HDCN CME Site or Case of the Week: 1998 Archive    
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CME Site or Case of the Week: 1998 Archive
(listed in reverse chronological order)

December 27, 1998 - January 2, 1999
Hyperphosphatemia: Clinical Complications and Management in 1998. (ASN 1998 Satellite Symposium)
This Satellite Symposium at the American Society of Nephrology Annual Scientific Meeting in Philadelphia, was sponsored by Genzyme, a company which is marketing the new phosphorus binder Renagel. There were three speakers: Dr. Jill Lindberg, Dr. Francisco Llach, and Dr. Eduardo Slatopolsky. Dr. Slatopolsky chaired the symposium. He opens the meeting and gives an introduction the the topic. Then Dr. Llach presents an overview of the problem of hyperphosphatemia. Dr. Lindberg puts previous therapies in a historical context, and Dr. Slatopolsky presents new data relating to use of Renagel. A substantial audience question period is also reproduced.

One and one-half hours of Category I CME credit are available to persons who listen to the talk and successfully complete a post-test and evaluation form via the University of Minnesota.

December 20 - 26, 1998
Treatment of Hypo- and Hypernatremia (Dr. Tomas Berl)
With the collaboration of the American Society of Nephrology, HDCN is reproducing a subset of the lectures given at the Fall, 1998 ASN Board Review Course held in San Francisco in slide/audio format. We will be focusing on the acid-base and sodium lectures from the course.

Last weeks, we presented Dr. Carlos Ayus from Baylor College introducing the pathogenesis and diagnosis of hypo- and hypernatremia. Next week, Dr. Tomas This week Dr. Tomas Berl from the University of Colorado discusses therapy of hypo- and hypernatremia, and the text of a very informative question and answer session pertaining to the dysnatremias is presented.

December 13 - 19, 1998
Pathogenesis and Diagnosis of the Dysnatremias (Dr. Juan Carlos Ayus)
With the collaboration of the American Society of Nephrology, HDCN is reproducing a subset of the lectures given at the Fall, 1998 ASN Board Review Course held in San Francisco in slide/audio format. We will be focusing on the acid-base and sodium lectures from the course.

Last two weeks, we presented an introduction to metabolic acidosis by Dr. Robert G. Narins. More lectures on acidosis will follow. But this week we change subjects, and Dr. Carlos Ayus from Baylor College introduces the pathogenesis and diagnosis of hypo- and hypernatremia. Next week, Dr. Tomas Berl will discuss therapy of hypo- and hypernatremia, and the text of a very informative question and answer session pertaining to the dysnatremias will be presented.

December 6 - 12, 1998
Introduction to Metabolic Acidosis, Part 3 of 3 (Dr. Robert Narins)
With the collaboration of the American Society of Nephrology, HDCN is reproducing a subset of the lectures given at the Fall, 1998 ASN Board Review Course held in San Francisco in slide/audio format. We will be focusing on the acid-base and sodium lectures from the course.

This week, Dr. Robert G. Narins, from Henry Ford Hospital in Detroit, finishes up his lecture on acidosis with a discussion of toxic alcohol syndromes (methanol, ethylene glycol toxicity), osmolal gap, and the pathogenesis of hyperchloremic acidosis. Last week's talk by Dr. Narins introduced the concepts of acid generation, buffering, and excretion, respiratory compensation, and the anion gap. Next week we will move to a discussion of the pathogenesis of hypo- and hypernatremia by Dr. Juan Carlos Ayus.

November 29 - December 5, 1998
Introduction to Metabolic Acidosis, Parts 1 and 2 of 3 (Dr. Robert Narins)
With the collaboration of the American Society of Nephrology, HDCN is reproducing a subset of the lectures given at the Fall, 1998 ASN Board Review Course held in San Francisco in slide/audio format. We will be focusing on the acid-base and sodium lectures from the course.

This week, Dr. Robert G. Narins, from Henry Ford Hospital in Detroit, begins with an introduction of metabolic acidosis, a detailed discussion of acid generation, buffering, and excretion, respiratory compensation, and the anion gap. Then Dr. Narins talks about the utility of comparing the anion gap increase with the serum bicarbonate decrease, and causes of high-anion gap acidoses. Part 2 of the lecture focuses on ketoacidosis and salicylate toxicity.

Part 3, which will be put up next week, will feature a discussion of the toxic alcohol syndromes, especially methanol and ethylene glycol intoxications, and the osmolal gap. Also touched upon is the pathogenesis of normal anion gap acidoses.

