Talk:Osteitis fibrosa cystica/Archive 1

Adoption as a Project
This article has been adopted as part of the AP Biology Fall Semester Wikipedia project. More information can be found at Wikipedia talk:WikiProject AP Biology 2008. I'm in no way claiming ownership of this article, however: help is welcome, and, in fact, very much appreciated. --Strombollii (talk) 00:08, 25 September 2008 (UTC)


 * Good luck with your challenging undertaking! I'll keep an eye out for you and this page. Feel free to ask if you have any questions or need help. Chaldor (talk) 02:08, 5 October 2008 (UTC)

Good info
Click Me —Preceding unsigned comment added by FoodPuma (talk • contribs) 19:42, 25 September 2008 (UTC)

Citation
Your selection of a reference to cite was adequate. But you failed to include the relevant and available information. Author date of publication etc...--JimmyButler (talk) 19:23, 4 October 2008 (UTC)

I tried this citation from the "citation machine" for a web site: and got this--JimmyButler (talk) 23:30, 4 October 2008 (UTC)

But I'm thinking this is actually an encyclopedia. So I am gonna try that instead. (There was an author/editor... in the fine print!) at least one that "updated the entry. --JimmyButler (talk) 23:30, 4 October 2008 (UTC)

Amazing - online web sites generated by organizations can be beastly. What role did the NIH also listed on the cite have. All you can do is try your best to fill in the blanks. In the end you hope someone with mad skills will come along and clean up the mess. I'm going to bed now. --JimmyButler (talk) 23:46, 4 October 2008 (UTC)


 * This is rather after the fact, but NIH, I believe, is the organization that Dr. Hurd works/writes for. I've seen the same write-up multiple times under the A.D.A.M./NIH name. Strombollii (talk) 04:21, 18 November 2008 (UTC)

Over-lap?
Chris... I was thinking that this disorder was once / maybe still is ... thought to have effected the Joseph Merrick. But I then saw it was Neurofibromatosis type I - which is also called von Reck^%*$& Disease. I'm confused now and wondering how two different disorder are associated with the same syndrome?

- Never mind I justsaw the disclaimer at the top of the neuro$%^&% page. I am going to bed.--JimmyButler (talk) 23:58, 4 October 2008 (UTC)

Causes
The Causes section starts with "There are three major factors of hyperparathyroidism that can lead to OFC: random adenomas, genetics, and parathyroid carcinoma." What exactly does this mean? Is it simply that those are the three commonest causes of hyperparathyroidism, and hence of OFC – or is it that those aspects of the etiology of hyperparathyroidism are particularly responsible for OFC? I'm thinking it's the former, and if so it probably should be expressed more like that. But if it's the latter it needs spelling out a bit more clearly. A case for a little rewriting in the interests of clarity? SNALWIBMA ( talk - contribs ) 07:47, 19 November 2008 (UTC)
 * Fixed it =] Thanks 71.74.28.68 (talk) 03:48, 20 November 2008 (UTC)Strombollii (talk) 03:59, 20 November 2008 (UTC)

Peer Review
Comments

I believe there is a better link for your "calcified bone" - namely "ossification" What does "peritrabecular" in the intro mean? What does "hypercalcemia" mean (in "Treatment")? Typo in wikilinking "bone re-absorption" in "Diagnosis" You might want to wikilink your use of "parathyroid carcinoma" in "Treatment" - It was linked earlier on (in the intro), but as your article gets longer it is acceptable to wikilink a technical term twice or more as long as it isn't one right after another (in other words: wikilink in sections at the beginning and end if need be) Literal quotes = bad.

"The only opportunity for cure is surgery with meticulous resection of the tumor intact because disruption of the capsule will seed tumor cells. This diagnosis should be considered in patients with hyperparathyroidism who have severe hypercalcemia, extremely high parathyroid hormone (PTH) levels, or a palpable neck mass."

