User talk:Nephron/Archive 2

Thanks for your feedback about the MaRS article; I guess using MaRS' promotional materials as a source doesn't bode well for a NPOV! I'll make some changes over the next couple of days and let you know when they're up. If you're able, I'd appreciate to hear what you think.

I'd appreciate your thoughts over at http://en.wikipedia.org/wiki/Wikipedia_talk:WikiProject_Clinical_medicine#Getting_Image_Permissions_from_a_Med_School Robotsintrouble 19:50, 1 December 2006 (UTC)[reply]

RE: the RFc. Thank you. First, your supposition of my personal experience is correct. That is why I am alarmed at the apparent lack of interest in the effects of rupture. Further, Holmich was originally cited by Droliver (not I), in a statement that said either 3-8% or 5-8% (I cannot now recall) at 10 years. In fact, if you read Homich, the study concluded that a minimum of 15% (of the newer implants rupture) between 3-10 years. So I am not selectively choosing studies as you suggested, since I did not provide this reference. Unfortunately, the misquoted statement was only representative of the manner in which this article was edited. If you look at the BI article now, you will see that there is currently a disagreement on links. The primary editor does not want any links that do not support a glossy assessment of implants. The fact is, that this issue has become political, and the organizations like NOW and National Women's Health Network are decrying the FDA decision, and pointing out the limitations of the "vast" body of literature. Senators in Congress have also raised the issue. To not mention any of this, even in a link, is disingenous.

Those who insist there is no global warning are about as informed as those who insist the earth is 6,000 years old. I don't appreciate being compared to these people, even speculatively. I also am an engineer (electrical) , but chose law instead of medicine as an advanced degree. However, I was too sick to work for three years. My health dramtically improved after removing ruptured implants. The FDA has acknowledged the lack of studies on rupture (beyond 10 years), hence the recommendation for regular MRIs--which are expensive tests. Of course there are no studies on rupture of the older implants, which many women still have. As to the RFC...there were insults to go around by all. However, Wikipedia sometimes reminds me of a condo board (a small group of thugs).Jance 23:26, 10 December 2006 (UTC)[reply]

Thank you for a thoughtful and kind response. The Holmich article to which I referred is here. It most certainy does concludes, "A minimum of 15% of modern implants can be expected to rupture between the third and tenth year after implantation." I agree that in the short term, there is no association. The fact remains that there are no long term studies showing the rupture rate, or its effects. No studies of rupture rate in the older implants, or what happens if ruptured implants remain in a woman's body for any length of time. If doctors believe that this is sufficient to show "no association" then so be it. And of course, as you know, a joint replacement is not the same as silicone gel. And yes, some people do reject (some) foreign bodies, don't they? Isn't that the purpose of immunosupressant anti-rejection drugs for organ replacement? Also, some people do reject hip /joint replacements. I do believe that my consistently high ANA, anti-Smith antibodies, anti-SSA, anti-RNP, high 24-hr urine tests, polyarthritis, malar rash, low-grade fevers, photosensitive rashes, oral ulcers, vertigo, ataxia, numbness, abnormal brain and c-spine MRI, abnormal spinal tap (elevated igG and oligoclonal banding) are more than 'not feeling well' as one here suggested. In fact, although I am not a medical doctor, I would say all of this probably indicates an immune dysfunction, wouldn't you? Anyway, a couple neurologists and rheumatologists that treated me concluded it did. I have had normal blood tests for over two years now, and no signs of lupus or MS. Haven't had the pleasure of repeat MRIs or spinal tap (I won't do it). I also understand that these illnesses can go into remission. However, the timing and degree of the change convinced me that my rapidly declining health was related to the implants that had been ruptured in my body for five years. I no longer wake up in hives and thus I no longer carry an epipen. I discontinued Avonex because the side effects outweighed any benefit, to me anyway. Unlike those that market the interferons, I could not see that MS drug studies showed an improvement beyond a reasonable doubt. I still take plaquenil and wonder if someday I can discontinue it. I won't be able to base this on any medical advice or studies, of course, since the "standard of care" would be to continue the medication - especially since there will be no studies to determine whether or not this might be reversible, as is a drug-induced lupus. If many doctors have shut minds as did the one here who expressed "antipathy" toward women who had BI and believe they have immune dysfunction, there are not likely to be any. I do not suggest politics should be equated with science. I do suggest that the controversy and ongoing concerns be mentioned. To write this off as a "few women who claim they became ill" is misleading. But I don't care to edit with the doc mentioned above, and with Oliver here - athough I must say it has been an education.

By the way, my father died of mesothelioma. I suspect studies would show no association between asbestos and mesothelioma at 10 years. He died 40 years after his exposure, approximately 5 months after he was diagnosed., He never smoke, drank or used drugs. He was a geologist and loved the outdoors. One bright bulb here on Wikipedia tried to tell me that there was no way to prove he or anyone died from asbestos exposure. The presence of asbesotos fibers in the lungs does not prove anything. Yep, true enough.

One last thing - it was not only historical perspective and remaining concerns that Oliver wanted to eliminate, as links. He also wanted to eliminate a statement that the FDA recommended regular MRIs after implantation to detect rupture (it was too US-centric) and that augmentation was approved for women 22 years old and older (he can use implants off label so why bother mentioning it). Jance 15:25, 11 December 2006 (UTC)[reply]

You are welcome, Nephron. I still am not used to some of the Wiki notation. First, I was appalled at the misstatements of case holdings on defamation lawsuits which Barrett (of Junkscience) filed against various people. For exmaple, the CA Supreme Court did not find for defendants on the merits, in one instance. The court never reached the merits, but instead interpreted the meaning of computer "user" under "The Communications Decency Act" (typically misnamed, as usual) which provided computer users with immunity from defamation liability. Secondly, I wonder why doctors despise lawsuits and lawyers unless it is their own. I agree with some of the "Junkscience" articles but wonder also if Stephen Barrett has become little more than a lobbyist. "Truth" and "science" are much more ambiguous than I once believed, even as an engineer. After my experience with silicone implants, reading the studies in PS journals, and hearing the level of curiosity from some MDs (mostly here, I admit), I now wonder about those who so predictably complain about "junkscience". Of course, if I go back to my younger days, I always did think that "truth" or "hard science" was not nearly as "pure" as engineers liked to claim. One example, and then I have to prepare for court tomorrow. Many scientists and engineers claim that mathematics just describes the physics - that tangible hard stuff we see around us. But if you look at the history of mathematics research (reducing a system to its least necessary components) you may conclude something else. Einstein's general theory of relativity was what - 1905? (Something like that). He used math concepts developed over a century before his birth. Specifically non-Euclidean geometry (and Euclid's 5th postulate). Chew on that one.Jance 22:26, 11 December 2006 (UTC)[reply]

I think I was thinking of someone else when I wrote the statements above about case holdings. If it seemed like it was coming out of left field, that was why. Sorry about that. What kind of engineer were you before med? Jance 23:10, 13 December 2006 (UTC)[reply]

Nephron/Archive 2, thank you for your support in my RfA which passed on 13th December 2006 with a tally of 49/10/5. I am delighted by the result and a little daunted by the scope of additional responsibilities; I shall be cautious in my use of the new tools. I am well aware that becoming an Admin is not just about a successful nomination, but a continuing process of gaining further experience; for this I shall welcome your feedback. Again, many thanks for supporting my RfA, feel free to contact me if you need any assistance. :-) David Ruben 03:45, 16 December 2006 (UTC)[reply]

G'day Nephron and thank you for your note. My expertise in the medical field is mainly limited to technology -- started out as an electronic engineer then commenced specialising in medical applications, including clinical & research in the late 50's thus I have a lot of historical knowledge which I try to use to improve articles. Graeme (QRS) is an old friend, now 76. He was keen to try and straighten things out re the article Telectronics but was pretty upset by an abusive late night phone call. Not sure whther he wants to continue to contribute to other articles. I hpe so as he was one of the pioneers of open heart surgery. A'll the best for Christmas & 2007. Geoffrey Wickham 23:07, 21 December 2006 (UTC)[reply]

Thank you for your advice in my recent RfA, which failed. If you have any further advice it would be appreciated! Seraphimblade 14:44, 24 December 2006 (UTC)[reply]

You wrote, "Medical practise is based on what physicians know with some certainty and historical precedent-- not on unlucky patients that may have gotten horribly sick regardless of the intervention and improved regardless of a second intervention. Also, I'll point-out that foreign bodies are, generally, not proven to be health risks."