November 22 - 28, 1998
Renal disease-specific sites on the web
There are a large number of these, it turns out. A partial list follows. The sites will be collected at the "Societies" link off the home page of HDCN. There are of course many others, including sites for multiple myeloma, Sjogren syndrome, hepatitic C. If readers of HDCN wish to suggest additional sites for consideration, please send mail to editor@hdcn.com with the words "New Website" in the subject line.

November 15 - 21, 1998
A case of lithium toxicity  
This is one of a large number of toxicology cases on MedConnect. There is an archive of no fewer than 35 such cases on the MedConnect site. Free registration on the site is required. A number of other cases relevant to nephrology from this and other sites are listed on HDCN under Internet Renal Rounds by Diagnosis, found under the "Clinical" tab on the HDCN home page.

November 8 - 14, 1998
Babelfish on Altavista  
Named after a character on a classical computer game ("Hitch-hiker's guide to the galaxy"), this web service offered by the Altavista web browser allows one to translate phrases, documents, or entire web pages by either cutting and pasting the text into a form box, or by entering the name of the desired internet address (URL). A large number of translations to and from English are available, and include Spanish, French, Portuguese, German, and Italian. I know some French, German, and Spanish, and the translations into those languages are more verbatim, and certainly don't capture idioms well.

I tried translating a page from the French Canadian newspaper "Le Devoir" to English, and the results are more amusing than pretty, and the message of the French text comes through with great difficulty. However, there are times when you just need to look at a website in a language with which you are not familiar, and, with careful, repetitive reading of the translation, you can get some idea of what is being conveyed. There remains a lot of room for improvement, obviously, in automated translation software.

One nice feature of the program is, that if you input the URL of a web page into the babelfish forms box, all subsequent links within the site are translated as you click on them. Given the large number of non-native English speakers using HDCN, I thought this translation service, albeit crude, might be of interest. There will be a link to babelfish from the home page of HDCN, next to the Altavista search engine link. Altavista, in my (limited) experience, is the best of the internet search engines.

Note about slide/audio symposia: We will not be posting any new slide/audio symposia on HDCN for the next 2-3 weeks. However, a large number of talks, to be posted in either the key zone or the free zone, are in preparation, and we will begin posting them towards the end of November.

November 1 - 7, 1998
Full text article links on PubMed  
As HDCN readers should know, a number of full-text articles are available on the web via publisher web sites. Most of these require a paid individual or institutional subscription to the journal in question. In some lucky instances, e.g., J Clin Invest, and (until Jan 1, 1999) the American Heart Association Journals, full text is available for free.

A new, valuable feature of PubMed is, that on the page that retrieves the abstract, if full text is available, there is a link to the journal publisher website next to the "Links" heading near the top of the page.

This week, we have selected several articles from the journals "Hypertension", "Circulation", and "Journal of Clinical Investigation". The link on HDCN leads to the PubMed abstract site. But from there, for each of these papers, you can click on the journal hyperlink to retrieve the full text of the article in question.

October 25 - 31, 1998
12-lead ECG library homepage 
This library of about 46 annotated ECG tracings has been compiled by Drs. Stephen Gerred (medical registrar Auckland, New Zealand) and Dean Jenkins (Specialist Registrar, Llandough Hospital, Cardiff, Wales). These authors have written a related book "ECGs by example"' published 1997, by Churchill Livingstone (ISBN 0443 056978).

The site is a valuable resource to review various ECG abnormalities, including those associated with hypo- and hyperkalemia.

Net Medicine EKG case of the month 
This is a collection of fewer (n=14) cases than the Jenkins/Gerred site, but the tracings are of higher quality, and the cases are presented as unknowns with clinical information, making this a more interesting and valuable teaching experience.

October 18 - 24, 1998
Lancet full text supplement on Stroke 
This is one of a series of full text supplements available from the Lancet. Available for free, but you must first register at the Lancet site to obtain a loginID and password. The supplement includes 8 articles, dealing with epidemiology of stroke, diagnosis, treatment, prevention, stroke in the developing world, and issues and answers in stroke care.

October 11 - 17, 1998
Slide/audio symposium on HDCN from the 1997-1998 NY Soc Nephrol Evening Lecture Series 
"Why do we reject renal grafts?" by Mohamed H. Sayegh, M.D.

This is a wonderful talk that deals with the role that indirect presentation of graft antigens (after processing by recipient antigen presenting cells) plays in graft rejection, and especially chronic rejection. The role of delayed type hypersensitivity response in graft rejection is discussed, as well as how sensitization to donor peptides can induce a delayed-type hypersensitivity response to donor cells in the recipient. Finally, Dr. Sayegh presents some preliminary data in humans, where patients with DR mismatch and allograft dysfunction were found to mount immune responses to synthetic peptides derived from DR based donor antigens.

