User talk:Axl/archive 1

Archive 1

HMG-CoA reductase

Hi Axl, I'm not sure what you're getting at for the HMG-CoA reductase pathway diagram. Someone (was it you?) changed the names of some of the enzymes. I'll gradly modify the diagram, but please tell me in what way... JFW | T@lk 13:59, 4 Nov 2004 (UTC)

PS Talk page messages are generally appended at the bottom of the page. This makes them easier to spot.

Thanks, JFW. Yes, I did change the enzymes. Your list was somewhat simplified, so I expanded it to include the full steps. [E.g. you had mevalonate going to isopentenyl pyrophosphate as a single step catalyzed by mevalonate kinase. This should actually be a two step procedure, catalyzed by two enzymes: mevalonate kinase and phosphomevalonate kinase.] Can you change the diagram to fit the new text please? Axl 14:05, 4 Nov 2004 (UTC)

I'll see when I've got time. I can also email you the .sxd file (if you have OpenOffice.org, that is). JFW | T@lk 14:54, 7 Nov 2004 (UTC)

Hey, you didn't give an email address! I was going to send you an email to review the changed version.

Please have a look at the diagram now (Image:HMG-CoA_reductase_pathway.png) and send me any further corrections. JFW | T@lk 15:35, 7 Nov 2004 (UTC)

JFW, that's a really good diagram! It fits with the text and is much easier to understand.

Regarding the e-mail address, I am concerned about privacy so I didn't want to include it. [To be honest, I didn't even want to register.] Axl 10:46, 8 Nov 2004 (UTC)

I'm glad this is okay now. As for the email address: it does not display anywhere. Actually, Wikipedia e-mail does not reveal your address until you decide to respond! I would certainly suggest supplying an email.

As for usernames: this is actually more secure than editing under your IP. If you use a pseudonym, nobody will be able to trace your identity. JFW | T@lk 12:40, 8 Nov 2004 (UTC)

Hey Axl, are you a respiratory physician by any chance?? JFW | T@lk 14:39, 8 Nov 2004 (UTC)

Yes. I'm currently doing research in Portsmouth. I'll be joining the SpR training programme in February. Axl 16:40, 8 Nov 2004 (UTC)

Splendid. I hope you'll hang around - Wikipedia has many docs but few edit on a regular basis. PS I'm an SHO in London. JFW | T@lk 18:43, 8 Nov 2004 (UTC)

---

Wikiproject

Ho, I even forgot to invite you to the WikiProject "Clinical medicine", an attempt to bring all our Wikidocs under one banner. It's been a bit quiet lately since we lost our Australian anaesthetist and our gastroenterologist from Chicago :-(. JFW | T@lk 21:34, 8 Nov 2004 (UTC)

Lesch-Nyhan syndrome

Why should it matter if LNS does not affect a large part of the populus? one would think that it affects more lives in this world than an exploding whale, don't you think? come on now. --Larsie 17:14, 10 Nov 2004 (UTC)

Well, I suppose that it depends on what 'Featured article' means. In my opinion, the topic should be something that many general readers would find interesting if they happened to come across it. I would prefer to see more common (and, in my opinion, more important) diseases, such as ischaemic heart disease, diabetes mellitus or lung cancer, gaining 'Featured article' status. My point of view is not actually stated in the description of 'Featured articles', so you will probably still gain support from the community.

I suspect that 'Exploding whale' got through on its comedy value. Axl 20:37, 10 Nov 2004 (UTC)

Since my complaint is not actionable, it looks like your request will (eventually) be passed. Axl 13:30, 11 Nov 2004 (UTC)

Axl, could you have a look if my pathophysiology edits are correct? JFW | T@lk 20:22, 14 Nov 2004 (UTC)

All accurate, JFW. Axl 09:25, 15 Nov 2004 (UTC)

Wow, first time lucky! The 1997 article by Nyhan was nice but he digressed into rare variants. JFW | T@lk 12:55, 15 Nov 2004 (UTC)