Actually, a foreign body in one's system is indeed 'generally' proven to be a health risk. Joint replacement surgery carries the risk of any surgery, and joint replacements do fail and have to be replaced. The issue is whether the benefits outweigh the risks. More importantly, do you see the illogic in comparing ruptured breast implants to a solid joint replacement? To my knowledge, pieces of a joint replacement do not migrate and end up in other places in the body. http://www.thedoctorsdoctor.com/bodysites/lymph_node.htmOn what is medical "certainty and historical precedent" based on when there are no studies on the long-term effects of rupture, and only one or two that even look at the silicone migration? The (US) FDA points out - notwithstanding recent approval - that there is insufficient data on the new implants to determine a rate of rupture. That is one reason it recommended follow-up to detect rupture.

1. "Precedent" is also used in a legal context, and is valued in English and US law. Sometimes "precedent" is abhorrent and flat out wrong, too. It was precedent for a long time to consider black people and women as property. In medicine, I presume the use of leeches for 'bleeding' was precedent. Also, did you assume that I suggested medical practice be based on the unlucky patients? Why is it that you would assume such a thing? I have never said or implied this. (Although, I daresay that it might be worth a physician taking off his blinders long enough to consider the unlucky patients).
2. There is nothing anything close to certainty --eg studies of the long term effects of rupture - note that some silicone migration can occur from older style implants in just "bleeding" or leakage, and from the new implants as well since the material is incompletely cross-linked. But the medical practice is to use silicone implants (heck, it is the bread and butter for a whole group of medical doctors). Okay. So the FDA at least has suggested - precisely because of this uncertainty -- that women be followed up with an MRI at 3 years after implantation and every 2 years thereafter.

There are still plastic surgeons who will not remove ruptured implants (arguing that surgery carries greater risk) or will not remove them without replacement. Is this responsible? These surgeons are not basing their risk/benefit decisions on any certainty, although arguably it is precedent - notwithstanding the recommendation of at least the US FDA. And is it responsible to argue against inclusion in the article of the recommendation for follow-up?

Is it appropriate medical practice for doctors to ignore women as soon as they say the have implants, and not even check to see if there might be a medical basis for their complaints (eg look at the woman, run tests, and the like). Is it responsible for a doctor to immediately assume she is hypochondriac, or malingering, or worse? I did not have that experience, thankfully, because I never mentioned to any doctor that I had implants as I did not see it as relevant to any medical problem. With what I know now, I would discourage any woman from telling their doctors they have implants - that is, not if they want to be treated. This attitude of too many doctors did not come out of nowhere. It is an arrogance and dislike for anything hinting of "lawsuit", at least in the US. My own internist, whom I absolutely adore, was convinced that US juries award huge non-economic damages (pain and suffering) without even a finding of negligence by the doctor. I could not convince her otherwise. Legally, that is not possible and would never happen. But God knows who is telling doctors that it is. Jance 18:28, 24 December 2006 (UTC)[reply]

1. You argue against the use of anecdotal evidence in making generalizations (a good policy, I agree). However, you use a single anecdote on a blog by a complaining doctor to assert that jury verdicts are not based on scientific evidence. And, you use an equally questionable anecdote to declare that Edwards made millions by using junk science. How many cases did he try? In how many is the validity of the science questioned? In fact, Edwards probably made the most on the Valerie Lakey case.[1]
2. You cited The Washington Times, owned by Sun Yung Moon, as your source re Edwards. It is a notoriously right-wing rag in every sense of the term. It has no credibility, by any journalistic standards. When I see a reference to that, I know it is not worth reading. CBS might be somewhat different. And, it is possible that the science did not warrant that award. It is also possible that it was warranted - the doctor in the article said in his opinion there is a possiblity of the injury occurring for the reason determined (so it is not impossible), and that doctor did not see the evidence at trial. Also, this case established the North Carolina precedent of physician and hospital liability for failing to determine if patient understood risks of a particular procedure. Is that a bad thing?
3. You think that non-economic damages can be awarded without a finding of negligence. That is not true. Whether you agree with the finding of negligence may be another story.
4. If you think that a jury is not capable of determining negligence, then perhaps you would be more comfortable with something else? Like what? What would be more independent or fairer? At the end, it is up to the rules of evidence as to what comes in and what doesn't (as far as expert testimony) and up to juries. Perhaps a jury made up only of medical doctors would be preferable (I'm sure they would be fair in assessing the actions of one of their own)?

5. " Now, cost isn't only driven by lawsuits, big pharma[2] and private for-profit care also have a hand in it, -- but lawsuits is a factor." Okay. How much a factor or do you know, are lawsuits a part of the cost of travel insurance?
6. You also don't like contingent fees. How do you propose to give those who can't afford lawyers a fair access to the courts, to remedy injury? Or do you? I happen to think doctors (at least specialists in the US) make far too much, and I don't know many doctors who are willing to accept Medicare, or Medicaid.
7. You think lawyers should work for free, or assume all the risk of litigation without compensation for that risk? And, the US is not the only country that allows contingent fees. In the US, anyway, there is a maxim that for every right there is a remedy. There is a philosophy in the US about fairness, and access to the courts, regardless of ability to pay. (And no, it isn't perfect). It's a pity there is not such a maxim about health care.
8. You quote GP Maxwell who likens the concern over BI with cell phones. First, I have no respect for GP Maxwell. I have read about his background. Second, I actually know something about cell phones since I am an electrical engineer that designed cell phone systems for 15 years. The parallel is absurd. (Yes, the FDA has regulatory power, but it is not the same, I don't believe, but I am not an expert in FDA regulation). The health effects of RF radiation are pretty well known, unlike rupture with BI. There is no suggestion that rupture of a cell phone might create a special problem. One is not testing a person with implants to determine illness. One would be testing to determine rupture.
9. You state, "A large statistical sample would be enough to determine the rupture rate-- you don't have to screen everyone." I agree. But there is no such study and insufficient data to determine rupture rate. There is a reason I keep coming back to that. The FDA has acknowledged the lack of data sufficient to determine rupture rate. So in lieu of approval for use and recommending follow-up with MRIs, perhaps approval for widespread use should have been delayed until there is such a large study.

10. If ultrasound is as effective at detecting rupture, then that would be a great (and cheaper) alternative. Your agreement that the recommendation to follow-up after implantation is 'political' is interesting. What would you do? Not tell women considering plastic surgery about this recommendation? Not tell them what the long-term expense and care would be? Or do you just think follow-up is not necessary?
11. You ask what the relationship is between rupture and pathology. Well, that is a good question. The answer is that we don't know. And evidently, a lot of doctors don't care.

Finally, you ask this question:

If you encourage dishonestly about this-- how are doctors supposed to figure-out that BIs may actually be the cause of the problem?