October 4 - 10, 1998
Slide/audio symposia on HDCN from the 1998 Annual RPA Meeting  Both talks are from the Renal Physicians Association 1998 annual meeting. Two weeks ago, we posted three other talks from the same meeting: One discussed the RPA as an organization: Its history and the reasons for its creation by Dr. John H. Sadler, the first President of the RPA. Then Dr. Emil Paganini, a Past-President of the RPA, discussed present challenges, and last, Dr. Allen Nissenson, the President-Elect, talked about his vision of the future of nephrology and managed care, as well as what role nephrology organizations such as the RPA should play.

September 27 - October 3, 1998
The Genetics of Polycystic Kidney Disease  
An HDCN slide/audio presentation from the PKRF Foundation annual meeting, Dr. Greg Germino explains the differences among PKD1, PKD2, and autosomal recessive PKD, and also details evidence supporting the two-hit hypothesis of how cysts develop. Also included are introductory remarks by Mr. Dan Larson and Mr. Thomas Flesch, representing the PKRF Foundation. In about 4 weeks, we will present another talk from the same meeting, by Dr. Ellis Avner, which focuses on the new animal models of PKD and how they contribute to our understanding of human disease.

This talk is in the free zone, web presentation having been sponsored by an unrestricted educational grant from Sigma-Tau Pharmaceuticals.

September 20 - 26, 1998
The RPA turn 25: A Retrospective  
A selection of 5 talks from the annual US Renal Physicians Association Meeting is being posted on HDCN. This week, three talks from the meeting that focus on the RPA as an organization: It's history and the reasons for its creation are detailed by Dr. John H. Sadler, the first President of the RPA. Then Dr. Emil Paganini, a Past-President of the RPA, discusses present challenges, and lastly, Dr. Allen Nissenson, the President-Elect, talks about his vision of the future of nephrology and managed care, as well as what role nephrology organizations such as the RPA should play.

Next week we will be posting talks from the Polycystic Kidney Research Foundation Annual Meeting, and the following week we will post the remaining two selections from the RPA meeting: talks focusing on the economics of ESRD health care: one by Dr. Lou Diamond on "Evidence-based medicine, clinical guidelines, clinical pathways, and performance measures", and a talk by Dr. Robert Rubin about "Disease management in 1998, including coordination of pre-ESRD care".

September 13 - 19, 1998
Endovascular Forum: Ask the Expert   A nice interactive site that has been chosen before. You need to register at the Endovascular Forum Site before entering (free). In 1998, no less than three experts have responded to questions in the dialysis area.
Sep 98    Lytic Therapy of Fibrin Sleeves by Dr. Scott O. Trerotola
Aug 98    Vascular Access by Dr. Thomas M. Vesely
Jan 98    Thrombosed Hemodialysis Grafts by Dr. Karim Valji
The site is a bit hard to navigate. "Experts Online" is divided into two sections: "Ask the Expert" and "Opinion/Editorial". Click on the former to get to Dr. Trerotola's talk, and then click on Archive and not on Index, to get to the talks by Drs. Vesely and Valji.

AJP and AHA Full Text Journals On-Line
The AJP journals have been available (since Jan 1998!) in full text form. The AHA Journals (Circulation, Circ Res, Stroke, Hypertension, etc.) have just been put on the web in full text form, all courtesy of the Highwire Press from Stanford University. The introductory period for free full text papers extends through October 1, 1998 for the AJP journals, and through December 31, 1998 for the AHA journals. See the HDCN journals page for direct links to the these journals.

Full text abstracts and itinerary tool from the upcoming 1998 ASN meeting.
What we've all been waiting for! A searchable tool to look at full text ASN abstracts, with a "shopping cart" type of tool to add abstracts to an itinerary, which then can be printed out and used at the annual meeting. This link has been added to the HDCN's "abstracts by meeting" page.

September 6 - 13, 1998
Special Symposium on Management of a PD Program.   A selection of 5 talks from a Special Symposium held at the 1998 Annual CAPD Meetings held in Nashville this past winter. The two talks being posted this week are: Three other talks from this symposium were posted 2 weeks ago on HDCN and, of course, are still available: This symposium is in the KEY ZONE of HDCN as preparation and posting costs were not defrayed by any company or organization. For information about subscription to the KEY zone, click here .