Trimethoprim

Hi Axl, I uploaded an uploaded version of the diagram but this wasn't reflected in the trimethoprim article. I've tried to fix that up by editing the article subtly (must be a bug in the system), so hopefully it should show correctly now. Also, I had a look at Wikipedia:WikiProject_Clinical_medicine... I'm currently a (soon to be) 4th year BPharm (Hons) student so I might be able to contribute to the pharmacological/pharmacotherapeutic side of things. Thanks for the invite. =) Techelf 09:36, 18 Nov 2004 (UTC)

Eicosanoid

I've modified Image:Eicosanoid_synthesis.png to reflect your changes :-) JFW | T@lk 22:33, 27 Nov 2004 (UTC)

Thanks, JFW. Axl 10:05, 28 Nov 2004 (UTC)

Often, you have to press "reload" for new versions of the image to replace the ones in the cache. I hadn't noticed the absence of LTC4. JFW | T@lk 10:15, 28 Nov 2004 (UTC)

PS Are you going to put something on your userpage? Even a whacky aphorism or a sour note about people's spelling should do :-)

DCT

Thanks for your recent dabs at distal convoluted tubule. I'm embarrassed to say those were mostly my errors you corrected (from my early wiki, pre-compulsive proofreading days). And it's a good thing you did -- a quick Google for "distal convoluted tubule eosinophil" brings up tons of Wikipedia-mirrored articles that are bound to cause some confusion. Thanks for setting things straight. --David Iberri | Talk 19:19, Dec 1, 2004 (UTC)

• You're welcome. :-) Axl 11:10, 2 Dec 2004 (UTC)

Pneumocystis carinii

I think the page can be safely moved, although many physicians will still refer to pneumonia caused by P. jiroveci as "PCP" (and not PJP). Time will tell. For the moment I would recommend against moving pneumocystis carinii pneumonia for reasons given. JFW | T@lk 22:51, 8 Dec 2004 (UTC)

Thanks. Indeed, we still do call it "PCP". :-) Axl 17:02, 9 Dec 2004 (UTC)

Rubra means 'red'. Vera means 'true'.

Thank you, Axl, for the clarification. I suppose secondary and relative polycythemia are not "true" polycythemia, eh ? :-) -- PFHLai 23:20, 2004 Dec 8 (UTC)

Your're welcome. Relative polycythemia certainly isn't "true", but I reckon that the guy who named it only knew a bit of Latin and was just trying to show off. ;-) Axl 17:05, 9 Dec 2004 (UTC)

Drug stubs

I think that we can mark drug articles as med-stubs. Or, if you want, you can create your own stub template, for example drug-stub. What do you think?

Darwin 11:41, 12 Dec 2004 (UTC)

That's fine. I'll mark the stubs as med-stubs from now on. Axl 11:59, 13 Dec 2004 (UTC)

Adenine

Hey, it's no problem. I was the one who uploaded the original, correct image, and I never realized that the image was replaced with an incorrect image until you updated the page. You don't need to be an admin to revert an image. Go to the source image page, and look at the history. Just click the "rev" selection for the image you want back there. Have a good one.  :-) --G3pro 17:27, 15 Dec 2004 (UTC)

Ah, I see. Thanks for the tip. :-) Axl 12:45, 16 Dec 2004 (UTC)

Ibuprofen and aspirin

I've a few questions about these drugs, not sure if the answers are worthy of being included in either entry, this is more my personal curiosity! What was Boot's motivation to develop ibuprofen? Which has the greater anti-inflammatory effect at their respective standard doses (or is there no significant difference?) Which has the lower incidence/severity of side-effects at standard doses? Hope you can help :). Dan100 13:07, Dec 21, 2004 (UTC)

To answer your first question: I don't know. I assume that Boots recognised the anti-inflammatory effect either in vitro or in an animal model, and took it from there.

Regarding your second question, I have found only one helpful reference: [1]

However Nelson et al. used only 200 mg of ibuprofen against only 500 mg of aspirin. The respective highest single standard-release doses (as recommended by the Royal Pharmaceutical Society of Great Britain) are 600 mg and 900 mg. In short, my answer is: I don't know.

For your third question, I didn't find any comparison of side-effects at given doses. So my answer is: (you've guessed it) I don't know. However, ibuprofen does not have the same degree of antiplatelet effect that aspirin has. The incidence of (non-gastrointestinal) bleeding is lower with ibuprofen than with aspirin.

