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Since early 1994 we have offered access to the National Cancer Institute's guidelines for current cancer therapy to physicians via WWW. These guidelines, which are provided by the NCI in accordance with the rules for evidence-based medicine, are accompanied by general information for non-professionals. Since we launched this comprehensive cancer-related WWW information service in 1994, more than about 1 million customers retrieved documents from our CancerNet service via WWW (http://www.meb.uni-bonn.de/cancernet/). From user surveys in 1996, 1997, 1998, and 1999, we obtained demographic data about our users, their interests, and their opinions regarding this information service. The following analysis shows how this service was used over the years and includes some unexpected differences between users in the US, Europe, and developing countries.

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OBJECTIVE: We started the CancerNet project to evaluate the suitability of the internet to improve the quality of health care and the physician-patient relationship by offering worldwide access to high quality guidelines and standards. METHODS: Since early 1994 we have offered access to the National Cancer Institute's guidelines for current cancer therapy to physicians via WWW. These guidelines, which are provided by the NCI in accordance with the rules for evidence-based medicine, are accompanied by general information for non-professionals. Every month about 500 text-documents are HTML-encoded, linked together to about 10,000 abstracts available online as well as to MEDLINE. CancerNet is offered in English, Spanish, and German (only patient information) (http://www.meb.uni-bonn.de/cancernet/). RESULTS: From analyzing log files and user surveys in 1996, 1997, 1998, 1999, and 2000, we know that offering guidelines and patient information via the web fits most expectations of our users (physicians, health professionals, scientists, and laymen) on a high quality medical information service. Since 1994 nearly 2 million users, including more than 200,000 physicians, used our service. About 95% rated our service excellent or good.

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A distributed multimedia electronic patient record (EPR) is a central component of a medicine-telematics application that supports physicians working in rural areas of South America, and offers medical services to scientists in Antarctica. A Hyperwave server is used to maintain the patient record. As opposed to common web servers--and as a second generation web server--Hyperwave provides the capability of holding documents in a distributed web space without the problem of broken links. This enables physicians to browse through a patient's record by using a standard browser even if the patient's record is distributed over several servers. The patient record is basically implemented on the "Good European Health Record" (GEHR) architecture.

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The validity of the Cockroft and Gault formula in monitoring renal function during cisplatin therapy was examined in 110 consecutive cancer patients. A good correlation between estimated creatinine clearance (ECC) and the standard measured creatinine clearance (MCC) was found both before and after the onset of cisplatin. The correlation was better in males (r = 0.78 prior to cisplatin and r = 0.79 after the initiation of cisplatin) than in females (r = 0.69 and r = 0.63 respectively). Obesity (> 125% of ideal body weight) had no major effect on the correlation between ECC and MCC. The presence of third-space body fluids, on the other hand, had an influence on the relations between ECC and MCC, particularly in females (r = 0.49). It is concluded that estimation of creatinine clearance, without the cumbersome collection of 24-h urine specimens, is accurate enough for the purpose of adjusting cisplatin dose. It should not be used in females with third-space body fluids.

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Among 56,249 maternities in the Collaborative Perinatal Project, 615 were twin maternities. One of these resulted in stillborn thoracoomphalopagus MZ female twins with multiple cardiovascular, alimentary and other malformations. The case is of further interest in that the mother had a surgically removed brain tumor in childhood and exhibited neurological symptoms and bizarre behavior before and during pregnancy. Drugs and treatments which she received during pregnancy are not known to be teratogenic.

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Sixty-seven 7-year-old children, who had asymptomatic lead exposure between 1 and 3 years of age, were compared in their performance on a series of psychologic tests to 70 children of the same age and socioeconomic background who presumably did not have significant exposure to lead. Exposed children had deficits in global IQ and associative abilities, in visual and fine motor coordination, and in behavior. School failure due to learning and behavior problems was more frequent in the lead exposed than in the control group.

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Lead storage in teeth was evaluated by examining the lead concentration in deciduous teeth of 32 children whose habits of pica and state of lead exposure had been studied when they were between 1 and 3 years of age. Concentratios of lead in their teeth depended on the reported amount of paint or plaster intake and the duration of exposure. The mean dental concentration of lead in exposed children was significantly higher than the mean value in 36 controls, who presumably did not have undue exposure to lead. A difference in dental lead concentration related to living area was noted. The significant difference in lead content of teeth between the two groups, even though the concentrations of lead in blood at 8 years of age were similar, emphasizes the importance of dental lead measurments for retrospective studies of lead exposure.

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