—Kearns

I suggest moving links from "See also" to the beginning of sections in which they pertain. I can do this for you if my wording is confusing :-P Try to expand the links in your disease_box : You can always get to the database websites by going to an article (like OCD) and clicking on the blue-linked text in the disease_box. From there, just search "Osteitis Fibrosa Cystica" and post the link #'s in the disease_box template. I can help if this is confusing. Elaborate on "detected in its early stages." (From intro): Suffering my ignorance, is hyperthyroidism genetic at all? If so, how early is the onset of OFC after birth? Can it be detected prior to birth? If it isn't genetic, then how early can it be detected? Will the patient suffer any ill effects before it is detected? Is it ever confused with osteoporosis (as you described the bones turning "soft")? This is a rate of incidence, not a cause... thus it would be appropriate under "Etiology". You might desire to keep the information about tumors, however the & rate is strictly a statistic. Also, I see no reference!:

"The vast majority of cases of hyperparathyroidism are the result of random tumors which invade the parathyroid glands. These instances comprise approximately 80–85% of all documented cases of hyperparathyroidism."

Also, in referring to the "soft" quality of bones and some of your descriptions in "Signs and symptoms:" these would be more appropriate placed in a section entitled "Pathophysiology." Some of these describe the effects of OFC on a patient, AKA how it damages their skeletal structure:

{quote|"Osteitis fibrosa cystica is, in essence, the replacement of outer layers of calcified bone with fluid-filled cysts. In some cases, the marrow of the bone is then replaced with vascularized fibrous tissue and osteoclasts. If left unchecked, the bones will turn soft."|Rubin}}

Overall, not too bad! Quite a few of my comments are merely personal and not part of any formal requirement. Thus, feel free to address these as you see fit. Good work so far, keep it up. Cheers! FoodPuma 00:38, 21 November 2008 (UTC)

To Do

 * Fix wikilinks, explain technical terms.✅


 * Eliminate literal quotes.✅


 * Eliminate "See Also" section, integrate links at top of sections.✅


 * Expand Disease info box✅


 * Expand intro, eliminate vague statements


 * Is hyperthyroidism genetic at all? ✅


 * If so, how early is the onset of OFC after birth?


 * Can it be detected prior to birth?


 * If it isn't genetic, then how early can it be detected?


 * Will the patient suffer any ill effects before it is detected?


 * Is it ever confused with osteoporosis (as you described the bones turning "soft")?


 * Etiology section ✅(integrated into other sections)


 * Change references to Vancouver Style (help here would be vastly appreciated)


 * Expand pathophysiology✅

Thanks guys!

Strombollii (talk) 15:49, 4 December 2008 (UTC)

Thoughts
Generally a good article, time to get a variety of other people's opinions to help review and tweak the style. So in no particular order some points: David Ruben Talk 02:13, 7 January 2009 (UTC)
 * Ask at the Medical Wikiproject for comment & input - go to WT:MED✅
 * In Causes: awkward structure with "Three of the major causes of hyperparathyroidism that can lead to OFC are...". Surely you do then list out THE 3 major causes, there being no other major causes not listed (only some minor causes). Jargonistic to list the 1st item in the list as "adenoma", especially given next paragraph fails to mention this medical term at all, instead describing "random tumors".✅
 * In Causes: why not mention the 3 major causes as a numbered list (start each line with a "#") ✅
 * MEN description seems over wordy and detracts from getting on and discussing this condition.
 * Seems excessive wikilinking of calcium, parathyroid, parathyroid carconoma and hyperparathyroidism in the article (not that a term can't be linked again further down in an article, but calcium should not need be relinked and certainly no double linking within the same section - i.e. "parathyroid carcinoma" x2 in causes section)✅
 * In history: unwise to state "Von Recklinghausen was the first to describe...", if you follow to the article Friedrich Daniel von Recklinghausen, one of its references is to the excellent Who Named It site. The link given is to the doctor's part of that resource, from where you will find link to various eponymously named conditions. You should recognise then a problem: * - is disorder of schwannomas and neurofibromas *  - aka "von Recklinhausen disease II", or "von Recklinghausen’s disease of bone" which is what we seek here (the "II" or "of bone" qualification is critical). Now WhoNameIt often lists syndromes with additional names that are often not used in English-speaking countries (go look up Graves' disease and the term that takes precidence as that website is rather different). What is of importance is that von Recklinghausen published in 1890, yet a Gerhard Engel had published in 1864. Now I can't translate either German title, nor have access to them to see what was actually being recorded. However a rephrasing in wikipedia article seems prudent, to perhaps: ✅


 * Care needs be taken with list of causes (now much easier to follow that split into a list). I think you had confused parathyroid adenoma (benign lumps but autologously (ie on their own & without feedback regulation) can pump out parathyroid hormone) (aside adenomas have a small risk of undergoing malignant change: in part as active tissue and partly as already somewhat out of normal control) from parathyroid carcinoma which are malignant. The Mayo clinic reference sets this out but somewhat repeats itself which is where I think you got misled (confused me on first reading to try and untangle). So for a 1st revision: benign parathyroid lumps going "hyper", genetic problem causing cancers and non-genetic bad-luck cancer going rampant seems to sum up. I'll need to reread that Mayo clinic reference more leasurely later to have another look at the causes section. David Ruben Talk 14:04, 7 January 2009 (UTC)✅...I think?