If an anti-inflammatory drug is required, I suggest that ibuprofen is superior to aspirin because of aspirin's antiplatelet effect. If an antiplatelet effect is required, aspirin is king. Axl 15:24, 21 Dec 2004 (UTC)

I have looked more rigourously now, and I have found some potentially useful articles.

Fries JF, et al. The relative toxicity of nonsteroidal antiinflammatory drugs. Arthritis and Rheumatism 1991:34(11);1353-1360. "Least toxic were coated or buffered aspirin (1.19 +/- 0.10) ... and ibuprofen (1.94 +/- 0.43)."

Unfortunately I only have access to the abstract, so I can't comment on the validity or application of this result.

Hill J, et al. A double-blind cross-over study to compare lysine acetyl salicylate (Aspergesic) with ibuprofen in the treatment of rheumatoid arthritis. Journal of Clinical Pharmacy and Therapeutics 1990:15(3);205-211. "Lysine acetyl salicylate (1.8 g t.d.s. (Aspergesic 1,000 sachet)) has been compared to 400-mg ibuprofen tablets t.d.s. in a randomized double-blind trial in patients with rheumatoid arthritis using double-dummy technique. Both drugs proved effective in relieving symptoms. Three patients experienced drug-related side-effects with Aspergesic, and one patient with ibuprofen, that necessitated early discontinuation of treatment. Aspergesic was associated with a greater number of haemoglobin values falling below the normal range than ibuprofen. At the end of the study, eight out of 10 patients who expressed a preference selected Aspergesic for improving mobility whilst 15/24 selected Aspergesic for improving pain."

Again, I only have the abtract. The aspirin dose, 1.8 g tds, seems (to me) to be a particularly large dose, while the ibuprofen dose, 400 mg tds, is more representative. This would explain aspirin's greater efficacy, and also its (probably) increased incidence of side-effects.

Friedman H, et al. Multiple-dose safety study of ibuprofen/codeine and aspirin/codeine combinations. Journal of Clinical Pharmacology 1990:30(1);65-69. "This multiple-dose, double-blind, placebo-controlled, randomized, normal volunteer study compared formulations of ibuprofen/codeine and aspirin/codeine for systemic safety. Vital signs, hematologic, biochemical and urinary parameters, side effects, mood and mental alertness, were monitored. The placebo group had less gastrointestinal side effects and more frequent stools than the active treatment groups. There was statistical evidence for greater adverse effects of aspirin/codeine on mood and mental alertness in comparison to ibuprofen/codeine and placebo. Ibuprofen/codeine had a more favorable adverse effect profile than aspirin/codeine. A mild respiratory and cardiac depressant effect attributable to codeine was evident in all active treatment groups after 7 days of frequent therapy. More work needs to be done to elucidate the factors regulating the development of tolerance to the respiratory and cardiovascular depressant effects of opiates in general, and for codeine in particular."

The doses aren't included in the abstract, so this makes interpretation difficult without the original paper.

Busson M. Update on ibuprofen: review article. Journal of International Medical Research 1986:14(2);53-62. "Prior to 1969, a limited number of NSAID drugs were available. Aspirin and indomethacin became the mainstay of treatment but tolerability, particularly gastric irritation, at doses necessary to control rheumatic symptoms limited the usefulness of these valuable agents. The pyrazolone, phenylbutazone, showed slightly better gastro-intestinal tolerability but has since been associated with an increased risk of blood dyscrasiae and is now only available for restricted use in most countries. Ibuprofen was the first of a new breed of NSAIDs originally introduced into the United Kingdom in 1969. Chemically quite distinct from its forerunners it was the first of the propionic acid derivatives to be used in rheumatic practice. The propionics have since become the largest, single and most important group of NSAIDs accounting for 50% of NSAID prescriptions in the United Kingdom. It is estimated that over 100 million patients worldwide have received ibuprofen which is now available in over 100 countries throughout the world including all the major markets. Ibuprofen was developed directly as a result of the problems associated with the use of corticosteroids in the treatment of rheumatoid arthritis and also because of the gastro-intestinal irritation and general intolerability of the established NSAIDs, at that time. Ibuprofen was readily accepted because, unlike the previous drugs, its therapeutic efficacy was easily seen to outweigh the severity of its side-effects. Ibuprofen was the first new drug with the potency of aspirin but without its major disadvantages."

