User talk:Richiez

Email: I am reading email but not nearly every day

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By the way, are you interested in Medicine? (I saw your edit at Inflammation. I'm an EMT, thinking about going to physician assistant school.  Anyway, Let me know on my talk page if you have any questions or want to discuss anything.

Again, welcome! Peace, delldot | talk 20:48, 30 December 2006 (UTC)

Wilhelm Gustloff Discussion
I see you have disputed my words on the Wilhelm Gustloff article. I assure you I have done extensive research on the tragedy and the aftermath. The words of Grass are opinions at best. Most people who know aboout the tragedy do believe that the sinking of the Wilhelm Gustloff was in fact a war crime, and hardly any of these people are on the far Right as Grass claims. This is supposed to be an information site, free from bias. I was merely stating the other side of the story, just without the citation some people, like you, would like. — Preceding unsigned comment added by 68.33.203.38 (talk) 07:59, 16 November 2012 (UTC)

A tag has been placed on Inflammation is not infection, requesting that it be speedily deleted from Wikipedia. This has been done under the criteria for speedy deletion, because it is a very short article providing little or no context to the reader. Please see Wikipedia:Stub for our minimum information standards for short articles. Also please note that articles must be on notable subjects and should provide references to reliable sources that verify their content.

Please do not remove the speedy deletion tag yourself. If you plan to expand the article, you can request that administrators wait a while for you to add contextual material. To do this, affix the template   to the page and state your intention on the article's talk page. Feel free to leave a note on my talk page if you have any questions about this. MarcoTolo 01:31, 25 July 2007 (UTC)


 * To contest deletion, consult Deletion review. --User:Ceyockey ( talk to me ) 11:38, 25 July 2007 (UTC)


 * That was a bit too fast for me to apply the hangon marker, I am not online 24 hours to check for such requests. Ok, learned a bit more.. should have placed a stub marker on the page when I created it I guess.


 * Anyway I have a new version of that article ready and will recreate it unless someone gives me other than formal reasons why it should not be there. Richiez 21:28, 25 July 2007 (UTC)\


 * Well, first of all, what content would your proposed article provide that isn't already in the main Inflammation article? -- MarcoTolo 21:35, 25 July 2007 (UTC)


 * I have uploaded a draft in User:Richiez/test1. It is short and says nothing that is not fairly obvious, but before saying it is unneeded try a search for "*itis is an infection". I found way too many instances even in "professional" literature. The intended use is to provide it as a link in places where this kind of confusion is frequent - a link to the main inflammation article may not be easy enough to understand for someone trying to figure out whether hepatitis is an infection or inflammation. Richiez 22:51, 25 July 2007 (UTC)


 * I doubt neither the confusion issue nor the validity of what you've written on your test page (you do need to cite your sources per Wikipedia guidelines, but that's another issue) - but I do think creating a new article as you propose is unlikely to be the best way to solve the problem. Most of what you've written could be added to the Inflammation and/or Infection articles, either in-line with current text or in a Historical (or perhaps Usage or Confusion) section. While I understand your desire to "make it easier to find", I think the opposite is more likely to happen: very short pages can easily get "lost" - other editors are much more likely to prefer linking to the main articles. I'm happy to continue to discuss the options with you - whatever the outcome. -- MarcoTolo 23:07, 25 July 2007 (UTC)


 * Maybe an "infobox" that could be placed on relevant pages would be better than a main article? Never created any infobox so that would be a bit over my head atm. The infobox could provide a link to a more verbose explanation somewhere else.Richiez 12:06, 26 July 2007 (UTC)


 * Infoboxes are seen by some editors as visually distracting, especially when several infoboxes appear in the same article (personally, I'm fine with one or two, but more than that can get to be a little much). It is possible to link to an article section (Smallpox would be an example) - you might consider proposing, say, a Usage section under Inflammation that could be pointed to as needed. -- MarcoTolo 21:03, 26 July 2007 (UTC)
 * If the infoboxes don't seem such a good option I would prefer having it a separate article. It does not fit into neither infection nor inflamation very well - it is a different subject and should be more of an introductory style. It will have one, maybe more subsections which would make it unfitting for the introduction part of the article. The inflammation article is already long enough that some parts of it are in separate main articles. Richiez 11:23, 27 July 2007 (UTC)

I should have been a bit more bold, but I do not have the time to repair that, nor was I aware that particular citation style was outlawed, I just knew it wasn't correct. In either case, it'll be fixed. There's no problem. Khargas (talk) 00:13, 29 February 2008 (UTC)
 * No need to be more bold but beeing more specific would help, also this does not belong to my talk page but rather Talk:Mastitis. The article is not perfect but the citations are mostly ok. Anyway I have started converting the citations to a different style. Richiez (talk) 17:57, 9 April 2008 (UTC)

Richiez, it is my impression that you loathe robotic surgery and think that it is useless. You have every right to your opinion. Your point is that the long-term benefits of robotic surgery are yet to be proven. I agree with you. However, the immediate benefits are indisputable. Robotic hysterectomy has at least the same immediate benefits as total laparoscopic hysterectomy. The problem with total laparoscopic hysterectomy is that most GYN surgeons are not interested in performing it. This is why most hysterectomies are still performed open. And that is precisely the reason why robotic hysterectomy is growing so quickly.

Thank you very much for not deleting my work this time. Lisa11777 (talk) 19:31, 29 January 2010 (UTC)


 * If you had seen so many new promising overhyped techniques and medications not deliver what they promised like I did you might be just as cautious. The problem with laparoscopic surgery is that it can take extremely long to perform and robotic surgery makes that significantly worse. There are other problems, see eg PMID 18175521.