August 30 - September 6, 1998
A. American Journal of Medicine On-Line.   This major internal medicine journal has been on-line since January of 1998. Each month, one article is selected and presented in full text form. The paper is also discussed in depth using a journal club format. Of interest to nephrologists, for example, is Dr. Glen Chertow's paper on mortality after cardiac surgery and ARF published in the April issue. In addition, an internal medicine case of the month is presented as an unknown, with the answer given the following month. The July case may be of particular interest to nephrologists. Registration is required to access this content, but at the moment there is no charge. The Am J Med home page hyperlink has been added to HDCN's journals page.

B. Lancet Heart Failure Supplement On-line.   The Lancet periodically publishes supplements of its content, where articles are available full text for no charge (registration is required). As the Am J Med, Lancet makes some papers available from each issue for free in full text form, and all articles available to journal subscribers. The heart failure supplement includes 7 full text review articles, including pathophysiology, epidemiology, treatment, and future directions of approaching this condition. Prior registration at the Lancet site is required.

August 23 - 29, 1998
Special Symposium on Management of a PD Program.  Some HDCN readers have complained that there is too little information on HDCN for nephrology nurses and other non-physician ESRD health workers. Also, practical clinical material is always a focus of HDCN. With this in mind, we are presenting a selection from this Special Symposium at the 1998 Annual CAPD Meetings held in Nashville this past winter. The posted talks include: The remaining two talks, Managed Care In Dialysis by Ramon G. Hannah, M.D., and Comparison of Economic Implications for Various PD Therapies and Payers by Maureen Michael, M.B.A., R.N., will be posted two weeks from now.

This symposium is in the KEY ZONE of HDCN as preparation and posting costs were not defrayed by any company or organization. For information about subscription to the KEY zone, click here .

August 16 - 22, 1998
Physiologic changes in the urinary tract during pregnancy.   Dr. Marshall Lindheimer from the University of Chicago gave this excellent presentation at the ASN last year. It is now reproduced on HDCN in slide audio format.

This symposium is in the new KEY ZONE of HDCN (scheduled to be activated in the next day or so), as preparation and posting costs were not defrayed by any company or organization. For subscription information to the key zone, click here .

August 9 - 15, 1998
Dr. Agnes Fogo's On-Line Atlas of Renal Pathology.   Dr. Fogo has been hard at work with the help of the NKF Cybernephrology team to make this a reality. Four conditions down (membranous, membranoproliferative, dense deposit disease, IgA nephropathy), and countless more to go. A new condition is covered each month at the Am J Kidney Dis online site (see above hyperlink). The photographs are excellent, and relatively high resolution figures are available to download which can be inserted into computer slide-making programs to use for educational purposes.

August 2 - 8, 1998
USDA (US Department of Agriculture) Nutrient Database.   This is a good example of our tax dollars at work! The USDA has compiled an extensive database of every conceivable food, prepared in any conceivable variation (I am sure some foods and preparations are not included and did not check for ethnic foods) and detailed the nutritional composition of that food, including minerals, fats, amino acids, and vitamins.

One useful part is the search function. For example, I wanted to know how much potassium is in a potato. Click on the Search hyperlink, put in potato, and then select from among at least 30 forms of potato. I chose "potato, baked, flesh, no added salt". I learned that such a potato has 391 mg of K per 100 g portion, and I also learned that what the government has decided is an average sized potato, measuring 2-1/3 x 4-3/4 inches (weighing 156 g), contains 609 mg of potassium.

One problem with the database is, that it contains too much information. For example, this same potato contains 0.335 mg copper and 0.11 g of threonine. Did we want to know this? However, the US government allows one to download the entire database in a relational format, allowing one to design whatever queries or groups one wishes. Presumably, one could, after downloading the database, ask: Please list all the foods having more than 300 mg of potassium per 100 g portion. I think such queries should be available on-line to accommodate most frequently asked questions. Nevertheless, this is an enormously useful resource.

July 26 - August 1, 1998
Abstracts and Press Releases from the 58th Annual Scientific Meeting of the American Diabetes Association.   The annual ADA meeting is of course an important one for those interested in diabetic nephropathy. From the home page linked above, go to "Press Releases" for information on the newest advances, including the use of inhaled insulin preparations. Then go to the "Abstracts Online" link, and choose "Abstract Category Search". From the menu, choose "Complications: Nephropathy", to view the text of 44 abstracts in this category area.

July 19 - 25, 1998
Electrolyte Quintet: Potassium.   The Lancet completely redid their site several months ago. Now you can have full text access to almost all of the content if you subscribe to the print version. Even if you do not subscribe to the print version, as long as you register at the site, you can access selected full text material from every issue FOR FREE! In the July 11th issue, the first of five review articles on electrolytes is presented (hence "Electrolyte Quintet"). The series (quintet) editor is Dr. David Bushinsky. Dr. Mitch Halperin and Dr. K.S. Kamel wrote the first installment on potassium. After you go to the site, click on the New User hyperlink and register. Then go to Journal, Back Issues, Vol 352, Issue 9122 (July 11th), and Contents at a Glance. A direct hyperlink to the potassium review paper is also present in this week's update.