Busson's article helps to answer your first question.

Cooper SA. Five studies on ibuprofen for postsurgical dental pain. American Journal of Medicine 1984:77(1A);70-77. "Ibuprofen (Motrin, Upjohn) was evaluated in five studies using the Dental Pain Model, which is representative of most acute postsurgical pain situations. Ibuprofen 400 mg was consistently more effective than aspirin 650 mg, acetaminophen 600 mg, and both aspirin and acetaminophen when combined with codeine 60 mg. In two studies, ibuprofen 400 mg was at least as effective as zomepirac sodium 100 mg. No serious or prolonged side effects were reported in any of these studies."

Again, not the highest dose of ibuprofen, nor the highest dose of aspirin, but both doses are representative of standard prescribed doses.

Squires DJ, Masson EL. A double-blind comparison of ibuprofen, ASA-codeine-caffeine compound and placebo in the treatment of dental surgery pain. Journal of International Medical Research 1981:9(4);257-260. "A double-blind randomized clinical trial was conducted in eighty-seven patients with mild, moderate or severe dental surgery pain to evaluate the analgesic activity of a single dose of the following compounds: (i) ibuprofen 400 mg, (ii) ACC-30 (a compound containing ASA 375 mg; codeine phosphate 30 mg; caffeine citrate 30 mg), (iii) placebo. Ibuprofen was significantly better than ACC-30 and placebo on almost all pain intensity, degree of relief and duration of analgesia parameters. ACC-30 was not significantly different from placebo on any analgesic measurement. No serious side-effects were reported with any of the study medications."

Only a modest dose of aspirin here.

That's enough references, I'm sure. ;-) In my opinion, the anti-inflammatory effects are probably not much different between aspirin and ibuprofen at standard doses, but the side-effect profile of ibuprofen is (probably) slightly superior. Axl 12:10, 22 Dec 2004 (UTC)

• Thanks, Axl. Impressive research. I found the Busson (1986) article particulary interesting, as that's exactly what my mother remembers from the time ibuprofen was introduced :). Do you think there would be any merit in including summaries of this information on the respective drug pages? Dan100 23:24, Dec 22, 2004 (UTC)

• Hi Axl. Nice research there. Thought I'd just mention that anything that inhibits cyclooxygenase-1 (COX-1), i.e. all NSAIDs, will inhibit platelet aggregation as this inhibits the synthesis of thromboxane A2 (TxA₂)). The main point-of-difference with aspirin is that it is the only NSAID to irreversibly inhibit COX-1, thus explaining its efficacy as an antiplatelet agent. As for the adverse drug reaction issue - there was also the recent Paracetamol, Aspirin and Ibuprofen New Tolerability (PAIN) study reported by Moore (2004), where apparently ibuprofen had an even lower incidence of ADRs than paracetamol - though the design of this study has been criticised by some academics here in Australia. I don't have any references off the top of my head (probably in AMH 2004), but it's commonly accepted that ibuprofen at less than 1200mg daily has better safety profile than other NSAIDs. This benefit is lost, however, for doses greater than 1200mg daily. Efficacy of NSAIDs is dose-dependent with considerable interindividual variability, so it's difficult to say whether any one NSAID is more efficacious than another. Thought I'd also mention, for completeness, that there hasn't really been any good evidence for the benefit of COX-2 inhibitors over "conventional" NSAIDs. And now it seems that the coxibs and naproxen increase the risk of adverse cardiovascular events... -Techelf 04:57, 23 Dec 2004 (UTC)

• Sorry about the delay with my reply; I've been away for Christmas and I've just arrived back. Kieren, thank you for adding your comments.

"All NSAIDs inhibit the synthesis of thromboxane A₂."

Sure, I agree, but most NSAIDs do not cause clinically significant platelet inhibition, because of their reversible nature.

Moore's study is very interesting. I'll have to try to get the full article.

"There hasn't really been any good evidence for the benefit of COX-2 inhibitors over "conventional" NSAIDs."