 * Would you rather expose an patient to much longer surgery or choose a much quicker and safer laparotomy with the implication of longer healing time and reduced life quality for several weeks? Tough choice. Rates of complications are worse for laparoscopic surgery than for abdominal and even if there is an improvement for robotic over plain laparoscopic surgery (for which it is hard to find definitive data) it is not yet nearly enough to be en par with laparotomy in this regard. Richiez (talk) 23:28, 29 January 2010 (UTC)


 * Richiez, robotic surgery does have a tough learning curve, but expert robotic surgeons are able to complete their cases much quicker than expert conventional laparoscopic surgeons. Please view the following video which shows robotic hysterectomy completed in just 25 minutes.  Tell me what you think about it.
 * http://www.youtube.com/watch?v=w6bgr8SByWc&feature=related
 * Lisa11777 (talk) 00:03, 30 January 2010 (UTC)
 * Here's another quick case...
 * http://www.orlive.com/pinnaclehealth/videos/robotic-assisted-minimally-invasive-hysterectomy
 * Lisa11777 (talk) 02:16, 30 January 2010 (UTC)


 * "The 63 robotic procedures required a median operative time of 213 minutes from skin incision to closure, compared with 240 minutes with laparotomy (P=0.0015). Other significant differences favoring robotic surgery included:
 * •Estimated blood loss, 50 versus 400 mL, P<0.0001
 * •Number of lymph nodes, 29 versus 24, P=0.04
 * •Length of stay, one day versus four, P<0.0001"
 * http://www.medpagetoday.com/MeetingCoverage/SGO/12784


 * "Mean robotic hysterectomy time 129 minutes, few complications"
 * http://findarticles.com/p/articles/mi_m0CYD/is_9_41/ai_n27000052/
 * Lisa11777 (talk) 04:13, 30 January 2010 (UTC)

Hi again, I think it might be good to move the discussion to the Hysterectomy talk page, it may be of more general interest.

I did read many promising things about robotic surgery and remain sceptical, some of the claims appear unrealistic and strangely made up comparisons. My impression is that time required for surgery is still excessively long and rate of complications comparable or only slightly better than for classical laparoscopic surgery. It does not really matter if this is because of the learning curve - the fact that not enough surgeons are good enough to perform it better than traditional surgery is very relevant for the patient. Keep in mind nobody would like to be a patient in the starting end of this tough learning curve. Another aspect - so far robotic surgery was performed mostly by top surgeons. Only time will show what happens when it "hits the streets".

Anyway, in a wikipedia article personal opinion should not matter that much. The article can have any kind of information if it is in the appropriate context. For robotic hysterectomy it should be clear in the article that it is an emerging and essentially unproven technique until it becomes more widely used and more data exists. We should not kill it and we should not promote it. There is so many other things that require loads of work in the article. Richiez (talk) 14:06, 8 February 2010 (UTC)
 * Richiez, I'll tell you why robotic hysterectomy will become the standard of care. Robotic prostatectomy is now the standard of care for prostatectomy despite the fact that it is a much more difficult procedure than robotic hysterectomy because it requires anastamosis.  Many urological surgeons were as skeptical as you are about robotic surgery.  The whole point of robotic surgery is that it is MUCH easier than conventional laparoscopic surgery.  If conventional laparoscopy were easy, there would be no need for robotic surgery.  I "test drove" a robot last year and it is very easy to control.  It is designed that way.  Surgery with a robot feels as if your hands magically appear inside the patient without a large incision.  Compare that to conventional laparoscopy which feels as if you are performing surgery with 2-foot chopsticks.  Suturing with hands is a lot easier than suturing with chopsticks.  In my opinion, you should test drive a robot before you can truly judge it.  Lisa11777 (talk) 23:27, 11 February 2010 (UTC)

Previously you explained that robotic surgery has a tough learning curve and now you are trying to explain me how easy it is. Is it possible that a test drive is somewhat deceptive?

We are speaking about a technique which does not appear to have reached anything like 0.1% market share. Meanwhile it is not easy to finding reliable basic data for established procedures. You would think that with some 700,000 hysterectomies in the US it should be easy to find out something as trivial the mortality rates of the most frequent procedures. No way - the only thing that I found out after reading too many paper is that biggest mortality risk is beeing Medicare/Medicaid insured (HR 2.2-2.4).

Anyway, do you have suggestions what should be in the article? Actually there is so much that could be improved that I do not know where to start. Richiez (talk) 21:50, 14 February 2010 (UTC)
 * Richiez, where did you get your 0.1% market share figure? Approximately 70,000 robotic hysterectomies were performed in 2009.  That's 10% of your 700,000 figure.  That's more than significant.  Approximately 35,000 robotic hysterectomies were performed in 2008.  That a 100% growth rate in just one year.  Robotic surgery is not the fad that you want it to be.  Let me ask you a question... If you were to need a cholecystectomy, would you choose an open cholecystectomy or a laparoscopic cholecystectomy?Lisa11777 (talk) 04:07, 17 February 2010 (UTC)

The 0.1% market share was my impression after reading a few dozen abstracts on medline. Do you have a source for your 10%? It was my impression that laparoscopy as whole has around 10-15% or less, much less robotic surgery. Also do not forget other parts of the world.

No I do not think it is a fad although the term "robotic surgery" is rather unfortunately chosen in my opinion.