In almost every issue of The Lancet there is a paper concerning cardiovascular disease or nephrology. In the July 11th issue there is also a full text letter concerning the use of ACE inhibitors in patients with aortic stenosis. In the July 18th issue is a paper dealing with possibly reduced cancer risk with ACE inhibitors. You can reach the Lancet also via the Journals Page of HDCN.

July 12 - 18, 1998
Ovid free Database of the Month.   If you want full text on-line, you almost invariably have to pay for it. One of the full text aggregators is Ovid, available to many people through their universities, or via personal subscription at the Ovid website. Unfortunately, most nephrology subspecialty journals are not yet included in the Ovid full text journal set. Meanwhile, each month, Ovid is allowing users to get free access to one of their databases.

The free July database is Evidence-Based Medicine Reviews Database. As described on the Ovid site: "Evidence-Based Medicine Reviews will provide content from two premier sources; the Cochrane Database of Systemic Reviews, published by the Cochrane Collaboration, an international organization dedicated to applying evidence-based-medicine principles to the review of important clinical topics, and Best Evidence, a database which contains the ACP Journal Club (a publication of the American College of Physicians), and the journal Evidence-Based Medicine (a joint publication of the ACP and the British Medical Journal Group)."

Actually, there is not much that the Cochrane Group has done in terms of renal disease yet that I know of, and this particular database is more useful to address questions of cardiovascular disease. Still, it's nice to mark this site and see which databases will be opened up each month.

July 5 - 11, 1998
Two slide/audio symposia are being posted this week on HDCN: Both are from the Seventh Annual Spring Clinical Nephrology Meeting of the U.S. National Kidney Foundation.  This completes the posting of 10 talks from this meeting on HDCN.

June 28 - July 4, 1998
Journal of Nephrology On-Line Site.   A relatively new journal, published by the Italian Society of Nephrology, now in its 11th Volume. Apparently this journal is not yet indexed by Medline. Beginning with the January-February 1998 issue, the JN is online in full text form, including all editorials and editorial reviews. These are made even more useful, as hyperlinks have been created between most references and medline abstracts. For some reason, though, only the Jan-Feb 1998 issue is posted, so I hope they will continue to do so with subsequent issues. Full text editorial/review topics from just the Jan-Feb issue include: Another page, still under construction, is a Collection of "Reviews". Here there are also selected reviews from 1997 issues, including topics such as: The challenge will be to index these reviews properly as their number increases.

All in all, the SIN (Italian Society of Nephrology) should be congratulated as one of the most forward looking of the national nephrology societies in terms of developing web-based communications.

A direct link to the SIN home page can be found on the Society Link Page of HDCN, and a link to the home page of the Journal of Nephrology has been added to the Journals Link Page.

June 21 - 27, 1998
Update on Clinical Cardiology.   A collection of about 5 presentations from the 13th World Congress of Cardiology held this spring in Rio de Janeiro. Two talks are of special interest: a review of hypertension treatment and guidelines by Dr. John Chalmers, and a review of heart failure by Dr. Jay N. Cohn. The technology used is Real Media, and the quality of the voice transmission and slides is quite good. Also, go to the American College of Cardiology site, register, and look at the news summaries (ACC '98 News On-Line) of the 1998 Annual Scientific Meeting. This includes summaries of some of the key talks, along with 5-minute interviews using Real Audio with the key presenters. The interview with Dr. Packer (Sunday March 29) is quite useful, describing potential benefits of high- vs. standard dose lisinopril in treating CHF (ATLAS study).

Technical note:
Incidentally, we found a coding error in the most recent slide/audio presentations on HDCN, causing problems with Internet Explorer version 3.0, and with America On-Line when using an embedded IE 3.0 browser. Viewers using Internet Explorer 4.0 or Netscape 3.0 or 4.0 were not affected. The coding error has been corrected. If you are using IE 3.0 or AOL and are still having problems viewing the slide/audio presentations on HDCN, please contact the editorial office at editor@hdcn.com.

June 14 - 20, 1998
Two slide/audio symposia are being posted this week: Both are from the Seventh Annual Spring Clinical Nephrology Meeting of the U.S. National Kidney Foundation.  This now makes 8 talks from this meeting which have been posted on HDCN. Yet two more are in preparation.