Well, I suppose that it depends on how you define "good evidence". There are several RCTs that show a beneficial side-effect profile. Here is one: Hegi TR, et al. Effect of rofecoxib on platelet aggregation and blood loss in gynaecological and breast surgery compared with diclofenac. British Journal of Anaesthesia 2004:92(4);523-531. "In this double-blind, active controlled study, women undergoing vaginal hysterectomy (n=25) or breast surgery (n=25) under general anaesthesia received preoperatively 50 mg of rofecoxib followed 8 and 16 hours later by two doses of placebo or three doses of diclofenac 50 mg at the same time points.... In the rofecoxib group, stimulated platelet aggregation was disturbed less (p=0.02), and estimated intraoperative blood loss (p=0.01) and the decrease in haemoglobin were lower (p=0.01). At similar pain ratings, the use of anti-emetic drugs was less in the rofecoxib group (p=0.03)."

This is from a review article: Lazzaroni M, Bianchi-Porro G. Gastrointestinal side-effects of traditional non-steroidal anti-inflammatory drugs and new formulations. Alimentary Pharmacology and Therapeutics 2004:20(Suppl.2);48-58. "The selective COX-2 inhibitors (rofecoxib, celecoxib, parecoxib, etoricoxib, valdecoxib, lumiracoxib) show consistently comparable efficacy to that of conventional non-steroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis and osteoarthritis, but have a significantly reduced propensity to cause gastrointestinal toxicity. In many cases, the gastric effects of therapeutically active doses of COX-2 inhibitors are indistinguishable from placebo. The safety benefits of COX-2 inhibitors given alone appear similar to combined therapy with conventional NSAIDs and gastroprotective agents. These findings warrant the consideration of COX-2 inhibitors as first-line therapy in patients requiring long-term pain control."

In my opinion, the COX-2 inhibitors do show fewer gastrointestinal side-effects. However, as you pointed out, Kieren, the cardiovascular effects are worrying (and led to withdrawal of rofecoxib). While their use as analgesics may soon decline, there may be some potential in the treatment of cancer.

Dan, perhaps some info about the development of ibuprofen would be appropriate. However, the rest is relatively esoteric. I don't think that such details are necessary in a general encyclopedia. Still, if you think that it is worth adding, please feel free. Axl 19:36, 29 Dec 2004 (UTC)

If asprin irreversibly inhibits cox-1, what about its effects on cox-2, are those irreverible too? Is the chemical mechanism of irreversibility against one and not the other understood on the basis of asprin or functional site structure? Is there any "rebound" production of cox-1 in response to asprin? thanx, --Silverback 16:00, 31 Jan 2005 (UTC)

Hi, Silverback. Sorry about the delay in my response. I have just moved jobs and I am rather more busy now, with less time to spend surfing. Aspirin irreversibly inhibits both COX-1 and COX-2. In general, irreversible inhibitors do not bind to the functional site of the target; rather they bind at another place. The new chemical bonds distort the architecture of the target, altering the shape and/or charge of the functional site. I don't know for sure about your third question. However I would expect an increase in COX production. Axl 08:24, 9 Feb 2005 (UTC)

It is interesting that a single compound inhibits both and doesn't target the functional site, because it is the functional site that one would expect to be conserved and remain similiar while the non-functional parts diverge. The enzymes must have diverged only recently, or perhaps the aspirin site has role in the function that causes it to also be conserved. -- thanx, --Silverback 10:06, 9 Feb 2005 (UTC)

It is likely that the non-functional sites on COX-1 and COX-2 to which aspirin binds are probably not quite identical. Irreversible binding tends to be slightly less site-specific than reversible inhibition. Axl 20:25, 9 Feb 2005 (UTC)

Sorry for my delayed response, as I've been away too. You're right that aspirin irreversibly binds to both COX-1 and COX-2. It covalently modifies COX by acetylation of Ser₅₃₀ in COX-1 and the corresponding Ser₅₁₆ residue in COX-2. This results in steric hindrance, preventing the natural ligand (arachidonic acid) from reaching the catalytic site. Aspirin is indeed more selective for COX-1, which I agree is probably due to subtle differences in the structure of the isozymes. Techelf 08:47, 21 Feb 2005 (UTC)

Anybody wants the PAIN paper, I can provide it (nicholas.moore@pharmaco.u-bordeaux2.fr). I still do not understand the "methdological flaws" stuff in Australia. This was ranting by a guy with vested interests against ibuprofen going in supermarkets, and who really doesn't know much about clinical trials and plays in the hands of competition (beware of the marketing interests ion drug assessment...)