Cholecystectomy or other kinds of surgeries may be a good indicator of things to come. But every new technique needs some time to find its place, sitautions when it is particularly good, bad or useless, data on counterindications, experience how to deal with problems, experience with training of staff. Richiez (talk) 14:51, 17 February 2010 (UTC)
 * The following article mentions 69,000 robotic hysterectomies in 2009.....
 * "Clinically, we had another excellent quarter, once again experiencing double-digit sequential procedure growth. Demand for our targeted da Vinci procedures continues to be robust. Hysterectomy growth, both for benign and malignant conditions, continues to lead the way. In 2009, our customers performed approximately 69,000 dVH's worldwide, which is an estimated doubling of the 2008 total. dVP, which is still our largest individual procedure, showed solid growth for the year, registering an estimated 90,000 procedures worldwide. Overall, we finished 2009 having completed an estimated 205,000 procedures, representing several different procedure categories. In addition, nearly 300 da Vinci-related clinical publications and abstracts within various peer-reviewed journals during the quarter."
 * http://seekingalpha.com/article/183777-intuitive-surgical-inc-q4-2009-earnings-call-transcript?source=yahoo&page=-1
 * Lisa11777 (talk) 21:56, 17 February 2010 (UTC)

Thanks for the link. The figure is worldwide so that would give perhaps 0.5% market share. Maybe more in the US but I do not have the numbers. Not that market share would matter that much, the amount of good publications is more important.Richiez (talk) 13:14, 20 February 2010 (UTC)
 * Richiez, if you are a surgeon, there's a good chance that Intuitive Surgical would bring a robot to your home or office for free so that you could test drive it without further obligation. What have you got to lose? Lisa11777 (talk) 00:20, 18 February 2010 (UTC)
 * Lisa11777 (talk) 21:56, 17 February 2010 (UTC)

Thanks for the link. The figure is worldwide so that would give perhaps 0.5% market share. It may be a lot more impressive in the US but for whatever reason they choose to publish the worldwide figure.

Anyway, thanks for your suggestions. Regarding the WP article it is certainly possible to add more details about robotic surgery but some balance should be maintained - the other methods and sections could use plenty more details as well and atm they are still more important than robotic surgery. Richiez (talk) 13:14, 20 February 2010 (UTC)
 * The vast majority of robotic surgeries are currently perfomed in the United States because most of the surgical robots sold are in the United States. If you want to see the future of hysterectomy, study the history of prostatectomy.  If you are a surgeon, you will soon be at a competitive disadvantage if you refuse to learn robotic surgery. Lisa11777 (talk) 13:57, 20 February 2010 (UTC)
 * Approximately 1.8 million hysterectomies per year are performed worldwide. 69,000 robotic hysterectomies equals 4% market share, plus continued future aggressive exponential growth.
 * Lisa11777 (talk) 14:05, 20 February 2010 (UTC)

The 1.8 mio hysterectomies worldwide estimate is wrong by several orders of magnitude.Richiez (talk) 14:47, 20 February 2010 (UTC)
 * Very well. What is your figure for annual worldwide hysterectomies?Lisa11777 (talk) 01:08, 21 February 2010 (UTC)
 * " Of the 1.8 million hysterectomies performed annually worldwide, (600,000 in the US and 60,000 in Canada), treatment of dysfunctional uterine bleeding accounts for approximately 50% of these procedures." http://www.thermablate-eas.com/thermablate/AboutUs/CompanyHistory.aspx   Lisa11777 (talk) 02:29, 21 February 2010 (UTC)

Just a little common sense. 700,000 for a population of 240 mio. 1,100,000 (the rest) for a population of 6 billions? UK has a rate (per capita) close to the US, Germany and rest of Europe and Russia around 2/3 of it. This alone is more than your 1.8 mio and does completely ignore China, Africa, India and Southern America among others - approx 80% of world population and especially in China and Southern America they have not diminishing rates of hysterectomy. Under the assumption that rest of the world has 60% of the US rate you get 10,700,000 per year. You can tweak the numbers a bit but 1,800,000 is a joke. Richiez (talk) 13:17, 21 February 2010 (UTC)
 * Don't be rude. 1.8 million is not a number that I created.  It was from a website that I provided.  What is your source for 10.7 million other than your own guess?  If your motivation is to conclude that robotic surgery is insignificant, then you need to back up your claims with sources.  Furthermore, of course rest-of-world robotic surgery is going to be less common than it is in the USA.  Robotic surgery is a U.S. invention with no international competition.  And U.S. medicine is state of the art.  Not to mention that most people who read this Wikipedia hysterectomy article are Americans who are most concerned with U.S. medicine, not international medicine. Lisa11777 (talk) 14:21, 21 February 2010 (UTC)
 * Quote: "Hysterectomy is the surgical removal of a woman’s uterus. Approximately 1.8 million procedures are performed worldwide each year." Source:  http://www.biomet.com/biologics/international/print/BIV0010.0_051508_new.pdf
 * Quote: "The frequency with which hysterectomies are performed in the United States has been questioned in recent years. It has been suggested that many hysterectomies are unnecessary. The United States has the highest rate of hysterectomies (number of hysterectomies per thousand women) of any country in the world.Also, the frequency of this surgery varies across different regions of the United States. Rates are highest in the South and Midwest." Source:  http://www.faqs.org/health/topics/56/Hysterectomy.html
 * Quote" "The United States has one of the highest rates of hysterectomy in the world, with about 5 out of every 1,000 women each year having the operation, according to the CDC. Other industrialized countries show lower rates; in England, for example, the rate is less than 3 per 1,000 women annually. In Norway, it's less than 2 in 1,000. Some are concerned that many hysterectomies are done unnecessarily in this country."  Source:  http://www.hoptechno.com/Hysterectomy.htm
 * Quote: "We have four times the hysterectomy rate of any industrialized nation, in this country,'" said [Ernst] Bartsich, a clinical associate professor at Weill Cornell Medical College. Source:  http://hysterectomyinformation.blogspot.com/2009_01_18_archive.html
 * Quote: "We have four times the hysterectomy rate of any industrialized nation, in this country,'" said [Ernst] Bartsich, a clinical associate professor at Weill Cornell Medical College. Source:  http://hysterectomyinformation.blogspot.com/2009_01_18_archive.html

This does not lead anywhere and your US centric attitude is not wikipedia policy. If you want to include information about "market shares" of the different techniques try to find a single reputable source that lists the market shares of all variants for any particular industrial country. The information would be interesting to have but must pass reality checks. Most of the links you provided above do not pass any reality check. France and Germany have a hysterectomy rate that is 50-80% that of the US rate, not 4 times lower as some associate professor wants you to believe. Russia and much of eastern Europe were traditionally hyster-happy and this is changing only very slowly.

