Talk:Heyde's syndrome

Major revision to article in June, 2015
I chose to re-write this article to improve readability, detail of information, breadth of coverage, and the use of supporting citations.

I am not a specialist in this area, but I am a biomedical researcher and I chose to make these changes to the Wikipedia entry as part of a literature review of my own. Specific potentially controversial changes and additions are listed below.

As I am not a specialist in this area, it is quite possible that I made some mistakes in my edits to this page, although I worked very hard to avoid that. If you discover a mistake, or more likely a statement that you disagree with, please feel free to make a change, but also clearly document your reasoning in this talk section. I will be monitoring this page and making edits in the weeks and months to come, and I will carefully review and alter all changes if I feel they are unsupported by the literature, unless you provide a clear and compelling reason in this talk section. Michael Dacre (talk - contribs - email) 21:09, 25 June 2015 (UTC)

Diagnosis
I expanded the existing diagnosis section maintaining all of the content that was already there. This is the section I am least comfortable with. My knowledge of the subject comes from an extensive literature review, an includes no clinical experience. My discussion of diagnosis is based on my understanding of the pathophysiology. If any actual physicians are able to edit this section to include a more experienced and well rounded point of view, I would really appreciate it.

Changing 'described' to 'noticed'
I left the the first sentence unchanged other than to add a citation, I changed the second sentence to use the word 'noted' instead of 'described', as the letter by Dr. Heyde merely notes the association in a small number of his patients and requests input, it does not describe the condition at all nor provide any evidence for the association.

Major expansion of the history section
I chose to add a history section due to the controversial nature of this disease since its description by Edward Heyde in the 50s. For a while there was considerable debate as to whether the association was even real, and the possible cause remained open until very recent years.

This section is intentionally incomplete as I left out the several possible explanations proposed in earlier years that were easily dismissed by later research.

Order Change
I moved 'Diagnosis' to be after 'Pathophysiology' section based on my observation of WikiProject Medicine featured articles.

Removal of 'Signs and Symptoms'
This section can be rolled into 'Diagnosis', and is not present in the majority of WikiProject Medicine featured articles

Moving first paragraph from pathophysiology paragraph to history
The previous first paragraph of the pathophysiology section is a historical note and not a discussion of the current understanding of the pathophysiology of this disease. I therefore moved it to 'History' and merged it with the first paragraph there.

The second sentence of the pathophysiology section was written like a history section also, I chose to expand the discussion of the pathophysiology greatly, and to do so in an encyclopedic fashion, rather than in the historical fashion previously. I retained all of the information in the original sentence however.

Language choice
Rather than repeatedly refer to Heyde's syndrome, I made the choice to explicitly state 'the association between gastrointestinal bleeding and aortic stenosis'. This is much more long winded, but I feel that it is much clearer for a lay audience.

Prognosis
I could not find any prognostic data on Heyde's syndrome in specific, only data on IA and AS, so I left this section out. Michael Dacre (talk - contribs - email) 21:09, 25 June 2015 (UTC)

Confusion of von Willebrand's disease and angiodysplasia
This article refers to von Willebrand's and angiodysplasia interchangably despite the fact that these are totally different diseases. Michael Dacre (talk - contribs - email) 21:41, 22 June 2015 (UTC)

Attempted Clarification
I tried to clarify the introductory paragraph by removing the bit about where the syndrome got its name (I moved that info to the history section). Here's the original introduction:


 * In 1953, Dr Edward C. Heyde described a syndrome of aortic valve stenosis associated with gastrointestinal bleeding from angiodysplasia in the colon.

Cheers! --Diberri | Talk 21:06, Apr 19, 2004 (UTC)

Chronology
Currently, wikipedia is coming across as suggesting that the 2003 paper suddenly and somewhat unexpectedly clarified the underlying pathophysiology. In fact, several lines of evidence started to be developed in the late 1970's, and gradually came together, such that the hypothesis was clearly presented in the early 1990's, and received substantial corroboration from many sources over the next decade. In fact, the 2003 article credits much of that work. The elucidation of this syndrome "took a village." I'll see if I can find a nice secondary source review of how this developed, but readers are cautioned that the chronology was a little less simple than might be inferred from the current wording. FeatherPluma (talk) 04:00, 10 November 2011 (UTC)

NEJM again
10.1056/NEJMcibr1205363 JFW &#124; T@lk  19:34, 7 February 2013 (UTC)


 * The association is far from complete. vWD IIa probably promotes angiogenesis of angiodysplasias. 10.1111/bjh.12272 JFW &#124; T@lk  23:29, 7 December 2014 (UTC)


 * 10.1093/ageing/afp019 - review from a geriatric perspective.
 * 10.1111/jocs.12131 - cardiac surgery perspective. JFW &#124; T@lk  23:34, 7 December 2014 (UTC)

Why are 'medical references needed'
User:Ozzie10aaaa: You put many requests for 'medical references' without any clarification or edit summary. Please provide your rationale for me. With one exception that I intend to remove shortly, everything in this article is substantiated by medical review, and primary sources are provided for clarification of individual points. Many sources are quite old, but this is not an actively researched syndrome, and so they are still absolutely current. In cases where they are not current, they support single statements that describe the work done by that article, and not the pathophysiology or diagnosis. Again with one exception, I do not understand any of your requests. Can you please enlighten me? Michael Dacre (talk - contribs - email) 08:23, 7 July 2015 (UTC)
 * Michael Dacre ...no problem.......irrespective of primary or secondary, the sources are dated (references #1,4,5,6,7,9,14,15 (have place inline citations...the History section is exempt)--Ozzie10aaaa (talk) 20:10, 6 July 2015 (UTC)....this is what I had placed due to the fact that they where dated (old) and generally should be replaced with newer ones, if you find difficulty in finding any newer ones just remove the tag (I will have a shot at PubMed to find a few),,,feel free to ping me with any question,,,thanks--Ozzie10aaaa (talk) 17:30, 7 July 2015 (UTC)
 * Thanks Ozzie10aaaa; I am editing the article right now and I will try to clean up the older references; I think I am too attached to my non-Wikipedia style of citing primary literature. I have found a few newer reviews that I am going to use to edit the text right now. Do you think I should just delete older references entirely, or simply add the newer reviews to the list? Also, if I am using reviews only, as seems to be Wikipedia policy, should I be citing less often? When I made wrote most of this content I cited often and mixed newer reviews supporting entire paragraphs with older literature supporting single sentences in those paragraphs. Should I just cite less and only have the reviews supporting larger chunks of text? Thanks again for all of your help :-) Michael Dacre (talk - contribs - email) 17:37, 7 July 2015 (UTC)
 * no problem,,,,the first ref we decided to leave in....im looking for the rest (before deleting make sure you have a replacement reference) usually I go 1-2 sentences per references, everyone is different,.....remember you can use GOOGLE books and position statement (FDA,NHS,NIH,WHO,HHS,) --Ozzie10aaaa (talk) 17:39, 7 July 2015 (UTC)
 * PS....Michael Dacre...    ...see if these help,,i will keep looking--Ozzie10aaaa (talk) 17:57, 7 July 2015 (UTC)
 * Thanks Ozzie10aaaa, I think that I have addressed all of the major citation issues now. When you have time, if you can make sure it all looks ok, that would be fantastic. Thanks again for all of your help Michael Dacre (talk - contribs - email) 20:45, 9 July 2015 (UTC)