My interest is that women find proper treatment. If I thought doctors had any interest in finding out if BIs may actually be a cause of any systemic problem, I would not advise this. However, I do not think the majority of doctors have any interest in finding out. I absolutely believe that the chance that a doctor would refuse to treat a woman (who says she has BI and worries there may be a problem) is greater than the chance a doctor would show any curiosity whatsoever. In fact, I think the mere question about BI engenders a hostile reaction and a bias against further investigation. That is a danger, when there might actually be a health problem. And I think it goes back to doctors' hostility towards lawyers and what they deem to be bogus claims.

Jance 00:53, 25 December 2006 (UTC)[reply]

Just thought I would add a "Happy Holiday".

1. I suspect it is ignored by many plastic surgeons -- absolutely. It is meaningless.
2. Generally, I think there should be manditory adverse event reporting[14]--something I think will happen when the medical community gets their act together on information technology. Beyond that, I think there should be post-market launch review/studies. Unfortunately, even the "mandatory" review/studies were ignored in the US ("adjunct studies") so I don't expect it to get any better after launch.
3. To that there is probably some truth.[15] That said, I think is just an indication that there are (1) some serious problems with the system and (2) some people with wildly unrealistic expectations. Yes, and not all on the part of 'plantiffs' or their lawyers.
4. As to Bi issues. My concern is that there will be no research on the long term effects of rupture. You wonder why I keep coming back to this. Pretty amazing that after 40 years and all these studies, there is not enough data on any one implant style to determine rupture rate or the effect of rupture. And since doctors don't seem interested,I suspect there never will be. For the majority of docs (and probably 99.9% of plastic surgeons) it is a 'done deal'. The only interest in research was that which was necessary to obtain FDA approval. And the only interest of PS is in putting implants in, not what happens after they are in. It has been an eye-opener for me!
5. Overlawyered - You have to stop using this as a source. It's about as accurate as the Washington Times, possibly less so. That said, there is a difference between "negligence" and "product liability". Product liability is "strict liability" - the product has a defect, the defect caused an injury & the product was defective at the time it left the defendant's possession. There is not an issue of 'standard of care' in strict liability. Don't know if you were aware of the difference. It is not possible in a negligence case, for damages (any kind of damages) to be awarded without a finding of negligence. End of story. Anything that tells you otherwise is simply untrue. And, a finding of negligence is anything but a 'technicality'. As to strict liability - there is no recovery unless all the elements of the claim are proven. It just drives me crazy when rags like "Overlawyered" butcher reality. And "Overlawyered" is pretty good at it.Jance 06:20, 26 December 2006 (UTC)[reply]

4. How about judges? That's how it is done here[9] for the most part (in civil proceedings) and I'm happy with that being so. Where I'm from we have a longer life expectancy and lower infant mortality than the US... and the health system costs less too.

I assume you are Canadian? What do you think is different about judges here? Jance 21:11, 26 December 2006 (UTC)[reply]

Cell phones do not rupture inside a person's body. The studies about the rate of rupture or effects are not 30 years. More like 3-4 years, and very scant at that. Most of the 'volumes' of research either excludes women who removed ruptured implants and does not study women who have had rupture over time. So the analogy is completely wrong.

As to health insurance - yes, the US is in a sorry mess. No argument from me.Jance 22:10, 28 December 2006 (UTC)[reply]

Nephron/Archive 2

---

Thanks for your support on my successful Request for Adminship (final result 78 Support /0 Oppose / 1 Neutral) I have now been entrusted with the mop, bucket and keys. I will be slowly acclimating myself to my new tools over the next months. I am humbled by your kind support and would certainly welcome any feedback on my actions. Please do not hesitate to contact me. Once again, many thanks and happy new year! All the best, Asterion^talk 16:12, 27 December 2006 (UTC)[reply]

---

I emailed you. Here is the concluding sentence in the medical journal article:

"High cohesive gel implants may not be as safe as is commonly believed and all implant ruptures, irrespective of the cohesiveness of the silicone gel, should be investigated thoroughly."

I am not speculating on what the long term effect of migration is, so please do not put words in my mouth. The fact is that doctors do not know, because it has not been studied over time. The local effects are obvious, and recent local findings (in studies) suggest that further research is needed to determine whether these can result in systemic problems over time. You know that this will not happen, with the current attitude of doctors regarding this issue.Jance 20:16, 29 December 2006 (UTC)[reply]

Hi Nephron, As you have much more knowledge of Wikipedia procedures than me you might be able to tidy-up a couple of my recent contributions; particularly Victor Parsonnett where the stub article headline does not spell the name correctly, and the article Cardiac resynchronization therapy where I suggest deletion because of duplication. Both are a long way from nephrology but it's more about Wikipedia procedure than clinical procedures.

Not happy to see the flack you got re breast implants which seems to be more about opinions/emotions/semantics than clinical reality. I could add a relevant comment but maybe best to let it cool. Geoffrey Wickham 03:39, 2 January 2007 (UTC)Geoffrey Wickham

Hello there. I'd like to bring to your attention that a merge between WikiProject Drugs and the newly-created WikiProject Pharmacology has been proposed on Wikipedia talk:WikiProject Drugs#WikiProject Pharmacology. As you are a participant, I would appreciate it if you could weigh in. Thanks, Fvasconcellos 02:00, 3 January 2007 (UTC)[reply]

Is it possible to upload SVG files, and have wiki automatically convert it on the fly to png? If so how do I do this, when I tried to upload an SVG it said it was not a recommended format, I did not see a way to force it to go. I noticed in the uploaded files area you have a couple that are .svg.png. Anyway, please resond on my user-talk page. Thanks. --Green-Dragon 06:40, 3 January 2007 (UTC)[reply]

Nice one! Enjoyed the read. Consider DYK? -- Samir धर्म 06:58, 19 January 2007 (UTC)[reply]

Oh, I didn't even see liver dialysis -- Samir धर्म 06:58, 19 January 2007 (UTC)[reply]

Off topic but I'm very proud of this one: referral as asthma -- x-ray. Even gastroenterologists can make medical diagnoses from time to time -- Samir धर्म 07:18, 19 January 2007 (UTC)[reply]

I've made an attempt to update and sort the listing of medicine navigation templates. Could you look over it? There are one or two duplicates in the mix.

I've seen other navigation templates that have links to related topics or back to a top level template in the title bar... for example, a small link at the top of "arteries of head and neck" that returns you to the template for "circulatory system". I think something along those lines to make moving around between templates easier would be really helpful... I'll try to find an existing example of what I mean. Robotsintrouble 13:56, 26 January 2007 (UTC)[reply]

Hi Nephron,
I am also a medical student (at UBC); I noticed that you did some work on Elizabeth McMaster's article. Are you a med student at Mac?

cheers —The preceding unsigned comment was added by 65.95.161.186 (talk) 02:10, 3 February 2007 (UTC).[reply]

You should sign-up. :) There are a whole bunch of med students around and projects devoted to preclinical (Wikipedia:WikiProject Preclinical Medicine aka WP:PCM) and clinical medicine (Wikipedia:WikiProject_Clinical_medicine aka WP:CLINMED). The doctor's mess is here... feel free to drop by there. Nephron  T|C 04:04, 3 February 2007 (UTC)[reply]

Hi, Nephron. It's about time someone awarded you another barnstar. (Looking through your archive, you have only received two.)