You think that I have something against robotic hysterectomy? Not really. If the US would convert to 100% robotic hysterectomies everyone would be happy: there would be 90% less hysterectomies because nobody could pay them and there are not enough surgeons who could perform them were they doing hysterectomies 24 hours a day. Health care providers would feel real economic pressure to improve on alternatives. The few women who would still have hysterectomies would have much better care and surgeons would get much more money for less hysterectomies. So go ahead and push it but wikipedia is not the platform for this. Richiez (talk) 23:57, 21 February 2010 (UTC)
 * You criticize my sources yet you fail to provide sources. As for me "pushing" robotic surgery, I don't have to push it.  It is growing exponentially against your wishes.  Of course it is more expensive than open surgery.  Less-invasive surgery is expensive.  Smaller incisions is more expensive.  Shorter hospital stays are more expensive (oh wait maybe not).  Heck, if you really want to save money, don't perform surgery at all.  Lettting the patient die is the most economical option.  In fact, think of the money we can save by getting rid of anesthesiologists.  Just put a bite block in the patient's mouth and tell them take the pain.  Let's get rid of ALL expensive hospital procedures including MRI and CT scan.  You have the freedom to be anti-robotic-surgery, but you shouldn't be writing a public hysterectomy article if you are so biased.  When laparoscopic cholecystectomy was invented, plenty of general surgeons thought it was a joke and a fad.  Now the vast majority of cholecystectomies are laparoscopic.  Your dismissal of robotic surgery is precisely similar to their hatred of lap chole when it was new.  If you can find a reputable source that claims 10.7 million hysterectomies per year, then you should add the figure to the article.  You should not base a wikipedia article on your opinion.  Lisa11777 (talk) 01:25, 22 February 2010 (UTC)
 * You stated that patients would not be able to afford robotic surgery. Hundreds of thousands of patients have already had robotic surgery covered by their health insurance.  Lisa11777 (talk) 01:25, 22 February 2010 (UTC)
 * Robotic surgery will eventually become MUCH less expensive once the patents expire and competitors produce generic robots. Lisa11777 (talk) 02:00, 22 February 2010 (UTC)

Ok, this is getting ridiculous, you are implying things which I never wrote and incidentally are neither my opinion nor do I wish to discuss them. I see no point continuing this kind of discussion. If you think that I have introduced any bias into the article be more specific. It is hard to avoid noticing that all but one of your edits are about robotic surgery so you seem to have a great interest in that. Want to explain your motivation?

If you want to improve the article go ahead. Have a thorough look at relevant wikipedia policies and how some of the better medical articles in wikipedia are written. Its no secret that the hysterectomy article currently leaves much to be desired. Please respect that the kind of number juggling that is perfectly fine in talk pages should not appear in medical articles. If you want to claim that robotic surgery has a 5% market share worldwide find a source that says exactly this but its generally not acceptable to take controversial numbers from different sources and combine them to compute a market share. If DaVinci doesn't publish market share its their decision. Richiez (talk) 12:53, 22 February 2010 (UTC)
 * I have no desire to publish the market share. You are were the one who brought up the topic of market share.  What I do know is that robotic surgery is much more important than you believe it is, and that it deserves much more discussion in the Wikipedia hysterectomy article than you are tolerating.  No, I do not want to reveal my background.  You already threatened to figure out who I am by using my IP address.  Let's just say I have been researching robotic surgery since 2005.  Do you wish to reveal your background? Lisa11777 (talk) 12:59, 22 February 2010 (UTC)
 * I have a suggestion. Add a section to wiki hysterectomy about the future of hysterectomy.  I would love to read it. Lisa11777 (talk) 13:07, 22 February 2010 (UTC)

I am not against discussion of robotic surgery but not on my talk page. How about improving robotic surgery. Robotic surgery can also have its place in the hysterectomy article if it is in approximate proportion of significance - which is where the approximate market share would be interesting for me. It is not terribly useful to describe something that most women can not have as of today.

Its ok if you are interested in robotic surgery only but the hysterectomy article has more serious problems. I have my own special interests which you can easily see if you look at my contributions, in fact I only stepped in for the hysterectomy article because it was even more desolate than it is now. But apparently you did not care about the overal shape of the article as long as it contained your statement that robotic hysterectomy is the fastest growing thing? Richiez (talk) 13:50, 22 February 2010 (UTC)
 * You stated, "It is not terribly useful to describe something that most women can not have as of today." That's like saying that it was no big deal when electricity was invented because most people did not have access to it yet.  The main reason that most women who need hysterectomy undergo open hysterectomy is that they are not educated that robotic surgery exists.  I would assume that most surgeons who prefer open surgery do not tell their patients that large incisions are avoidable.  Robotic surgery is important because it is REVOLUTIONARY.  And the revolution has just started.  Lisa11777 (talk) 13:59, 22 February 2010 (UTC)

Fine, at least I see what is your point. If you want a revolution wikipedia is not the platform of choice. Any blog or personal website is much better for that purpose. If you have an activist website there is even a chance that it could be linked from wikipedia.

Many laparotomies are indeed avoidable - almost all are avoidable in principle. Do not get carried away, many revolutions went wrong. There can not be a general recommendation for all cases. Today vaginal hysterectomy appears to be the best alternative in many cases - it may be robotic laparoscopy tomorrow. Progress is painfully slow and in retrospect you would wish many methods but especially medications had been tested even longer before they were unleashed. It is one of the problems in surgery that FDA approval procedure comparable to new drug evaluation is not required for most novelties. Robotic surgery had some evaluation because it introduced new tools but that is far from the scrutiny that new drugs have to pass.

