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HDCN's CME Site or Case of the Week
(listed in reverse chronological order)
(chosen by JT Daugirdas MD, Editor HDCN)

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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 the 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)

Pubmed 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.

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 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 the 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, colored red).

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 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 journal, the 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 site: 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 than 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 screen). The 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 the 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, 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 SYST-EUR trial, 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- blocker.

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 useful.

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 display.

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 volunteers?

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' (concomitant 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 these presentations.

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 kidney.

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 it.

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 nephrologists is the "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 On-Line Site. 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 posting case unknowns on the internet was begun last year. This year's cases are posted at the University of Colorado Medical Rounds site. Use login ID IAP and 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 taking indinavir.
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 provider) in late 1995 which consisted of four lectures (compliance, rehabilitation, intradialytic symptoms, and access problems), a series of question and answer sessions after each 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, with additional discussion being provided by Drs. Golper and Nissenson. The moderator-led discussions are available both in text form and in Real Audio. For those wishing CME/CEU credits, 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 faculty.

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 and 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 cardiovascular medicine. One is a perspective on racial differences in ESRD incidence and survival , by Eli Friedman, M.D., 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 uncomplicated case of nephrolithiasis. The advisability of a metabolic work-up of stones is not discussed (arguably important, although not necessarily after the first episode, as idiopathic hypercalciuria can lead to osteopenia if patients follow a low-calcium diet). Finally, the cardiovascular division presents a discussion of whether or not ACE inhibitors should be used in all patients after myocardial infarction. The discussion is limited to this drug, and makes no mention of aspirin or beta-blocker use (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 keep choosing MedConnect again and again for CME site of the Week. In my opinion it is THE best medical site on the web, although the material is more of a general medical nature, being focused 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 added, Osteoporosis I and Osteoporosis II , both by Nayan Kothari, MD, of Robert Wood Johnson Medical School. The toxicology cases presented by the Rocky Mountain Poison and Drug Center continue to be outstanding. There are cases of mushroom poisoning, cyanide poisoning , with a discussion of management of anion-gap positive acidosis, and most recently, a case of tylenol poisoning 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 wonderful resource, compiled by Dr. Edward C. Klatt and his associates, is one of the strongest medical sites on the Web. The scope of the site is difficult to describe concisely, as it is quite comprehensive. You need to browse the site yourself. Features that I found particularly interesting to nephrologists are, illustrated tutorals on urinalysis, pathology of renal cystic disease, and 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 laparoscopic 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 another very interesting area is glomerular disease laboratory, a series of cases for the student of glomerular disease with slides and questions and answers. There is also a large collection of both gross and microscopic pathology slides, each with a short explanatory legend. All in all, a wonderful site!

January 20-26, 1997
American Journal of Kidney Disease On-line. Prior to now, the only major nephrology journal on-line was Nephrology, Dialysis, and Transplantation (link on the home page of HDCN). Now, as of October 1996, the NKF and WB Saunders have put abstracts from the American Journal of Kidney Disease on the Web. Henceforth we will link directly to the full abstracts when reviewing from this journal. One nice feature is, that even short papers and case reports and op ed pieces have abstract summaries. You can now access the link to AJKD directly from the home page of HDCN (under "Nephrology Books and Journals").

January 12-18, 1997
Tulane University Student Cases in Pulmonary, Renal, and Acid-Base Disorders. This site is an effort by Dr. Jim Harrison to extend his lectures on acid-base and electrolytes to medical students at Tulane University. Six cases are posted; 3 renal and 3 acid- base with analysis of pulmonary function tests. While simply done, the cases have a nice level of interactivity, and obviously represent real patients, where the diagnosis is often not completely clear-cut. Soon there will be millions (at least several hundred) of these on the net, from many medical schools, for all to enjoy and study. Student/intern level of difficulty, although some 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 Multimed, Inc.).