		The Barnstar of Diligence
		Nephron, for numerous contributions to medical articles. Axl 14:22, 20 February 2007 (UTC)[reply]

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Perhaps you'd be interested in this:Talk:Historical_Eastern_Germany#Requested_move. -- Hrödberäht (gespräch) 05:06, 6 March 2007 (UTC)[reply]

Hi Nephron, When you have a moment-would you like to check out renal tubular acidosis? I've been polishing the article for a while now, and would like an expert's outside eye to see what changes need to be made before I think about nominating it as a good article. Cheers, mate.FelixFelix ^talk 15:52, 6 March 2007 (UTC)[reply]

Saw your kidney tubule page. I agree with you, and not Stedman. Dan Levy 18:11, 8 March 2007 (UTC)[reply]

hi, just to let u know that i've copied Image:Wch c1219.jpg over to commons (as Image:Womens College Hospital Toronto.jpg in order to use in this Wikinews article. best,Doldrums 18:07, 10 March 2007 (UTC)[reply]

Your thoughts are much appreciated! Don't feel guilty, you said what you thought, that's exactly what everyone is supposed to do. Seraphimblade ^{Talk to me} 04:14, 3 April 2007 (UTC)[reply]

Hey, I noticed you were involved with Wikipedia:WikiProject Anatomy, and I need some feedback! I had asked a question about the Tooth article because I do not know what would be the best way to deal with information on human vs animal teeth. Most of the information is about human teeth. So, should there be a separate "animal teeth" article that the section should show as the main article or should the majority of the content in the tooth article be moved to a "human tooth" (or would this be an exception to have plural: "human teeth") article? What are your thoughts on the matter? My initial instinct was to keep the article as is and make a new article about animal teeth for the section to refer to, but I did not know if most anatomy articles try to keep a certain format when addressing that issue. I have had one suggestion to move most of the information to a "human tooth" or "human teeth" article. I would appreciate any ideas. Thanks! - Dozenist talk 01:24, 4 April 2007 (UTC)[reply]

Thankyou! - Dozenist talk 10:59, 4 April 2007 (UTC)[reply]

I agree SV x2 deletions against consensus, and has been applying other significant changes without discussion (eg promoting Attribution as if it is yet accepted as the umbrela policy for reliable sources,verify etc). I've reinserted the points and added a fresh discussion thread. David Ruben ^Talk 01:59, 4 April 2007 (UTC)[reply]

Deleting again seemed premature, especially when then (on 11th) seems understand reason for section. However then archiving the free sources discussion thread on 14th, unintentionally I'm sure (WP:AGF), leaving just the thread about deleting the free sources section active. I've restored the section, and restored teh talk page (yes it is getting too long and needs some form of archiving into Archive15, but not with active or very-recent threads, so that needs to be a fresh edit probably by someone else in order to not "muddy the waters")... oops immediately been reverted back - need extra opinions on this (I try to follow 1RR) David Ruben ^Talk 22:06, 15 April 2007 (UTC)[reply]

I think it's time for your RfA. I've drafted a nomination here: User:Samir/Nephron RFA. Please review and let me know your thoughts. We can wait until after the LMCC if that works better for you. Cheers -- Samir 19:43, 15 April 2007 (UTC)[reply]

May it is then! I'll need a bit of time to review FLOAS, as the concept is new to me. -- Samir 04:58, 16 April 2007 (UTC)[reply]

I'd have to say that I'm in agreement with you. Unless a non-free source is exceptional, the use of an acceptable free source should be preferred -- Samir 04:44, 18 April 2007 (UTC)[reply]

I read your edit on Pulsus paradoxus

The previous edition was correct. Increased heart rate is due to baroreflex to reduced blood pressure (i.e. cardiac output). On inspiration, the intrathoracic pressure is reduced and releases some of the pressure on the pulmonary veins. This causes the veins to dilate and retains more blood. This causes less venous return to the left atrium, in turn causes lower ventricular end diastolic volume and hence reduces cardiac output. This in turn causes a lowering of blood pressure and activation of baroreflex, causing vasoconstriction and increased heart rate. If you have any objection to this, please make an entry in my talk page. Please do not mislead people by reversing key words in the article. Ignatius Eric Hadinata 08:57, 25 April 2007 (UTC)[reply]

New: I read your reply and now I understand that the reason that my explanation and yours differ is because we talked about different things: what you are referring to is the pathological process by which Pulsus Paradoxus is caused. The whole section "causes of pulsus paradoxus" (which you have completely deleted) was wrongly subheaded when I made it. It was meant to be the normal mechanism by which the blood pressure is reduced during inspiration. I'm going to re-edit it in (it had the reference to "Talley J, O'connor S. Clinical Examination: A systemic guide to Physical Diagnosis. Elsevier Churchill Livingstone 2006" which is one of the reference books we use at Medical School in The University of Melbourne. Hence, that section's validity can be verified. Its just that I wrongly subheaded it and caused a lot of confusion. I apologise if I've created the confusion and I'm going to re-enter it with an edited subheading.

And last year, my interest was mainly the GIT, and now, it is the Cardio, Respiratory and Locomotor System (which is really my main interest and it matches what they are currently teaching at medical school). Thanks for your comment and hope to see more of your entries. Also, please see my entry (under yours) in the Pulsus Paradoxus talk page Ignatius Eric Hadinata 12:17, 3 May 2007 (UTC)[reply]

Are they the same thing? Yep, is the short answer. Of course, strictly speaking, any 'itis' is by definition an 'opathy' but MPGN is usually and correctly called glomerulonephritis. Membranous GN whilst often called a glomerulonephritis, is correctly a glomerulopathy, as there is no histological inflammation, but that of course, is a different condition, but I expect that's where the confusion arises from.FelixFelix ^talk 11:43, 6 May 2007 (UTC)[reply]

The Germany WikiProject Newsletter Issue I - May 2007
From the editor This is the first issue of WikiProject Germany's newsletter. The newsletter is intended to help all members of the project to keep up with new developments and coordinate new collaborative efforts.	Other areas where you can help Assessment requests: Some open Requests for assessment need to be answered. To see new assessment requests as they come in, you can watchlist the assessment page. More task forces and subprojects: As this WikiProject covers a very large topic area, it is helpful to add more task forces that focus on specific aspects of Germany. Currently, we have a Mainz task force, a Munich subproject and some joint task forces with other WikiProjects. Any project member is invited to start a new task force. Suggestions for possible topics: Transportation in Germany German politics (the political system of Germany and the biographies of its politicians) German Democratic Republic Be creative! If you have an idea, just suggest it on the project talk page (don't forget to watchlist it). Categorization: Uncategorized Germany stubs need to be categorized
Project news Criteria for B-Class status: The assessment criteria for B-Class have been changed. {{WikiProject Germany}} template now has 5 switches, B-Class-1 through B-Class-5 that correspond to 5 easily checked criteria that an article should meet to be assessed as B-Class. The advantage of this system is that now there is a clear boundary between Start-Class and B-Class articles. Authors of articles that were assessed as Start-Class now get more direct feedback what they should improve to attain a B-Class rating. All of our B-Class, Start-Class and Stub-Class articles now need to be checked whether they meet any of the B-Class criteria. This is a major effort, and we need your help! If you want to help, but don't know how, please post at the project talkpage. Cities and municipalities task force A task force dedicated to creating and improving articles on all German cities and municipalities has been started and is looking for help.

This newsletter was delivered by Kusma using AWB to all members of WikiProject Germany. If you do not want to receive this newsletter in the future, please leave a note at the talk page of the Outreach department so we can come up with a better spamlist solution. Thank you, Kusma 12:06, 6 May 2007 (UTC)[reply]

Hello: I created a Userbox for the nephrology project. If there is strong feeling about changing the appearance, we can discuss that on the project talk page. The template is at: Template:User WikiProject Nephrology. To post it on your user page, paste {{User WikiProject Nephrology}} . —Gaff ^ταλκ 20:27, 22 May 2007 (UTC)[reply]

This user is a participant in the Nephrology task force

Nephron, Thanks for your comments, I think that some confusion has arisen, but I haven't changed my mind about anything, as far as I'm aware. The acidosis in RTA refers to a systemic acidosis resulting from a failure of the distal tubule to secrete (ie dispose) of acid into the urine. Thus the urine is never acid, it's always alkaline, so the acidosis doesn't refer to the urine. Systemic acidosis (or acidaemia) doesn't have to be present, but if it is not, then it is refered to as incomplete dRTA. This is indicated in the text. Thus my revision of your last edit was because it was factually wrong (there is no acidosis of the renal tubules). I think that keeping the introductory section simple is best, because the different types are quite different, and the relevant explanations are in the respective sections. I'm also unsure that agonizing over possible misnomers will make this traditionally confusing subject any clearer to the interested reader, although I am accumulating material for a section on the history of the nomenclature.