One thing to keep in mind, all variants of hysterectomy are relatively safe and free of serious adverse effect short term. The long term effects is what causes much greater concerns and unfortunately data is completely lacking to be able to evaluate if some technique has advantages regarding some particular adverse long term effects. It looks so simple, a smaller cut or bigger cut, more or less blood but how does hysterectomy cause renal cell carcinoma? Is it true that laparoscopic procedures carry a greater risk for RCC than laparotomic?

The hysterectomy article can of course list all variants so women have a chance to educate themselves. The robotic section can be as big as you wish if you volunteer to improve the other sections so that it is not out of proportion and respect wikipedia style. My impression is that it would be better to improve the robotic surgery article and link it form hysterectomy.

Respecting wikipedia style is not tyranny. It should be obvious that if you would reinstate the paragraph in the style as I have deleted it a few times you gain absolutely nothing - people will only turn away in disgust thinking that this is the most primitive form of advertisement. Richiez (talk) 16:27, 22 February 2010 (UTC)
 * You wrote, "Today vaginal hysterectomy appears to be the best alternative in many cases." Remember you asked me to point out your bias?  There's your bias.  You want readers to believe that vaginal hysterectomy is the way to go despite the fact that abdominal hysterectomy is indicated most of the time.  That sir, is bias.  You also omit the fact that vaginal hysterectomy carries a higher risk of injury to organs.  You act as if vaginal hysterectomy is risk-free compared to other techniques.  Would you care to explain why you omit the risks of vaginal hysterectomy?  You accuse me of advertising, yet your article sure looks like an ad for vaginal hysterectomy.


 * You wrote, "Do not get carried away, many revolutions went wrong. There can not be a general recommendation for all cases." There you go again.  You keep acting as if robotic surgery is still experimental.  It is not.  It is approved by the FDA.  There are over 1,400 robots in use worldwide despite the high pricetag.  And at least one new robot is sold everyday.  Let me ask you this.  How successful does robotic surgery have to become in order for you to take it seriously?  When your patients take their business elsewhere?


 * You wrote, "It should be obvious that if you would reinstate the paragraph in the style as I have deleted it a few times you gain absolutely nothing - people will only turn away in disgust thinking that this is the most primitive form of advertisement." Oh yeah, it would be so horrible if a woman learned that large incisions are unnecessary.  I'll tell you one thing.  If I were to need a hysterectomy, I would be very angry if my surgeon encouraged me to have an open hysterectomy without informing me that robotic surgery exists.  It would be like a car mechanic telling me that he needs to disassemble my engine just to change the oil.  Until patients are properly educated about their options, they will continue to get large incisions.  Luckily, open surgery is an endangered species of surgery.  Just look at prostatectomy.   Lisa11777 (talk) 23:08, 22 February 2010 (UTC)
 * Other disadvantages of vaginal hysterectomy: Possible shortenting of vagina length, which may cause painful intercourse in the first months after surgery. Difficulty in removing a large uterus or large fibroids and areas of endometriosis and adenomyosis. Less operating space makes it difficult for the surgeon to see other pelvic organs.  Lisa11777 (talk) 23:21, 22 February 2010 (UTC)
 * What we should do is publish a table of advantages and disadvantages of each technique. Lisa11777 (talk) 01:39, 23 February 2010 (UTC)

Regarding my "bias" towards vaginal hysterectomy - I am trying to give a reasonable interpretation of the Cochrane Review which is linked from the article. Of course there are many problems with every approach but that is the best data I have. I tried to obtain more detailed data on various kinds of complications with various techniques. I found many and they all give inconsistent and conflicting views which makes me believe that the Cochrane review is the best data that I have seen so far.

Laparotomy gets away pretty good in my opinion, if it is not clear from the comparison section than I will amend it somehow. I am currently somewhat sceptical about laparoscopic hysterectomy, and before robotic surgery can demonstrate how much better it is than I am obviously taking it with some caution as well - a case of difficult parents.

It is not the matter whether I take it seriously, I am SciFi fan - but in a wikipedia article about medicine you can not make claims that have yet to be proven.

What is so wrong about the current description of robotic hysterectomy anyway? I think the only thing that can be improved is the technical description. You can add to its advantages in the comparison section as more data becomes available. I am cautious because of the usual pitfalls of comparing old methods with expensive technology like only top surgeons perform it, manufacturer sponsoring, economic pressure etc.

You think women should be educated which is right. The problem is there is not even enough data to educate them about the options that are widely available now.

I do wholeheartedly agree that there should be a table with advantages and disadvantages of each approach. Obviously I had something like that on my mind when I started the comparison of techniques section. Did not get far - no data on long term outcome by technique, very limited data on mortality rates, only meaningful data on complications is the Cochrane report which is not enough to make a detailed table of complication by technique. For some variants not even the most basic data is available - how many LAVH procedures do US surgeons perform?

Also, "old" techniques are constantly evolving and what one surgeon can do with one technique another can do better with another.

What else is left? General wisdoms like length of surgery, hospital stay, approximately what is doable by which technique and trivia of that kind which someone of Mr Walids stuff is constantly pushing into this section to increase citation counts.

One particular problem is that much of data from the US is heavily blunted. In the US, beeing medicare/medicaid insured is the biggest independent mortality risk for hysterectomy (HR 2.9, http://content.nejm.org/cgi/content/full/335/7/483). When you take into account which variants of surgery these women will receive in 99% of cases you know which one should come out shining best because medicare/medicaid patients almost never have a chance to get this.

Speaking of that there should be also a table of risk factors and the alternatives section needs to mention the 2 best available alternatives and provide comparisons. Richiez (talk) 12:50, 23 February 2010 (UTC)
 * In the article, you wrote, "Vaginal hysterectomy was shown to be superior to LAVH and all other types of laparoscopic surgery (sufficient data was not available for all types of laparoscopic surgery)." Explain to me how you can conclude it is superior if the data is incomplete.