June 7 - 13, 1998
Two slide/audio symposia are being posted this week: Both are from the Seventh Annual Spring Clinical Nephrology Meeting of the U.S. National Kidney Foundation.  This now makes 6 talks from this meeting which have been posted on HDCN. Another four are in preparation.

May 31 - June 6, 1998
Three slide/audio symposia are being posted this week. The first two are from the Seventh Annual Spring Clinical Nephrology Meetings of the US National Kidney Foundation.  Dr. Lingeman's talk is from the NY Society of Nephrology Evening Lecture Series, 1997-1998.

May 24 - 30, 1998
Whether to restrict sodium in hypertensive patients.   (Slide/audio symposium from the Seventh Annual Spring Clinical Nephrology Meetings of the US National Kidney Foundation)
In the next 8 weeks, we will be posting a total of 10 talks in slide/audio format from this excellent meeting. In this first installment, Dr. Michael Alderman squares off against Dr. Alan Weder for an interesting debate on the dietary sodium issue. Dr. Alderman discusses results of his newly published study in the Lancet suggesting that low sodium intakes (NHANES data) are associated with increased mortality.

As an aside, this last week, a series of letters in the Lancet (May 16, 1998 issue) comment on Dr. Alderman's paper. To reach these letters, register at the Lancet site (still free, find this via the JOURNALS link on HDCN), then go to (1) Journal, (2) Back issues, (3) Volume 351, (4) May 16, 1998, (5) Contents at a glance. If you have already registered, try this direct link.

May 17 - 23, 1998
Uroradiology Rounds (Adult Section)
12 cases on the Digital Urology Journal site, put together by Dr. Julia Fielding from the Brigham and Women's Hospital, Boston, MA. The case history is very brief, and one problem is, that the answer is given on the initial screen, before presenting the radiographs, CT scans, and ultrasounds. What's somewhat more fun is a "Urology Olympics", also by Dr. Fielding, similar to a "Case of the Week", where you are presented a case and are asked for your diagnosis. The answers are posted at a later time.

May 10 - 16, 1998
More Cyberounds: (1) Non-Healing Foot Ulcer and (2) A Case of Calciphylaxis
Two conferences posted this month on Cyberounds might be of interest to HDCN readers. The first, by Dr. Caroline Fife from Univ TX Houston, deals with practical management of the non-healing foot ulcer. The second, presented as an unknown, by Dr. Eli Friedman, is a case of calciphylaxis. The latter is a topic which has been discussed on NEPHROL recently, with questions as to whether its incidence may be increasing. The foot ulcer lecture now has a supplement with CME questions, and both lectures offer the opportunity for listener feedback and comments. You need to register with Cyberounds prior to accessing these lectures.

May 3 - 9, 1998
NKF-DOQI Anemia Guidelines - Slide/Audio, Interactive.
Six slide/audio lectures that were given at the San Antonio ASN Meeting last November 1997 as part of a Satellite Symposium. Lectures by Drs. Eknoyan, Eschbach, Adamson, Stivelman, Berns, and Wish. Questions asked at the symposium are presented, and there is a mechanism to post further comments/questions/opinions.

April 26 - May 2, 1998
Toxic Spice Girl.
Yet another Toxicology Case of the Month (from the Rocky Mountain Poison and Drug Center) with renal implications, posted April, 1998. Meanwhile, the Medconnect Site has been completely reorganized.

April 19 - 25, 1998
Shaping the Future of Peritoneal Dialysis.
This slide/audio symposium is a record of a Satellite Symposium at the Nashville Peritoneal Dialysis meetings held this February. Dr. Dimitrios Oreopoulos first gives a "Brief History of Peritoneal Dialysis". Then Dr. Peter Blake evaluates morbidity and mortality in PD vs. hemo patients, comparing the US experience as reported by the USRDS (Bloembergen et al) with data from the Canadian Registry. Dr. Blake also presents some preliminary data from Dr. Ed Vonesh's analysis of PD vs Hemo mortality in the USRDS dataset in the years subsequent to the original Bloembergen study. To conclude, Dr. Karl Nolph talks about Peritoneal Dialysis 2000. He discusses economic factors that might favor PD over Hemo in the next decade, and then talks about how the new concept of "early start" may be implemented from a PD perspective. He then discusses recent advances in PD solutions which may impact on nutrition, ultrafiltration failure, and biocompatibility.