So in answer to your final questions; 1. What does the acidosis refer to? It refers to the systemic acidosis.

2. Why not describe the meaning of the words (like I did in an earlier revision)? (I don't think most lay people know what renal tubules are). Because I thought that it was too clunky, and the intro had all those terms helpfully wikilinked, which I reckon anyone can manage.

All the best, FelixFelix ^talk 17:59, 27 May 2007 (UTC)[reply]

Still debating? -- Samir 02:45, 28 May 2007 (UTC)[reply]

Not debating. I wrote-up the answers... will post later this week. I'm currently in the middle of a move. Nephron  T|C 06:06, 28 May 2007 (UTC)[reply]

No probs. Take your time. -- Samir 07:15, 28 May 2007 (UTC)[reply]

What medical school do you go to? MCG? Kitra101 05:16, 28 May 2007 (UTC)[reply]

It appears you are from Germany based on glancing over your edits. Are you a German med student? Kitra101 01:32, 29 May 2007 (UTC)[reply]

Great pic. --GreenJoe 05:23, 30 May 2007 (UTC)[reply]

Welcome to Wikipedia and thank you for your contributions. An article you recently created, ANCA (company), may not conform to some of Wikipedia's guidelines for new articles, so it will shortly be removed (if it hasn't been already). Please use the sandbox for any tests you may want to do and please read our introduction page to learn more about contributing. Thank you. Thewinchester ^(talk) 16:58, 3 June 2007 (UTC)[reply]

I saw the discussion at Talk:Uremia and offered my thoughts. Granted, uremia is a more broad, clinical phenomenen, whereas azotemia is basically elevated BUN. I agree with you that we should merge them, as having the articles separate seems fragmented. I may make the merge if nobody else comments, just to see...—Gaff ^ταλκ 05:42, 4 June 2007 (UTC)[reply]

Thanks for uploading Image:Guy_getting_hemo.gif. You provided a source, but it is difficult for other users to examine the copyright status of the image because the source is incomplete. Please consider clarifying the exact source so that the copyright status may be checked more easily. It is best to specify the exact web page where you found the image, rather than only giving the source domain or the URL of the image file itself. Please update the image description with a URL that will be more helpful to other users in determining the copyright status.

If you have uploaded other files, consider checking that you have specified their source in a complete manner. You can find a list of files you have uploaded by following this link. If you have any questions please ask them at the Media copyright questions page or me at my talkpage. Thank you. MECU≈talk 16:23, 5 June 2007 (UTC)[reply]

I agree with merging. As it is, we have closely related stubs that will go nowhere in terms of becoming good articles. It seems fragmented and confusing...—Gaff ^ταλκ 22:44, 5 June 2007 (UTC)[reply]

Dear Nephron,

Thanks for the welcome! My edits relating to pathology were largely to correct pre-existing links to my website that have recently moved when I overhauled things, so I hope that doesn't count as a conflict of interest! Actually, I was quite amazed to find them there in the first place. Nice, though!

Best wishes,

Fraser Charlton

— Preceding unsigned comment added by Frasercharlton (talk • contribs) 11:06, 8 June 2007

Thank you for commenting on my RfA, which closed successfully with a tally of 76/0/1! I hope I will meet your expectations, and be sure I will continue trying to be a good editor as well as a good administrator :) If I may be of any assistance to you in the future (or if you see me commit some grievous error :), please drop me a line on my Talk page. Again, thank you, and happy editing! Fvasconcellos (t·c) 18:20, 10 June 2007 (UTC)[reply]

Thank you, Nephron. I hope you're enjoying your studies (graduated yet?) and I seem to remember something about an RfA of your own? Fvasconcellos (t·c) 18:20, 10 June 2007 (UTC)[reply]

When adding to articles, I will sometimes paste text from one or more sources into the edit window and then rearrange and paraphrase before saving. I apologize for missing those two sentences that you expressed concern over. Thank you for catching them. I also really liked your copyedits to the intro.

My reason for relying on the Straight Dope article rather than the primary sources he cites is well explained at WP:MEDRS: In general, Wikipedia's medical articles should use published reliable secondary sources whenever possible. Reliable primary sources may be used only with great care, because it's easy to misuse them. For that reason, edits that rely on primary sources should only make descriptive claims that can be checked by anyone without specialist knowledge. Any interpretation of primary source material requires a secondary source.

I am well acquainted with searching PubMed - see for example the article I wrote early pregnancy factor. Also notice I added the citation for PMID 1287678 to the McClintock effect article. It's not unfamiliarity with these tools that guided my addition to the article, it's a high regard for the knowledge and research done by the Straight Dope staff and a desire to use reliable secondary sources whenever they are available. Lyrl^Talk _C 01:02, 24 June 2007 (UTC)[reply]

I think the article certainly has room for expansion, and primary sources are perfectly acceptable references for aspects of the topic not covered by any secondary source. For example, in the article diaphragm (contraceptive) I relied as much as I could on an American Family Physician article (which is indexed by PubMed) because it is a secondary source. But for items not covered by the Am Fam article, I used quite a few primary sources. I don't think this is a case of any secondary source or sources vs. primary sources - the article should probably have both.

If you disagree with the parts of the article that are sourced from the Straight Dope article, please bring it up on at Talk:McClintock effect. Or just edit the article - what I've seen of your writing style I like and don't think we'd have any problems agreeing on content if we were actually working on the article rather than discussing these abstract concepts. Lyrl^Talk _C 21:45, 24 June 2007 (UTC)[reply]

I would like to include a bit on a slow continuous ultrafiltration (SCUF). However, I'm unsure of where it should go. Any thoughts? --Jacobkearns 04:25, 10 July 2007 (UTC)[reply]

Thanks for your note! --Jacobkearns 03:58, 16 July 2007 (UTC)[reply]

Just to let you know, I've posted those changes to the MaRS article. Please let me know if you consider any material to be still inconsistent with Wikipedia guidelines.

Chjovans 19:13, 13 July 2007 (UTC)[reply]

Hey there, haven't seen you in a while. I'd definitely merge into doxylamine—vitamin B6 is AFAIK added to many antiemetics (at least here in Brazil it's available in association with dimenhydrinate and others). We don't generally have articles on proprietary preparations unless they are somehow exceptionally notable. Fvasconcellos (t·c) 03:08, 20 July 2007 (UTC)[reply]

WikiProject Pharmacology is currently organizing a new Collaboration of the Week program, designed to bring drug and medication related articles up to featured status. We're currently soliciting nominations and/or voting on nominations for the first WP:RxCOTW, to begin on September 5, 2007. Please stop by the Pharmacology Collaboration of the Week page to participate! Thanks! Dr. Cash 17:52, 1 September 2007 (UTC)[reply]

Aspirin has been selected as this week's Pharmacology Collaboration of the Week! Please help us bring this article up to featured standards during the week. The goal is to nominate this at WP:FAC on September 10, 2007.

Also, please visitWP:RxCOTW to support other articles for the next COTW. Articles that have been nominated thus far include Doxorubicin, Paracetamol (in the lead with 4 support votes so far), Muscle relaxant, Ethanol, and Bufotenin.

In other news:

• Bupropion has been promoted to featured status on August 31, 2007.