 * In the article, you wrote, "A recent Cochrane review recommends vaginal hysterectomy over other variants where possible." That article does not mention robotic surgery, so your comment is inaccurate.


 * Is that really so hard to understand. I will see if I can reword it better. It is unfortunate that the Cochrane review does not mention the robotic surgery. Which is why there was the "(sufficient data was not available for all types of laparoscopic surgery)" . A whole lot of other methods was never shown to be bad or inferior and they were neither elaborated in that article. They may be good or bad - there is nothing a wikipedia article can do about this if there is nor reliable data.
 * You seem to believe very firmly that robotic hysterectomy is much better than standard laparoscopic surgery. I did look at a bunch of articles and at least one review and at this point this has to be demonstrated. In fact the little data that I have seen does place it somewhere very close to laparoscopic surgery. Richiez (talk) 14:13, 23 February 2010 (UTC)


 * In the article, you wrote, "Abdominal hysterectomy is now used only in special cases such as after caesarean delivery, when the indication is cancer, when complications are expected or surgical exploration is required." Your comment is misleading because it implies that abdominal hysterectomy is rare, when it is in fact the most common approach.  Lisa11777 (talk) 13:28, 23 February 2010 (UTC)


 * You are right, it was more of a wish it was used only when there was solid indication. In this case I think it would be better to write that that while abdominal hysterectomy has some strong points it is probably overused by a factor of 3-4x. Richiez (talk) 14:15, 23 February 2010 (UTC)


 * I remember I wrote that at one time but have it improved very soon afterwards - and this was several weeks ago. Why do you waste my time with this now. Look at it again and see if there is anything that can be improved. Richiez (talk) 00:00, 24 February 2010 (UTC)
 * Are you saying there is a statute of limitations for wiki edits?


 * No idea what you are trying to say. The article was in heavy flux for a few days. I could have done my edits in a testpage and install them as one huge edit, however I prefer to edit wiki texts in smaller increments and lots of comments so everyone can see the progress of what I am doing and comment on it while I am doing it - and not three weeks after it has been changed. Inevitably the intermediate text is not always perfect and there is still lots that needs to be further improved... a wikipedia article is never complete. Richiez (talk) 22:18, 24 February 2010 (UTC)

Incidentally, if you would read the sources that have been linked from the article for weeks now you would know that in some countries the great majority of surgeries is not by laparotomy (PMID 11319467). Richiez (talk) 00:10, 24 February 2010 (UTC)
 * So you are saying that the trends of some countries is more important than the worldwide trend? Are you being "centric"?  Didn't you say it is against wiki policy to be centric?

No, I am saying that the US is not the only state on the planet and something that is completely unheard of in your country is standard practice in other places. Imo it is very important to compare data from different regions and countries, the fact that some 65% of hysterectomies are by vaginal route could be certainly very interesting for many people as it clearly demonstrates how much laparotomy could be reduced. It would be also interesting to know why this is possible in France - wonder if it has anything to do with the strong self- and body- consciousness of French women but the article does not say anything about that. Richiez (talk) 22:18, 24 February 2010 (UTC)
 * If you are fine with publishing that vaginal hysterectomy is most popular in a few countries, then you should be fine with publishing that robotic hysterectomy is growing like wildfire in the USA. Either we are centric or not. Lisa11777 (talk) 01:40, 25 February 2010 (UTC)
 * You wrote, "everyone can see the progress of what I am doing and comment on it while I am doing it - and not three weeks after it has been changed." You need to accept the fact that wiki articles are NEVER completed.  They are dynamic.  You are not the owner of this article.  Everyone has the right to make changes to it anytime they desire, especially if the article contains inaccurate statements.  Lisa11777 (talk) 01:44, 25 February 2010 (UTC)

I was never saying anything else. Also I am fine with your latest change.

Regarding the wildfire, I have not yet written the French vaginal hysterectomy part into the article. Of course it is ok to write both, in fact it would be very nice if there were a table listing a few countries and as many techniques as we can find data for. Table would be imho better than having this numbers/claims spreckled all around the place and getting outdated as things change.

Btw I hope you find good sources for your claim of a wildfire. The link from the manufacturer earnings conference is not well suited for a medical article, a statement from a major health provider or in the worst case an activist group or newspaper that does not directly quote the manufacturer would be much better.

I will be away for some time so play with it as you like. Richiez (talk) 20:38, 25 February 2010 (UTC)
 * Yeah, yeah, yeah.... all sources about robotic surgery are dishonest, and all sources promoting vaginal hysterectomy are honest. Only your sources are to be trusted.  Everything I write must be a lie.
 * You are underestimating robotic surgery at your own peril. Keep making those unnecessary large incisions until you lose your customers. Lisa11777 (talk) 22:42, 25 February 2010 (UTC)
 * If I were tell you that the sky is blue, you would tell me that my sources are dishonest. If I were tell you that the Earth is round, you would tell me that my sources are dishonest.  If I were to tell you that 2+2=4, you would tell me that my sources are dishonest.  If I were tell you that Obama is the president of the USA, you would tell me that my sources are dishonest.   Lisa11777 (talk) 22:47, 25 February 2010 (UTC)
 * Thanks for giving me permission to edit the article. I didn't realize that you are my boss.  Lisa11777 (talk)  —Preceding undated comment added 22:51, 25 February 2010 (UTC).

Thank you for the clarification. Good to know what your intention is. Richiez (talk) 23:37, 25 February 2010 (UTC)
 * My intention is educate people that large incisions are unnecessary. Lisa11777 (talk) 23:43, 25 February 2010 (UTC)

Some friendly soul placed a few useful links on your talk page, among others the manual of style which links to the manual of style for medical articles and many others. If you follow these nothing can go wrong. There is also about a hundred pages about sources, citations and related issues. Each of those has talk pages where you can ask for help. And whoever placed it there did really mean that you should read it and understand it before you start editing articles. You can educate people but wikipedia has rules how that can be done.