For other stuff: Cox2 inhibitors have no efficacy benefit. They may even be less effective painkillers than non-selective NSAIDs (some of the pain is Cox1 dependent). The benefit is only on GI safety, and this was proven mainly in extremely artificial conditions (long term continuous use at high doses, no gastroprotection allowed). We have just finished a 46000 patient study of Coxibs and NSAIDs in France, and the real-life rates of GI bleeding are 10 to 100 time lower thn in those clinical trials (because of good risk management by prescribers.and there is no difference between coxib or NSAID + PPI, with the added advantage of the latter that it also treats reflux and dyspepsia. So it really boils down to a cost perspective, which should improve even more with cheaper PPI. Or avoid Coxibs if your fear the cardiovascular risk (also very much exaggerated, at least for the lower dose Vioxx. In fact there was as little real reason for the hype whenit was put on the market as when it was removed... have a nice day NMooreBx 16:59, 25 April 2006 (UTC)

Barnstars

What makes you think you can't award barnstars? Pick one and knock yourself out. --fvw* 21:00, 2004 Dec 29 (UTC)

Hyponatremia

Hey Axl, you've left out cerebral salt-wasting syndrome! I'm not sure how to classify it - wasn't it a low volume state? JFW | T@lk 02:42, 31 Dec 2004 (UTC)

Hehe, thanks for pointing that out. :-) I have added it. Axl 10:23, 31 Dec 2004 (UTC)

Hypocortisolism and hypothyroidism both increase ADH secretion. This is in the Emedicine article on hyponatremia and confirmed by a smaller study I just read on hyponatremia in alcoholics. Don't ask me the molecular mechanism. By the way, I did respond to your post but it was archived :-) JFW | T@lk 21:55, 30 Jan 2005 (UTC)

Thanks for the reference (and the education). :-) Apparently, CRH stimulates ADH secretion. The lack of negative feedback from cortisol on CRH during hypocortisolism leads to increased ADH. Also, hypocortisolism itself reduces cardiac output. (I couldn't find your response in your archive. Perhaps it was lost in the shuffle?) Axl 11:09, 31 Jan 2005 (UTC)

It was probably shuffled improperly. The alcoholics/hyponatraemia study is here: PMID 11093969. JFW | T@lk 21:57, 31 Jan 2005 (UTC)

thanks

hey thanks for the kudos! man i thought i'd never get it done, have you seen the page history? also the archive for the nominations? (both). i had to fight pretty hard to get it up there. but anyway thanks for the help. my goal is to be the user with the most featured articles ( i only have one now) do you know who has the most? --Larsie 19:45, 31 Jan 2005 (UTC)

Orthomolecular medicine

The edit war is over an infobox. John Gohde is convinced he can save the world by embellishing all his articles with a totally redundant piece of extra formatting that (falsely) indicates some relationship between all sorts of non-mainstream medicine. I think this is going to be an arbitration case sooner or later.

My history with John goes back to last year, when he was no further than he is now with the WikiProject Alternative medicine. I have requested numerous times that he concentrate on content, e.g. what herbal interventions are used in arterial hypertension, or what the rationale might be for magnetic insoles in plantar fasciitis. So far, this has not been forthcoming.