Epidemiology
This article needs a section on epidemiology. How common is it? Are there any places with higher rates than other places. Yes it is rare in the developed world were surgery is an option. But what about the developing world were people do not get operation..

-- Doc James (talk · contribs · email) 20:25, 18 January 2009 (UTC)
 * I'll get to work on it. I'm having trouble finding solid statistical data Strombollii (talk) 04:11, 21 January 2009 (UTC)

Ebooks


— Preceding unsigned comment added by Strombollii (talk • contribs) 03:44, 27 January 2009 (UTC)



— Preceding unsigned comment added by Strombollii (talk • contribs) 14:45, 16 March 2009 (UTC)

Issues with this article
I feel there are still some issues with this article that need to be addressed.
 * One is the lack of epidemiology.  ✅
 * Another is that in the lead it lists three criteria for OFC and than under signs its lists three different ones? "The classic musculoskeletal manifestation of primary hyperparathyroidism is osteitis fibrosa cystica, which consists of bone pain, osteopenia, and bony cysts."http://emedicine.medscape.com/article/334845-overview ✅
 * There is no discussion of renal dialysis per say. It is eluded at but: "Previously, the only known dialysis-associated bone disease was osteitis fibrosa cystica, which was the result of abnormalities in vitamin D production that resulted in a secondary hyperparathyroidism, increased bone turnover, and subsequent peritrabecular fibrosis." http://emedicine.medscape.com/article/165315-overview
 * It says "Bone x-rays can also be used to diagnose the disease, though results can be inconclusive." This is followed by "Radiographs distinctly show bone resorption". Here is what emedicine says: "In severe cases, plain films reveal the classic bone finding, osteitis fibrosa cystica. It consists of bone cysts with or without pathologic fractures. These cysts are also known as brown tumors."  http://emedicine.medscape.com/article/280908-diagnosis ✅
 * FNA is not discussed. What about the histology of these? http://www3.interscience.wiley.com/journal/112701262/abstract?CRETRY=1&SRETRY=0 ✅
 * The picture is of a Parathyroid adenoma? This article I do not think distinguishes well enough between OFC and parathyroid problems.
 * There is not a single picture of the condition described.

-- Doc James (talk · contribs · email) 10:16, 28 January 2009 (UTC)

And it doesn't follow WP:MEDMOS, lacks of external links and images. It should be a medical collaboration of the week so we could improve it together. I can take care about the things I mentioned (finding an image will be hard though). NCurse work 14:01, 28 January 2009 (UTC)


 * The GA review is somewhat limited in supporting detail. This is disappointing in many ways to the student, in that they received a review that dampens the celebratory mood despite the pass. The agreement was - GA would be rewarded with extra points on their grade; this complicates things. I will give them the points - simply because they can and will address the concerns as they are raised. But they were still cheated out the sense of satisfactions that others felt when they made GA. It needs to be de-listed, edited and renominated. Is this an option?


 * This also opens up a whole new can of worms regarding the use of Wikipedia as a class assignment. Clearly it was a mistake to link student performance with GA or FA success. The element of excitement that went with overcoming the GA obstacle will be replaced with my personal definition of pass/fail. I see the potential for enough heat from disgruntled students and their parents looming in the horizon to pull the plug on this project. Old school trumps out again - break out the slate and chisels. --JimmyButler (talk) 15:35, 28 January 2009 (UTC)
 * I concur with your first paragraph. I'm considering putting it up for reassessment after addressing Doc James' concerns.  However, I don't quite see how this is ...as negative as you described it?  It's already been stated that this is so much more than a simple pass/fail project, and I feel as though those still plugging away at, and editing their articles in hopes of FA/true GA are more concerned with their projects than their grades.  Obviously, this is a set-back, but i just don't understand why the situation is as grave as it has been described. Strombollii (talk) 17:05, 28 January 2009 (UTC)