And please stop getting silly. Richiez (talk) 01:44, 26 February 2010 (UTC)
 * You keep referring to wiki rules, yet you have broken them. You insult surgeons who use robots, stating that they are too unskilled to operate without them.  You have intimidated users by bragging that you know their IP addresses.  You arrogantly try to dictate how I may edit articles even though you are not in charge.  You have turned the article into a biased ad for vaginal hysterectomy.  All of these behaviors are against wiki policy.  Your employees may have to tolerate your arrogance, but I do not.  Lisa11777 (talk) 02:35, 26 February 2010 (UTC)

Please look at the help pages you have been provided with and ask for help at the respective talk pages.

I have never claimed that the article is my property and I am open to criticism. However this is not a constructive discussion and I will stop replying to your comments until you change attitude.

You can safely ignore me, wikipedia is not my property. Others will keep an eye on you and enforce Wikipedia rules.

Once again, this place is not for advocacy. It is much easier to get a personal webpage where you can publish anything you like.

If you think I am unfair ask for help, wikipedia has rules and guidelines for it and someone will love to help you. I will completely ignore all your comments and if I see any disruptive editing or other bad behavior I will ask some experienced administrator to take care of the problem.

Period. Richiez (talk)

Optimal decision definition
Hi Richiez,

Thanks for your contribution to the Optimal decision article. It's not entirely clear to me what the phrase "An optimal decision in nondeterministic systems is is the decision with the best utility/risk ratio." that you added refers to. If you by "nondeterministic system" mean a system with uncertain outcome (such as described further on in the article), the optimal decision is as I see it a decision such that no other available decision options will on aveage lead to a better outcome (according to whatever system of rating goodness is used). The utility/risk ratio is only one particular such goodness measure, and I cannot see how it is better suited for nondeterministic systems unless you mean expected utility/risk ratio.

Best wishes,

--Winterfors (talk) 18:16, 1 May 2010 (UTC)


 * yes, I did mean systems with uncertain outcome. I think we agree that in such systems it is not easy to define what the optimal decision is. The utility/risk ratio was not meant literaly but as a compound metrics with elements of expected utility vers expected or tolerable risk. I do not think there is one such metrics that would fit all cases. The mathematical formulation further down imho is only one special case.


 * So please feel free to reformulate it as you see fit it - my edit was mainly to make it clear in the introduction that the situations are very different in deterministic and nondeterministic cases.


 * Richiez (talk) 22:59, 1 May 2010 (UTC)


 * Ok, I've now modified the intro, trying to simplify the language while keeping the point you wanted to make.


 * When you say the mathematical formulation further down imho is only one special case, what kind of generalization do you have in mind?


 * --Winterfors (talk) 12:24, 2 May 2010 (UTC)


 * I was scratching my head about the mathematical formulation and have problems understanding 2 aspects:
 * is "o" always a continuum where Integration is applicable.. perhaps this would deserve some explanation.
 * how does it work when there are risks that must be avoided at every cost? Can you assign a infinite negative value to the Utility?


 * Richiez (talk) 23:51, 2 May 2010 (UTC)


 * The integral is a symbolic notation, where "o" is not necessarily continuous, it might be discrete (finite or infinite). In that case, the integration is with respect to a counting measure (and can be rewritten as a sum).
 * One can assign infinite negative utility to an outcome, but that will require for the probability of that outcome to be zero in order to make the expected utility well-defined.
 * --Winterfors (talk) 10:19, 3 May 2010 (UTC)

Thanks for the comments. That is what I would have done intuitively but I hoped there would be a "canned" and mathematically usable formulation for all that. Assigning infinite negative utilities for risks is problematic - we have a more or less arbitrary defined utility mapping (such as -inf for certain risks) while the probability density and the set or continuum of choices may be physically defined. Such models require special attention otherwise they do not mix well.

Expected utility hypothesis should probably be linked from the article? It has a nubmber of links such as risk aversion and prospect theory which I consider interesting alternatives to your definition as they try accomodate psychological factors like overestimating highly improbable large risks - even if that means that the resulting choice may not be optimal in a mathematical sense anymore.

Still, neither elaborates the "avoid certain risk at all cost" scenario particularly well. Richiez (talk) 11:54, 3 May 2010 (UTC)

Please remove IP block!!!
--- block/unblock details removed ---

I am behind the NAT of my provider and have no influence which IP I will be assigned and several dozens maybe hundreds of users typically share IPs in this range. I have no idea why the user has been IP blocked but it is pure coincidence if he has been assigned the same IP like me.Richiez (talk) 20:48, 4 May 2010 (UTC)

Analgesic
fyi: it:Discussioni utente:Xqt -Xqt (talk) 16:26, 14 May 2010 (UTC)

Talkback
 Giftiger Wunsch    [TALK]  15:32, 2 June 2010 (UTC)

Dermatology
Any interest in dermatology? If so, we are always looking for more help at WP:DERM, particularly with the ongoing Bolognia push. I can send the login information to you if interested? Regardless, thanks for your help on Wikipedia! ---kilbad (talk) 20:40, 4 June 2010 (UTC)

Your query
The edit to which you refer is suggested by AWB and one I typically go along with. It doesn't result in any visible change to the article, but saves file space, makes source code easier to read, and, as you point out, is easier to type. See Wikilink. -- LilHelpa (talk) 22:14, 13 June 2010 (UTC)
 * Amazing, did not realise piped links are clever like that now. I tend to be cautious about such features because occasionally I do edit wikis in other languages where it is unlikely to work like that. Richiez (talk) 22:24, 13 June 2010 (UTC)