April 12 - 18, 1998
New Therapies for Acute and Chronic Renal Failure
One of the February 1998 evening lectures given to the NY Soc of Nephrology, by Dr. H. David Humes. A glimpse of what extracorporeal therapy may entail in the not too distant future. Slide/audio symposium. This sound file is encoded using new fractal Real Media encoder. The sound quality is better than before, but you now need to download Real Player version 5.0 to hear it. Earlier versions of the player will not work! Also, we now are putting the time elapsed in the talk next to every slide, so you can use the slider on the Real player to move to any point in the talk that you desire.

April 5 - 11, 1998
Annals of Internal Medicine On-Line.
Of course this site has been chosen before, but very quietly, the Annals staff have been posting increasing numbers of full text articles on their online site, such that four full text papers, including an excellent review on the history of use of the blood pressure cuff, were chosen among the articles of the week.

March 29 - April 4, 1998
Stroke Information and Resources.
On Doctor's Guide to the Internet. This is a collection of data similar to that relating to prostate cancer on the same site chosen several weeks ago. The information presented includes a collection of recent news alerts and press releases pertaining to stroke, stroke information for patients, links to stroke discussion newsgroups, and a set of links to stroke-related sites.

March 22 - 28, 1998
and 44 Multimedia Symposia on HDCN.
Nothing new, really, except that we have now indexed the talks on HDCN by topic area, and they also appear on the individual topic pages as well. The talks are now listed both by meeting, and by topic. Many more are in the production stage, so please keep tuned to these pages.

Incidentally, all subsequent talks will be posted in Real Media format, and not in Real Audio; same company, but an upgrade. So you will need to have the Real Player VERSION 5.0 (still free) to be able to listen to the subsequent talks. When you go to the Real Media site, it's a bit tricky to find the download icon for the FREE Real Player 5.0, versus the NOT-FREE Real Player Plus 5.0. The free Real Player icon is at the upper left of the Real Media Home Page.

March 15 - 21, 1998
Prostate Cancer Information and Resources.
On Doctor's Guide to the Internet. A collection of news releases, many of them from the pharmaceutical industry, pertaining to the many recent advances in the prostate cancer field in the past 6 months. This page also has links to several discussion groups, and to clinical guidelines. This is nice new feature on the Doctor's Guide site, which earlier had the problem of packaging the voluminous information on the site into digestible portions.

March 8 - 14, 1998
Hemodialysis Adequacy Lecture. Dr. Gerald Schulman. 
A continuation of the NY Soc Nephrology Evening Lecture Series presentations. Dr. Schulman reviews the 1980 NCDS Study, the relation between Kt/V and mortality, mortality in the US vs. that in Europe and Japan, and then describes the design of the NIH HEMO trial. For a related lecture on dialysis kinetics, see the talk given in Lund in May of 1997 by Dr. John Daugirdas as part of the Nordic Nephrology Days meeting.

March 1 - 7, 1998
USCAP Nephropathology Specialty Conference On-Line Renal Biopsy Cases. Five cases are posted, each having something to do with possible indirect consequences of infection in the kidney. Discussions of these cases take place on an email disscussion group called NEPHNPPT, which is a subgroup of a large discussion group called NEPHROL. To subscribe to the discussion of these and other renal biopsy cases, send email to Joseph DeAlmeida (joseph.dealmeida@ualberta.ca) or Dr. Solez (kim.solez@ualberta.ca) and ask them to subscribe you or alternatively, send email to majordomo@ualberta.ca with the following command in the text area:

subscribe NEPHNPPT

For renal biopsy cases from previous USCAP meetings (1997 and 1996), see the Renal Rounds by Diagnosis page of HDCN, where those and other renal biopsy cases on a variety of internet computers are listed along with hyperlinks to them.

February 22 - 28, 1998
American Journal of Kidney Disease On-Line Offerings. With the February, 1998, issue, the AJKD makes several steps towards becoming a mixed print/web-enabled journal. A number of features in the journal are now available in full-text form, including a historical essay on the role of dopamine in renal sodium transport by Dr. Anita Aperia. Three articles, one on use of mycophenolate mofetil to treat inflammatory glomerular disease by Briggs et al, and a pair of articles on the prevalence of hepatitis G in dialysis patients are accompanied by full-text on-line editorials (see the article summaries in this week's update to HDCN for links to the abstracts and the editorials).

But that's not all! A nephrology biopsy teaching case is up in full text complete with pathology slides. Also, the full text of a journal club, which features a discussion of a paper describing a chimpanzee with nutritional rickets is up in full text form. There is an Appendix to a paper by Dr. Kamyar Kalantar-Zadeh describing their method of scoring the Subjective Global Assessment to evaluate nutritional status. Finally, a pathology atlas series begun in January by Dr. Agnes Fogo continues with a discussion and pictures of dense deposit disease. Unfortunately, some of the the pictures posted to date in this atlas are somewhat lacking in detail and clarity. A final promised, but not yet realized feature, is a monthly CME program based on material posted in the AJKD, to be headed by Dr. Don Molony.