 * I think Jimmy is being a little bleak. One of the problems is the topic you have chose.  Medicine is a very difficult topic often written in a complicated manner with contradicting references.  There are a number of us here who special in this topic and therefore have exceeding high standards.  Now this is even one of the more difficult topics in medicine to address.  Much of it is historical making the finding of data difficult.  The condition from what I can gather has almost disappeared in the western world since the advent of proper treatment of thyroid problems.  Wikipedia is all a work in progress.  I have noticed that the standards for GA and FA have also increased over the time that wikipedia has existed.  Everything here is a little subjective.   Doc James  (talk · contribs · email) 19:10, 28 January 2009 (UTC)


 * I've delisted the article per the concerns raised above and the posts here. We all agree that it's not GA compliant yet, but because this is complicated by the fact that it's tied in to a student project, I've bypassed some of the usual steps so we can come to some sort of sensible WP:IAR solution. I'm happy to do a full re-review if needed, but that may depend on the student involved so I'll wait for further input (suggestions welcome!) EyeSerene talk 19:43, 28 January 2009 (UTC)


 * The saving grace is that I have a student that is mature enough to see the big picture from the stand point of its learning opportunity. The attitude is to be commended and gives me enormous pride.

However... bleak would translate to this.
 * Student reaches GA and by definition is awarded a 100 for a major assignment. Celebration ensues (see section below).
 * Student loses GA because it is determined that the reviewer was not competent in the task.
 * Discussion follows that determines article is in fact not GA worthy. Leading to the option that The 100 is forfeited. Try defending that position to the parents or student. You've essentially turned over the grading of a major assignment to complete strangers trusting in their skills and competence. Which is exactly the case here.
 * If the grade should stay... every student (which were several) that failed GA now feel cheated. Again... parental conferences and no position of defense.


 * I'm indeed fortunate that Strombollii is not a point-chaser or that his parent are not obsessively concerned about his class rank and performance relative to the peers in the class. Perhaps all of my students are of like mind - which would be the exception to the rule (a statement of fact from experience). If he was upset I'd be dancing the jig right now. I'm not a pessimist; otherwise, such avenues of education would never be attempted in the first place. But I can assure you with 100% confidence that if this issue was brought before a school board I would go down in complete and total flames. Again, thank you C. for taking the high road on this; rest assured that such an attitude will serve you well. Everyone involved has such good intentions,  even the reviewer; this too is of comfort. Meanwhile, I'll rethink the grading policy so that I don't relinquish control over the evaluation to strangers and be better prepared for such contingencies in the future. If anyone can suggest a way to maintain the excitement and reward motivation that the GA standard conveys without placing the responsibility of an academic outcome - GPA and class rank and all the other things that drive students/parents, then please share on my talk page - no cynicism to be implied in any way.--JimmyButler (talk) 23:32, 28 January 2009 (UTC)
 * I still fail to see fault with the notion of GA being a set means by which to arrive at a grade. There is a rather explicit criteria which has to be met, regardless of the article or reviewer.  Furthermore, Wikipedia is an obviously self-policing site, as exemplified by the number of editors/reviewers taking notice of a non-GA worthy article making it to GA status.  Is it completely fair?  Probably not, but in a way, I feel as though it's far more objective and unbiased than a single teacher making an unchecked, unverifiable decision.  Of course, the fact that I'm not involved in the "grade race" may contribute to this opinion.
 * On a different note, I really am appreciative of all of the attention this has received. I understand that there's a discussion over at the FA (GA?) team page as to what to do with the article.  Honestly, a solid review with advice on how to get to true GA status is all I request, along with any help any of you are willing to offer.  You've all been an immense help insofar, and I only hope that you'll continue to be as supportive... maybe moreso? haha.  I feel as though GA is within reach, as long as a few somewhat minor details can be taken care of.  Lightspeed! Strombollii (talk) 02:48, 29 January 2009 (UTC)
 * I think various of us are conversing on about three different pages now, so I'll make this my only venue from now on for anything relating to this article. Firstly, thank you for your dedication and positive response to this unfortunate turn of events; as has been noted by others above, this needn't be a disaster, and you deserve credit for not making it so. Secondly, the article's GA review is now complete, although I haven't transcluded it to this page yet because... you now have two! It seems that User:Axl and I conducted simultaneous reviews; fortunately we mostly agree with each other, so I've suggested that we run this as a joint review. Perhaps we can merge our reviews to make things less confusing, but I'll wait for Axl's response before refactoring anything. What's the similarity between GA reviews and buses...?
 * Anyway, please don't feel you have to hang around waiting for us to get our acts together! There's plenty on the review page to get on with, so over to WikiProject AP Biology 2008... EyeSerene talk 15:50, 29 January 2009 (UTC)