• The Wikipedia:WikiProject Pharmacology main page has been updated and overhauled, to make it easier to find things, as well as to highlight other goals and announcements for the project.

• Garrondo is asking for individuals to help review Therapies for multiple sclerosis, as he is considering nominating this article for GA status.

• Fvasconcellos notes that discussion is ongoing regarding the current wording of MEDMOS on including dosage information in drug articles. All input is welcome.

Dr. Cash 00:50, 5 September 2007 (UTC)[reply]

Here's a brief update in some of the recent developments of WikiProject Pharmacology!

• Aspirin has just completed its two week run as the first Collaboration of the Week! Many thanks to those editors that contributed; the article got a lot of good work accomplished, and in particular, much work was done in fixing up the history section. It's still not quite "done" yet (is a wikipedia article really ever done?), but after two weeks I think it's more important to push onwards with the development of the new collaboration of the week program. I will be fixing up Aspirin in the next few days and possibly nominating it for either GA or FA status.

• Muscle relaxant has been selected as the new Collaboration of the week until October 2, 2007! This article is currently rated as a "stub", so it's got quite a bit of work cut out for collaborators! Admittedly, featured status could be a long way off,... but still attainable! At the least, maybe we could at least get it up to meeting the Good article criteria? Please stop by the article and help improve it.

• Resveratrol, having recently achieved GA status on August 16, 2007, is now making a run for featured status. This is quite a fascinating compound. If you can, please stop by its discussion page and leave comments in support of it.

• Please remember that Wikipedia is not a forum for discussing or dispensing medical advice amongst users. Specifically, talk pages of articles should only be used to discuss improving the actual article in question. To help alleviate this situation, the template {{talkheader}} may be added to the top of talk pages, reminding users of the purpose of such pages. Additionally, unsigned comments and comments by anonymous users that are inappropriate may be removed from talk pages without being considered vandalism.

• There was an interesting article on ZDNet last week about Hewlett Packard licensing its patented microneedle technology used in common inkjet printers to be used in transdermal patches to deliver a time-controlled release of drugs to patients. This information could be added to articles such as route of administration or drug delivery.

You are receiving this message because you are listed as one of the participants of WikiProject Pharmacology.

Dr. Cash 04:57, 19 September 2007 (UTC)[reply]

I've tagged Apudoma with 'prod'. It's a term that's outdated and has become an historical oddity in pathology. You do some great work on Wikipedia; please don't take offence at my suggestion. Let's see what people think about this? Hovea 13:28, 22 September 2007 (UTC)[reply]

I've just joined in the discussion - I'm very interested in dialysis issues. I've been on dialysis since 1990; I've self-dialyzed at home since 2001 (using three different machines). I am trying to get up to speed. The thing the pushed me to join was my desire to post an entry for Dr. Joseph W. Eschbach whose memorial service I will be attending on Sunday. His work with sheep urine lead to treatments for anemia that are in use today, I think he is well within wikipedia's guideline.

I'm not so sure about my post regarding the Northwest Kidney Centers not because they lack historical importance but because I serve as their volunteer trustee board chair. I am, as you'd expect, a big fan of NKC but I tried to respect the guidelines and post a neutral factual entry. Have I crossed a line? Is this the wrong place to ask (sorry if it is)? thank you for any guidance you can provide.BillpSea 21:40, 26 September 2007 (UTC)[reply]

I see that you were a major contributor to the relative risk page. Could you possibly give me any information on this statement: "The log of relative risk is usually taken to have a sampling distribution that has an approximately normal distribution?" I am writing my senior thesis and am at a stand still until I can find proof of this statement. I need the "math" behind it. I also need to know what is the distribution of the random variable relative risk. Thank you. --Joyo711 16:59, 4 October 2007 (UTC)[reply]

Someone recently pointed out to me that chronic renal failure doesn't actually list the 5 stages of CKD we now employ routinely in clinical practice. Do you have the NKDOQI reference and would you be able to add that information? I'd be utterly grateful - I still don't translate my patients' creatinines into eGFR and CKD stages often enough. JFW | T@lk 21:24, 6 October 2007 (UTC)[reply]

Renal function would be a good spot for the stages of CKD. There is some ambiguity on how the term CRF is used - it is sometimes used to mean earlier stages of CKD other times specifically for ESRD. For instance the FDA document Information for Healthcare Professionals: Erythropoiesis Stimulating Agents (ESA) uses the terms: Chronic Kidney/Renal Failure and Chronic Kidney/Renal Disease interchangeably. In my view they are not the same thing. It would be good to develop a constant lexicon, chronic renal failure is really just one stage of chronic kidney disease. I'd prefer removing failure form the labels and use CKD5 for CRF. Here is the NKDOQI jump page

BillpSea 22:24, 6 October 2007 (UTC)[reply]

Interesting Chronic kidney disease redirects to Chronic Renal Failure. I think this reflects common usage but it's doesn't reflect the standard proposed under NKDOQI. refChronic renal failure should be identified as CKD5. NKDOQI defines chronic kidney disease (CKD) as either kidney damage or a decreased kidney glomerular filtration rate (GFR) of <60 mL/min/1.73 m2 for 3 or more months. On February 2002 K/DOQI published a classification of the stages of CKD, as follows:

• Stage 1: Slightly diminished function; Kidney damage with normal or increased GFR (>90 mL/min/1.73 m2)
• Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m2)
• Stage 3: Moderate reduction in GFR (30-59 mL/min/1.73 m2)
• Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m2)
• Stage 5: Kidney failure (GFR <15 mL/min/1.73 m2)

BillpSea 03:38, 7 October 2007 (UTC)[reply]

I think this discussion ought to be in the nephrology project (WP:RENAL). So, I moved the discussion HERE (Wikipedia_talk:WikiProject_Nephrology#CKD_stages). Nephron  T|C 18:13, 7 October 2007 (UTC)[reply]

Hello again Nephron. Back on 21 Dec 2006 you kindly invited me to be a member of CLINEMED, which I didn't follow-up, but have been contributing to various med or med related articles, particularly Artificial pacemaker in which I think we now have a very good article, so maybe you and your medical Wiki colleagues might like to have a look at it and give it a rating. All the best Geoffrey Wickham 05:31, 13 October 2007 (UTC)[reply]

Here are a few updates in the realm of WikiProject Pharmacology:

• The Pharmacology Collaboration of the Week has been changed to Collaboration of the Month, based on current participation levels. It is also more likely that articles collaborated on for one month are more likely to achieve featured quality than articles worked on for only a week or two.

• The current Collaboration of the Month for November is Receptor antagonist. Please take a look at that article and contribute to it if you get a chance. Ideally, the article should adhere to the featured article criteria.

• Therapies for multiple sclerosis is currently a featured article candidate. If you are familiar with the featured article criteria, please visit WP:FAC and review the article.

• Anabolic steroid is the wikiproject's newest Featured Article, having been promoted on October 8, 2007.

• Theobromine was delisted as a Good Article. The Peer review and GA reassessment discussions provide suggestions on improvement. Muscle relaxant was recently reviewed for Good Article status, but not promoted. Please see the full review full review here for details.