February 15 - 21, 1998
Nocturnal Hemodialysis: A New Alternative. This presentation was given last month by Dr. Andreas Pierratos to the New York Society of Nephrology. With the gracious permission of the Society and the speaker, we are reproducing this important talk on HDCN in slide/audio format. The results are very thought provoking, and certainly suggest that more units throughout the world should be trying this novel method of therapy, which differs from what is being done in Tassin in that dialysis is done 6 nights per week, and in the patients' homes.

See also the program for the upcoming PD meetings in Nashville and the included Home Hemodialysis Symposium (you can get to this program from the home page of HDCN by using the Meetings hyperlink, and then going to the Dialysis, Extracorporeal Therapy subtable).

February 8 - 14, 1998
Physician's Weekly. This is a medical news journal of general interest, but which often has stories that are of use to the nephrologist and specialist in cardiovascular medicine. For example, in the February 9th issue, there is a story that oral magnesium supplements prevent sickle cell crises. In the February 2nd issue, there is a story about the nationwide shortage of intravenous immune globulin (IVIG) in the United States. This and other stories can be reached by clicking on the "ARCHIVES" hyperlink at the bottom of the home page via a search engine.

Another site of great practical usefulness to internists is that representing the American Society of Internal Medicine. The site is a bit glitzy, but it is replete with information of a practical nature, including practice management, legislative issues affecting internal medicine, and managed care/third party payer topics. The ASIM's online news journal is called Today's Internist.

Both of these sites have been added to the HDCN News Page.

February 1 - 7, 1998
Toxicology Case of the Month: A New Antidote for the New Year. On Medconnect. This site has the best CME offerings on the Web that I have found, although it is slanted toward family practice residents, ER residents, and pediatricians. The toxicology series, run by Dr. Richard C. Dart, has been outstanding, and has been chosen as site of the week many times before. When you pull up the site, a password box will appear. You must click on cancel first to get a password and loginID (it's free).

January 25 - 31, 1998
NY Soc Nephrol Evening Lectures: Peritonitis in CAPD by Dr. Stephen Vas. The December 1997 lecture from this ongoing series is now posted on HDCN. It is a very intimate, personal look at the diagnosis and treatment of peritonitis by one of the true pioneers in the field.

January 18 - 24, 1998
Glaxo-Helix Frontiers in Biomedicine and Medical CME.   Glaxo-Helix has been putting on Real Audio lectures as part of its Frontiers in Biomedicine since April of 1997. You must first register to access the pages described below by going to the home page. The 1997 lecture program was quite basic science oriented, but the lectures included many topics of current interest, including HIV infection and Alzheimer's disease. The 1998 lecture program is much more clinically oriented. Unfortunately, no renal lectures are planned for 1998. The closest cardiovascular topic is a lecture in June dealing with the treatment of myocardial infarction. The only 1998 lecture posted to-date is the January lecture by Dr. JM Sackier dealing with endoscopy.

There is a companion set of CME programs that don't include a slide/lecture format. Here there is a nephrology-related offering: Escherichia coli O157:H7 - Diarrheal Illness and Hemolytic Uremic Syndrome . All in all, however, this site is undoubtedly a portent of many similar good efforts to come in distance learning.

January 11 - 17, 1998
New York Society of Nephrology Evening Lecture Series On-Line.   HDCN is pleased to put up selections from these talks, given over Fall 1997 and Winter 1998. The first two talks, now posted, are by Dr. Tom DuBose Jr, University of Texas at Houston: Distal Renal Tubular Acidosis: A Simplified Pathophysiologic Approach to Diagnosis, and by Dr. Josephine Briggs, Director, DUKHD Division at NIDDK, Bethesda, MD: New Directions at NIDDK. The talks are posted in synchronized slide/audio format. The full transcripts of each talk are also posted, along with hyperlinks to the source abstract of each slide. For a full list of slide/audio presentations available on HDCN, click on the Slide/Audio hyperlink on the home page of HDCN.

January 4 - 10, 1998
Journal of the American Society of Nephrology On-Line.   Finally, JASN is on-line, to join AJKD, NDT, Nephron, PDI and a host of other journals. The JASN site lists abstracts of each issue on one long scroll, which is a problem if one wants to print out a single abstract. An interesting feature is the provision of selected articles in their entirely in .pdf format. The first of these is the recently published Nephrology Core Curriculum.

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.