in the US has caused magnesium
deficiency in much of the US population, which in turn is responsible for
many thousands of unnecessary cardiovascular deaths (hence the title of the
Web-Site). Accordingly, changing to magnesium-laden water would save many
lives. Mr. Mason has written numerous letters to the FDA on this topic,
urging that efforts be made to supplement the water we drink with Mg. What
sets Mr. Mason apart from the run-of the mill nut is, the efforts he has
made to collect evidence from the medical and scientific literature
supporting his contentions. He has provided free Web-pages to reputable
researchers in the field, and lists abstracts of many articles in the
medical literature. There are abstracts from the Japanese Society for
Magnesium Research, a link to the upcoming 8th International Symposium on
Magnesium (to be held in Crete on October 5-9, 1997), and extracts of many
other reputable, if selected, papers. It is true that magnesium has been
and continues to be understudied in cardiovascular pathophysiology,
although this seems to be changing. Some of the verbal imagery of the site
(comparing deaths imputed to Mg-deficiency with holocaust victims) would be
better toned down or eliminated. Apparently the numerous letters Mr. Mason
has written to the FDA and Congress have had some effect, and the FDA is
looking into the matter, with a report due out shortly.
March 2 - 8, 1997
NEJM Full Text Articles on Molecular Medicine.
A collection of 27 selected articles and several letters pertaining
to molecular medicine published in the New England Journal of
Medicine since January of 1994. The full text of each article,
complete with figures and tables, is included. Together these papers form
a wonderful internet resource equivalent to an up to date textbook on
molecular medicine for the practicing physician.
February 23 - March 1, 1997
New Discoveries in Dialysis. On-site at HDCN. This is an
update of a
teleconference that was put together by Discovery International (a CME/CEU
late 1995 which consisted of four lectures (compliance, rehabilitation,
symptoms, and access problems), a series of question and answer sessions
lecture, and a series of moderator-led discussions. The faculty are well
known in the
dialysis community, and include Drs. Henrich, Porter, Schwab, and Sherman,
discussion being provided by Drs. Golper and Nissenson. The moderator-led
available both in text form and in Real Audio. For those wishing CME/CEU
posttests and evaluation forms are available at the end of each segment
(which need to be
printed out, completed, and returned to the CME/CEU provider with a nominal
fee to process
the credits). The conference was edited and updated with the cooperation
of the original
February 16-22, 1997
Radiological Society of North America On-Line Site. We chose
this site before, in July of 1996. It is chosen again by virtue of it's
links to abstracts from the 1996 fall annual meeting. If you want to know
what was presented pertaining to dialysis, for example, put the word
dialysis in the search engine box at the bottom of the home page, and you
will come up with a half-dozen abstracts pertaining to dialysis (mostly
vascular access) presented at the 1996 annual RSNA meeting. Unfortunately,
there appears to be no way to search just the abstracts of the meeting; the
search will also turn up article titles from Radiology, how to courses,
etc. In any case, abstracts (you can identify abstracts in the search
because the hyperlink files start with "/sci-program96/scisess/") of
interest to me included those describing the incidence of pulmonary
embolism after graft declotting, sonographic evaluation of abdominal wall
complications associated with PD catheters, results from snare stripping of
catheters versus replacement over a guide wire, etc.
February 9-15, 1997
More Cyberounds. This site has been chosed before (Jan 1, 1997
October 6-12, 1996). The material is password protected, and you need to
register if you want to access the site. Recently, three new
cyberounds have been added of interest to nephrologists and specialists in
medicine. One is a perspective on
racial differences in ESRD incidence and survival , by Eli
which asks more questions than gives answers (nobody knows what the answers
are at this
point). The ER division (Dr. Julie Ann Casani) presents a typical
case of nephrolithiasis. The advisability of a metabolic
work-up of stones is
not discussed (arguably important, although not necessarily after the first
idiopathic hypercalciuria can lead to osteopenia if patients follow a
Finally, the cardiovascular division presents a discussion of whether or
ACE inhibitors should be used in all patients after myocardial
discussion is limited to this drug, and makes no mention of aspirin or
(e.g., see the recent paper by
Vantrimpont et al. These remain mini-grand rounds, or
rounds-"lite", but each
makes a circumscribed
and useful point.
February 2-8, 1997
MedConnect Primary Care Board Reviews and Toxicology Cases. I
MedConnect again and again for CME site of the Week. In my opinion it is
site on the web, although the material is more of a general medical nature,
on emergency medicine, toxicology, and general internal medicine. You may
now need to
register to access the material at this site. Two new Board
Reviews have been
Osteoporosis I and
Osteoporosis II , both by Nayan Kothari, MD, of Robert Wood
School. The toxicology cases presented by the Rocky Mountain Poison and
continue to be outstanding. There are cases of mushroom poisoning,
cyanide poisoning , with a discussion of management of
acidosis, and most recently, a case of
with a discussion of use of intravenous N-acetyl cysteine. The
layout is one of
the nicest I have seen for a web-site, and the quality of all of the
material on this site
is just superlative!
January 26-February 1, 1997
The Internet Pathology Library (University of Utah). This
compiled by Dr. Edward C. Klatt and his associates, is one of the strongest
on the Web. The scope of the site is difficult to describe concisely, as it
comprehensive. You need to browse the site yourself. Features that I
interesting to nephrologists are, illustrated tutorals on
pathology of renal cystic disease,
pathology of SLE.
Another very interesting section is
examinations in pathology, which includes 103 questions
pertaining to renal
disease. The use of frames here sometimes makes you feel you are doing
surgery, but you can enlarge a given frame just like a window by moving
your mouse pointer
to a margin, and opening or closing it. I recommend doing this. Yet
interesting area is
glomerular disease laboratory, a series of cases for the
glomerular disease with slides and questions and answers. There is also a
collection of both gross and microscopic pathology slides, each
with a short
explanatory legend. All in all, a wonderful
January 20-26, 1997
American Journal of Kidney Disease On-line.
Prior to now, the only major nephrology journal on-line was Nephrology,
Transplantation (link on the home page of HDCN). Now, as of October 1996,
the NKF and WB
have put abstracts from the American Journal of Kidney Disease on the Web.
directly to the full abstracts when reviewing from this journal. One nice
short papers and case reports and op ed pieces have abstract summaries.
You can now
link to AJKD directly from the home page of HDCN (under "Nephrology Books
January 12-18, 1997
Tulane University Student Cases in Pulmonary, Renal, and Acid-Base
This site is an effort by Dr. Jim Harrison to extend his lectures
electrolytes to medical students at Tulane University. Six cases are
posted; 3 renal and
base with analysis of pulmonary function tests. While simply done, the
cases have a nice
interactivity, and obviously represent real patients, where the diagnosis
is often not
clear-cut. Soon there will be millions (at least several hundred) of these
on the net,
medical schools, for all to enjoy and study. Student/intern level of
the cases have twists that are of interest to all.
January 5 - 11, 1997
International Society for Peritoneal Dialysis Website. This
site has been up for over a year, but only now is it beginning to show
some content. One useful section is the new ISPD Ad Hoc Peritonitis
Treatment Committee recommendations (1996). A
Summary of the Peritonitis Treatment Committee Recommendations
is presented at the ISPD site, and the
full text of the article by Keane et al.
which is published in Perit Dial Int is given at the journal site
(PDI is published by