Dr. Cash 22:14, 31 October 2007 (UTC)[reply]

Are you sure? --BozMo talk 10:56, 22 November 2007 (UTC)[reply]

Okay, just asking. All these have lots of versions and that one (which was in my IVC for 5 weeks) seems to have a different number of legs to your reference image. However I agree it looks pretty similar. --BozMo talk 21:51, 24 November 2007 (UTC)[reply]

Hi Nephron. Given your previous hard word on pulmonary embolism, could you review CT pulmonary angiogram for me and add any sources you might be aware of? I borrowed most of the technical data from the Anderson article in this week's JAMA, although I appreciate that there must be better technical sources out there. JFW | T@lk 16:26, 20 December 2007 (UTC)[reply]

Nephron, can you tell me the difference between dehydration and hydropenia? Is there a difference? WhatamIdoing (talk) 07:03, 31 December 2007 (UTC)[reply]

Here's hoping the new year brings you nothing but the best ;) Fvasconcellos* (t·c) 15:20, 6 January 2008 (UTC)[reply]

Hi Nephron, erstmal danke für deine Hinweise zum Artikel. Ich wollte mal fragen ob du eine direkte Vorlage für die Abbildung im Artikel genutzt hast, oder ob du sie dir aus den mehreren Quellen hergeleitet hast? Ich bin natürlich sehr interessiert an einer korrekten Darstellung. Ich hoffe es ist in Ordnung, dass ich dir auf deutsch geschrieben habe, können das aber natürlich auch auf Englisch fortsetzen. Viele Grüße, --77.185.185.104 (talk) 20:44, 12 March 2008 (UTC) (Christian2003)[reply]

Hi at 23:14, 17 June 2006 you added a section to Pain and nociception headed "Selected common and serious causes of pain by region". At present I and another editor would appreciate your input in a discussion on the value of this section to the article. [Discussion here]. Thanks. SmithBlue (talk) 04:21, 21 March 2008 (UTC)[reply]

The Germany WikiProject Newsletter Issue II - March 2008
From the editor This is the second issue of WikiProject Germany's newsletter. The newsletter is intended to help all members of the project to keep up with new developments and coordinate new collaborative efforts. If you think anything should be featured in the next issue, please leave a note at the Newsdesk	Other areas where you can help Assessment requests: Some open Requests for assessment need to be answered. To see new assessment requests as they come in, you can watchlist the assessment page. More task forces and subprojects: As this WikiProject covers a very large topic area, it is helpful to add more task forces that focus on specific aspects of Germany. Currently, we have a Mainz task force, a Munich subproject and some joint task forces with other WikiProjects. Any project member is invited to start a new task force. Suggestions for possible topics: Transportation in Germany German politics (the political system of Germany and the biographies of its politicians) German Democratic Republic Be creative! If you have an idea, just suggest it on the project talk page (don't forget to watchlist it). Categorization: Uncategorized Germany stubs need to be categorized
Project news Cities and municipalities task force The task force dedicated to creating and improving articles on all German cities and municipalities is happy to announce that there are now (at least) stub articles for all municipalities of Germany. Now the task force is looking for help in fleshing these out a little bit. The current phase of activity for the task force is to copy in infoboxes from the articles in German Wikipedia. If you want to help, even just for a few articles, look at the instructions and links here Article Assessment: There are now way over 26.000 articles tagged as part of our Wikiproject and many still need either an importance or a quality assessment. Also there are many more out there that do need to be tagged like approx 8000 municipalities. If you would like to help take a browse through Articles needing Importance assessment or Articles needing a basic quality assessment.

- Newsletter Bot Talk 15:32, 23 March 2008 (UTC)[reply]

This newsletter is delivered by a bot to all members of WikiProject Germany. If you do not want to receive this newsletter in the future, please leave a note at the talk page of the Outreach department so we can come up with a better spamlist solution. Thank you, - Newsletter Bot Talk 15:32, 23 March 2008 (UTC)[reply]

Hi, Nephron. Your expertise is required here. Thanks. Axl (talk) 09:47, 5 April 2008 (UTC)[reply]

I have placed a "prod" tag on the article that you created at substitution principle (mathematics). I can find no evidence that this operation in elementary algebra is generally known as the "substitution principle", so I believe you may be (inadvertently) introducing a neologism. If you have references that show that this term is used in the sense of the article, please add them to the article. Note that the term "substitution rule" refers to integration by substitution, which is entirely different - so I also reverted your change to the "substitution rule" redirect. Gandalf61 (talk) 10:42, 21 April 2008 (UTC)[reply]

Thanks for uploading Image:Oskar_Lafontaine.jpg. I noticed the description page specifies that the media is being used under a claim of fair use, but its use in Wikipedia articles fails our first non-free content criterion in that it illustrates a subject for which a freely licensed media could reasonably be found or created that provides substantially the same information. If you believe this media is not replaceable, please:

1. Go to the media description page and edit it to add {{di-replaceable fair use disputed}}, without deleting the original replaceable fair use template.
2. On the image discussion page, write the reason why this image is not replaceable at all.

Alternatively, you can also choose to replace this non-free media by finding freely licensed media of the same subject, requesting that the copyright holder release this (or similar) media under a free license, or by taking a picture of it yourself.

If you have uploaded other non-free media, consider checking that you have specified how these images fully satisfy our non-free content criteria. You can find a list of description pages you have edited by clicking on this link. Note that even if you follow steps 1 and 2 above, non-free media which could be replaced by freely licensed alternatives will be deleted 2 days after this notification (7 days if uploaded before 13 July 2006), per our non-free content policy. If you have any questions please ask them at the Media copyright questions page. Thank you. Do you want to opt out of receiving this notice? Rettetast (talk) 14:51, 1 May 2008 (UTC)[reply]

Your contributions history shows that you have been aggressively cross-posting, in order to influence Template talk:Ont post-secondary. Although the Arbitration Committee has ruled that "The occasional light use of cross-posting to talk pages is part of Wikipedia's common practice."¹, such cross-posting should adhere to specific guidelines. In the past, aggressively worded cross-posting has contributed towards an Arbitration Committee ruling of disruptive behavior that has resulted in blocks being issued. It is best not to game the system, and instead respect Wikipedia's principle of consensus-building, by ceasing to further crosspost, and instead allowing the process to reflect the opinions of editors that were already actively involved in the matter at hand. GreenJoe 03:45, 4 May 2008 (UTC)[reply]

After I had already created cholesterol embolism I noticed that you had already been writing atheroembolic disease. I think both terms are quite prevalent, but I was hoping to expand the scope of my new page to include cholesterol embolism of all organ systems. I have therefore taken the liberty of redirecting the AERD page to my new creation. Let me know if you are at all disturbed by this :-). JFW | T@lk 16:04, 26 May 2008 (UTC)[reply]

Replied on my talkpage. JFW | T@lk 21:10, 28 May 2008 (UTC)[reply]

The image shown is my particular version of the Roux en-Y gastroenterostomy (drawn by a medical artist from Ethicon Endosurgery, to my specs). It can be connected end-on, or side-to-side. My specific technique involves use of a circular stapler, inserted through the upper end of the Roux limb, and connected to the posterior wall of the gastric pouch (the anvil is actually passed through the oropharynx using a pull-wire inserted with the PEG technique). After the circular gastroenterostomy is constructed between the stomach and the side of the bowel, the end of the bowel is closed transversely with a linear stapler.

Most laparoscopic surgeons use a side-to-side type of connection for the gastroenterostomy. Some use a linear stapler, others create a completely hand-sewn anastomosis. Topnife (talk) 08:33, 28 June 2008 (UTC)[reply]

Re the Distal Anastomosis:

There is probably no consequence of the orientation of the two limbs of bowel at the distal Y. The drawings are relatively schematic, but the orientation shown in my drawing is the way I lined it up before making the connection, for technical reasons related to the insertion of the linear stapler into the bowel laparoscopically. However, the insertion of the pancreato-duodenal limb, while anatomically side-to-side, is functionally end-to-side, and is isoperistaltic.

Topnife (talk) 07:27, 3 July 2008 (UTC)[reply]

There's a dispute brought on by changes in titles, already done or planned, by a user who I suspect does not have a close command of the language. Most urgently, I wonder whether you agree with the change from "Eye movement" to "Eye movement (sensory)"?