Congragulations!
I believe a formal "congragulations" is in order for Mr. Strombollii. Glad to see that your hard work and dedication has rubbed off and created an article truly worthy of being called a "Good Article." Again, congrats and hopefully we can expect to see only better things from you. Cheers! FoodPuma 15:46, 28 January 2009 (UTC)
 * Haha thank you...I couldn't have even approached GA without you and those you recruited. Now to fix everything so it's actually a Good Article. Strombollii (talk) 16:40, 28 January 2009 (UTC)

Readability

 * C. lets break that endless sentence in the intro up with a few periods. Readability is essential in an encyclopedia. These med guys; bless them, know their content, but are programed to reading/writing medical journals!

Original: Osteitis fibrosa cystica (OFC, also known as osteitis fibrosa or Von Recklinghausen's disease of bone) is a disease of the skeletal system that is caused by a surplus of Vitamin D or parathyroid hormone, which triggers a release of calcium from the bones into the blood, resulting in increased osteoclastic resorption of bone, peritrabecular fibrosis (in which calcified supportive structures inside the bone are replaced with fibrous tissue, weakening the bone), and cystic brown tumors.

One that does not lead to asphyxiation: Osteitis fibrosa cystica (OFC, also known as osteitis fibrosa or Von Recklinghausen's disease of bone) is a disease of the skeletal system {PERIOD)The disease is caused by a surplus of Vitamin D or parathyroid hormone, which triggers a release of calcium from the bones into the blood. (PERIOD) This results in increased osteoclastic resorption of bone, cystic brown tumors and peritrabecular fibrosis (in which calcified supportive structures inside the bone are replaced with fibrous tissue, weakening the bone).


 * I was thinking the reordering of the consequences - so that peritrabecuolar is at the end with its (definition)would be esaier on the brain - assuming order is irrelevant to the content itself.--JimmyButler (talk) 05:09, 31 January 2009 (UTC)


 * "this can be discovered by testing the sensitivity of a patient's fingers." Is sensitivity a specific concept in the medical field? As a novice I was left wondering "Sensitivity to what? ... touch? temperature? pain? —Preceding unsigned comment added by JimmyButler (talk • contribs) 05:16, 31 January 2009 (UTC)


 * I too was reading your intro and found myself in a peculiar position on the use of: "resulting in increased osteoclastic resorption.. and cystic brown tumors.." Are these tumors not a sign presented during diagnostic imaging? Should this be simplified to "and tumors" with a mention of the specific brown characteristic being an associated sign/symptom? Just thoughts... FoodPuma 15:37, 8 February 2009 (UTC)


 * Also, might I suggest that you move the sub-title "History" and it's contents further down as, according to WP:MEDMOS, you should have the most relevant material at the top (referring to reader-relevance). FoodPuma 15:44, 8 February 2009 (UTC)

Undiagnosed?
The History section says: as a result of undiagnosed renal stones. This makes me puzzled. How do we know that this was renal stones if it wasn't diagnosed? Was it diagnosed by historians, based on records? Was it diagnosed when the symptoms reappeared? --Ettrig (talk) 15:21, 1 February 2009 (UTC)
 * My understanding, based on the source, is that the renal stones were diagnosed post-mortem. Strombollii (talk) 18:28, 2 February 2009 (UTC)

Refs from intro
(leaving them here for the time being)

— Preceding unsigned comment added by Strombollii (talk • contribs) 16:56, 5 February 2009 (UTC)

Cool source(s)
Thought I would throw out something I found in a random google search: Check meh out!. They have some great pictures on there too that you should try to get permission to use: [http://www.pathology.vcu.edu/education/endocrine/endocrine/parathyroid/micros/ostfibcs.htm meh! meh!]. FoodPuma 15:50, 8 February 2009 (UTC)