When John returned a few weeks ago I offered my suport in resurrecting the infoboxes in return for some civility and cooperativity. I got shouted at, then got my postings from his talkpage deleted, and firmly resolved to let this user fend by himself. JFW | T@lk 09:03, 14 Mar 2005 (UTC)

Okay, thanks for the background. Axl 17:29, 15 Mar 2005 (UTC)

Peace Dove

To all participants of the WikiProject Kindness Campaign: There is a proposal on Wikipedia talk:WikiProject Kindness Campaign for the Peace Dove. Please comment as you see fit. Thanks, Sango123 16:02, July 14, 2005 (UTC)

Thoracentesis

Noticed you edited empyema by removing thoracentesis. Placed comment on its talk page. Kind regards--Nomen Nescio 22:41, August 30, 2005 (UTC)

Paid Editing Project

Hi: My name is Tess and I work for a global independent research firm in New York. I am interested in hiring you for a Wikipedia editing project, based on your technology and medical experience and expertise. I attempted to email you through your user page. If you received it, please read it over and contact me with any questions. If you did not receive this email, please let me know and I would be more than happy to tell you more about this project. (You can call 512-651-1797 or email tfurman@glgroup.com). Thank you and I hope to hear from you soon! Tess - Gerson Lehrman Group 18:48, 28 September 2005 (UTC)

• Thank you. I have replied by e-mail. Axl 17:00, 30 September 2005 (UTC)

Emergency department plea

I wonder if you would consider supporting this article by voting for it at Wikipedia:Article Improvement Drive to improve it towards feature article status. I hope to increase the profile of clinical medicine and related subjects on wikipeda. The current article is basic, in particular with regards to EDs around the world.--File Éireann 20:17, 13 November 2005 (UTC)

The article is indeed good as you say but still very far from qualifying as a featured article. I would really appreciate if you could vote for it, so to help it to move from the mere good to featured status. Many thanks. --File Éireann 17:01, 16 November 2005 (UTC)

The spelling doctor is back!

Axl, long time no see! Good to see you're back. Have a look at the WikiProject. Some interesting things have happened in your absence, such as WP:MCOTW. We're also in a bit of a war with anti-vaccine characters and quacks. Fun. JFW | T@lk 20:41, 1 February 2006 (UTC)

Wikipedia Project

Hi, my name is Federico (alias Pain) and I am creating a section for nominating th best user page, I was wondering if you were interested in joining the project.

The project has just started, and we need help to spread the word and ameliorate it.

Best regards, Federico Pistono ✆ ✍ 00:48, 4 February 2006 (UTC)

Schindlers list

I went back and removed the e's from Amon Goeths name,since somebody put the umlaut in on the o,where it's supposed to be,to make it a properly spelled German name,instead of the English transliteration.O.K.?Saltforkgunman 06:29, 4 March 2006 (UTC)

Thanks. I just tried to make the whole article use a consistent spelling. Axl 08:06, 6 March 2006 (UTC)

Block

I'm sure you are right about the shared ISP - as an AOL user, it happens to me all the time. Unfortunately, since it wasn't your username I blocked, I'm not even sure how to unblock you, since I don't know your ISP. If you let me know the address and reason given on the block notice, I'll try to revert this.jimfbleak 05:14, 27 March 2006 (UTC)

"Medicine" on MCOTW

After a bit of inactivity, Medicine has been selected as the new medicine collaboration of the week. I am taking the unusual step of informing all participants, not just those who voted for it, since I feel that it is important that this highest-level topic for our collaboration be extremely well-written. In addition, it is a core topic for Wikipedia 1.0 and serves as the introduction to our other articles. Yet general articles are the ones that are most difficult for individuals to write, which is why I have invited all participants. I hope it isn't an intrusion; I don't make plan to make a habit of sending out these messages. — Knowledge Seeker দ 02:16, 16 April 2006 (UTC)

$pringfield

You're right, I hadn't noticed that. Johnleemk | Talk 09:46, 12 May 2006 (UTC)

Mesothelioma

Thanks for your help in correcting 'diffuse pleural thickening' and 'plaques'. However, I am still not sure of the difference. Could you explain? I have found them used interchangeably or described as the same, such as this from the Department of Health & Human Services (US):

Asbestosis can manifest as pleural or parenchymal fibrosis or both. Pleural asbestosis, more properly termed "asbestos-related pleural abnormalities," is the most common finding in asbestos-induced pulmonary disease and, as described previously, involves pleural thickening, often manifested as discrete pleural plaques. Pleural plaques can be seen radiologically as bilateral images of hyalin scar formation on either the visceral or, much more commonly, the parietal pleural surfaces.

I left your edit, but am curious as to what the difference is. Thank you!MollyBloom 01:53, 23 June 2006 (UTC)

Thanks!