Talk:Eye_movement_(sensory)#Third_opinion TONY (talk) 02:44, 30 June 2008 (UTC)[reply]

Hi Nephron. Nice work on all of your contributions to nephrology. I was looking at the standardized Kt/V page, and I thought that the differential equations in this case were a bit out of place and missed the essence of the concept. In fact, there are 2 concepts here. The first is to develop a measure of clearance that is independent of the frequency of treatments, which is similar to creatinine clearance and UV/P, which translatest to g/time-averaged concentration, or Ctac (is this C-infinity?). This was developed by Casino and Lopez. The other concept is why this was modified by Gotch to use the C(mean predialysis) and not Ctac. It is not C0, but the average of the C0 values for each dialysis treatment. I think I could try to explain this without a lot of the math, which I think just confuses people, but I suspect that you put this up and didn't want to "erase" your work. Thanks for considering it. JT. —Preceding unsigned comment added by Jtdaugir (talk • contribs) 02:39, 24 July 2008 (UTC)[reply]

Dear Nephron,

The following addition is being discussed at WP:MEDMOS: "Where possible, it is preferable to reference review articles or other secondary or tertiary sources instead of primary sources (see Wikipedia:WikiProject Medicine/Reliable sources)." I would appreciate if you could comment on both appropriateness and the content of the addition. Thank you Paul Gene (talk) 12:00, 10 August 2008 (UTC)[reply]

A tag has been placed on Wikipedia defense, requesting that it be speedily deleted from Wikipedia. This has been done under section G1 of the criteria for speedy deletion, because the page appears to have no meaningful content or history, and the text is unsalvageably incoherent. If the page you created was a test, please use the sandbox for any other experiments you would like to do. Feel free to leave a message on my talk page if you have any questions about this.

If you think that this notice was placed here in error, you may contest the deletion by adding {{hangon}} to the top of the page that has been nominated for deletion (just below the existing speedy deletion or "db" tag), coupled with adding a note on the talk page explaining your position, but be aware that once tagged for speedy deletion, if the article meets the criterion it may be deleted without delay. Please do not remove the speedy deletion tag yourself, but don't hesitate to add information to the article that would would render it more in conformance with Wikipedia's policies and guidelines. Lastly, please note that if the article does get deleted, you can contact one of these admins to request that a copy be emailed to you. Minkythecat (talk) 09:00, 14 August 2008 (UTC)[reply]

Hi Nephron, I've recently rewrote the entire wiki page on MCC and I am thinking of merging MCCQE and LMCC into that one article to expand the volume instead of having 3 stubs on related issues. Given that you are the original author of the 2 articles, please let me know what you think.--Cahk (talk) 02:04, 20 August 2008 (UTC)[reply]

10-4 your message. I guess MCC can be used as a starting page and then add the main tag to the specific articles (once it has expanded enough...). I haven't been able to find much sources on LMCC/MCCQE/MCCEE (per Wiki verifiability policy) so if you got good sites, let me know. --Cahk (talk) 07:59, 23 August 2008 (UTC)[reply]

Thank you for your mail. I will try to contribute. Best regards patho (talk) 17:17, 27 August 2008 (UTC)[reply]

Thanks for asking me to look at trachelectomy: It is a nice and useful article and I made a few changes. Ekem (talk) 02:22, 8 September 2008 (UTC)[reply]

I notice that our little WikiProject is not terribly active. Would you support a move to a "task force" under the WPMED banner, much like some other small WikiProjects have done in the recent past? Let me know. JFW | T@lk 22:45, 11 November 2008 (UTC)[reply]

Please see:Wikipedia:Articles for deletion/Klaus Emmerich. Steve Dufour (talk) 15:49, 21 November 2008 (UTC)[reply]

Hi Nephron,

You may be aware that moves are afoot to subsume the pathology project under WPMED as a taskforce. Please see the message at the discussion page, and at Wikipedia talk:WikiProject Medicine/Task forces#Conversion of medicine-related projects. I support the idea, and as yet I'm the only participant who's voiced any opinion. Would you please add yours?

Cheers, Mattopaedia (talk) 23:16, 19 December 2008 (UTC)[reply]

Wherever you are, and whether you're celebrating something or not, there is always a reason to spread the holiday spirit! So, may you have a great day, and may all your wishes be fulfilled in 2009! Fvasconcellos (t·c) 14:39, 24 December 2008 (UTC)[reply]

Looks great. Thanks for working on the article! - Dozenist talk 01:31, 5 January 2009 (UTC)[reply]

Hi Nephron,

perhaps the general reader (or those of us who have already forgotten their histopathology courses) would appreciate a little arrow explaining the histology...

--Steven Fruitsmaak (Reply) 12:47, 6 February 2009 (UTC)[reply]

Thanks for the compliment and the copy-edit! --Steven Fruitsmaak (Reply) 07:42, 17 February 2009 (UTC)[reply]

Cardiology task force is looking for editors to help build and maintain comprehensive, informative, balanced articles related to Cardiology on Wikipedia. Start by adding your name to the list of participants at Cardiology task force Participants. ECG Unit (Welcome!)

-- MifterBot I ^{(Talk • Contribs • Owner)} 20:59, 27 May 2013 (UTC)[reply]

T.F.AlHammouri (talk) 22:20, 28 February 2009 (UTC)[reply]

Hi. I saw the expert needed tag you added to Pancreatic cancer. Is there any particular topic or part of the article that you think needs to be addressed? Thanks! Dgf32 (talk) 02:14, 6 April 2009 (UTC)[reply]

Some of your images or media files have been listed for deletion. Please see Wikipedia:Files for deletion/2009 April 29 if you are interested in preserving them. Thank you.

• File:Anterior tibial a.gif
• File:Celiac a branches.gif
• File:Internal thoracic a.gif
• File:Small saphenous vein.gif
• File:Superf veins of arm.gif
• File:Svc ivc and azygos vs.gif
• File:Vena saphena magna.gif

-- Common Good (talk) 19:47, 29 April 2009 (UTC)[reply]

Hi Nephron. As requested. Path = sessile serrated adenoma. Sorry took this long. Best regards -- Samir 10:16, 20 May 2009 (UTC)[reply]

In retrospect it is not a classic picture. It's not flat and bile-stained. The pits are Kudo II which correspond to SSA. Let me find a better one. -- Samir 10:25, 20 May 2009 (UTC)[reply]

Also if you had a chance to swing by Hepatorenal syndrome, would appreciate your medicalese-ectomy skills. (still looking for a better SSA pic). Take care dude -- Samir 15:44, 12 June 2009 (UTC)[reply]

A tag has been placed on Becky Middleton requesting that it be speedily deleted from Wikipedia. This has been done under section G12 of the criteria for speedy deletion, because the article appears to be a blatant copyright infringement. For legal reasons, we cannot accept copyrighted text or images borrowed from other web sites or printed material, and as a consequence, your addition will most likely be deleted. You may use external websites as a source of information, but not as a source of sentences. This part is crucial: say it in your own words.

If the external website belongs to you, and you want to allow Wikipedia to use the text — which means allowing other people to modify it — then you must verify that externally by one of the processes explained at Wikipedia:Donating copyrighted materials. If you are not the owner of the external website but have permission from that owner, see Wikipedia:Requesting copyright permission. You might want to look at Wikipedia's policies and guidelines for more details, or ask a question here.

If you think that this notice was placed here in error, you may contest the deletion by adding {{hangon}} to the top of the page that has been nominated for deletion (just below the existing speedy deletion or "db" tag), coupled with adding a note on the talk page explaining your position, but be aware that once tagged for speedy deletion, if the page meets the criterion it may be deleted without delay. Please do not remove the speedy deletion tag yourself, but don't hesitate to add information to the page that would render it more in conformance with Wikipedia's policies and guidelines. ttonyb1 (talk) 19:58, 22 July 2009 (UTC)[reply]