Re: Roeach
Actually no. Got basic information through google and worldcat search:

http://books.google.com/books?id=HlffQgAACAAJ&dq=Roeach&hl=en&ei=ZzgpTMW7OcL7lwe7yfX-Bw&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDoQ6AEwAg

http://www.worldcat.org/title/roeach-leerboeken-godsdienst-aso-jef-bulckens-werkschrift/oclc/67506911

http://dbiref.uvt.nl/iPort?previous=5&sessionid=312777704380&request=full_record&position=1&domain=Dome

Trying to find someone at Tilburg Netherlands who could bring me at least copies of a few front pages and the content quoted by Dr. Alexandra Colen.--Remind me never (talk) 00:10, 29 June 2010 (UTC)

Circumcision
It is being suggested that there is a consensus now on the use of 'uncircumcision', and editors have 24 hours to register their view on this. Your input would be appreciated. -  Mish Mich  -  Talk  - 00:31, 7 July 2010 (UTC)

Risk factors for breast cancer
We should go by what the ref says rather than adding our own analysis. PMID: 7473816 says "Taken together, these well-established risk factors accounted for approximately 47% (95% CI = 17%-77%) of breast cancer cases in the NHEFS cohort and about 41% (95% CI = 2%-80%) in the U.S. population." Thus this is what we should have IMO. Doc James (talk · contribs · email) 21:26, 15 September 2010 (UTC)
 * In that case I would rather remove the ref completely.. looking for something better now.Richiez (talk) 22:04, 15 September 2010 (UTC)
 * Yes it is a little old. If you can find something newer and better that addresses the same point please feel free to replace it. Doc James  (talk · contribs · email) 22:33, 15 September 2010 (UTC)
 * I must be blind but can not find anything better now, so unless I am lucky happen to find something I will reformulate the section to cite the contributions of single factors. I am under the impression it is a mainstream view that well known medical risk factors - excluding income which does not really count as medical risk factor - currently account for 20-35% of breast cancer cases but nowhere near 50%. Richiez (talk) 09:27, 16 September 2010 (UTC)

Re
I replied on my talk page. ---kilbad (talk) 14:25, 22 September 2010 (UTC)

Canon Law (Catholic Church)
I saw your comment on the structure of the Code. For that, see Code of Canon Law. Thanks and God bless! Canon Law Junkie §§§ Talk 16:46, 25 September 2010 (UTC)
 * Thanks for the info, seems to be work in progress? The articles need a more general perspective, for readers someone not too familiar with the inner workings the Catholic Church. Richiez (talk) 20:35, 25 September 2010 (UTC)

Breast cancer
Hi Richiez, can you recommend a specific revisionID of the breast cancer article for us to use in the Version 0.8 release? We're trying to wrap things up now. Many thanks, Walkerma (talk) 02:47, 24 October 2010 (UTC). Also, do you think this version of the Atorvastatin article is OK? Someone just added a paragraph in the "adverse effects" section which looks very reasonable and balanced, but I know such things are often controversial - can you take a look? Thanks, Walkerma (talk) 02:59, 24 October 2010 (UTC)
 * Actually, we found we'd failed to contact a few of the WikiProjects, so it's going to be at least another week before we shut things off for changes. If you can get a nice version by next Monday (15th), that should be OK.  Thanks, Walkerma (talk) 13:04, 8 November 2010 (UTC)

Male Lactation Article.
The length of the article is irrelevant. All information must be sourced reliably, avoid weasel words and be notable in nature.

"While human males may have frequently wished and attempted to breastfeed babies documented cases are exceedingly rare and may involve pathologic conditions."

The statement is POV as it is pejorative by saying "frequently wished" and "may involve pathological conditions" these are weasel worded and subjective. There are no sources backing up the claim and the whole phrase is badly worded and unverified. It could just be that you have added because that is what you think which is not how the works. Please see WP:notable WP:POV WP:verify and WP:weasel, for what can and cannot be included in an article. This statement wholly misses all of those points and fails to meet the standards for inclusion. --Lucy-marie (talk) 22:28, 6 December 2010 (UTC)
 * Do you want a source for which claim: an exact citation of the paragraph, any part of thereof? Richiez (talk) 22:53, 6 December 2010 (UTC)
 * The whole lot needs sourcing and verifying. The whole statement and all claims made within it need sourcing and verifying.--Lucy-marie (talk) 22:59, 6 December 2010 (UTC)

We need to go with what the ref says
The ref says "Our findings suggest that moderate physical activity, including brisk walking, may reduce postmenopausal breast cancer risk and that increases in activity after menopause may be beneficial." Thus we should say something similar. Doc James (talk · contribs · email) 16:36, 5 January 2011 (UTC)
 * Thats fair, the edit summary made me wonder. When I have nothing else to do I sure want to review the literature on BC and exercise - seen some information that it may have an especially significant effect in high risk groups. Richiez (talk) 19:05, 5 January 2011 (UTC)

Hi Richiez,

Thank you for giving me some constructive criticism on my edit on Hypothyroidism. I will work with the existing articles next time for citations.

Regards, Ellen — Preceding unsigned comment added by Ellen Ada Goldberg (talk • contribs) 19:56, 19 March 2011 (UTC)

Editing etiquette
Hi Richiez,

Thanks for extending a welcome. I'm all for working together harmoniously.

I came to Wikipedia from a forum that discusses hypogonadism, where some individuals wanted to lower their prolactin based on the statements that you've authored. They blindly believed that men should have a prolactin level of 2-4 ng / mL, simply because you said so.

I have nothing against you (I don't even know you), I'm just a bit flabbergasted by your insistence that I not update this unsourced information that I've repeatedly shown is incorrect. You insist that normal prolactin levels are between 2-4 ng / mL, and yet you cannot find a source to back it up. I've shown you two medical journal articles involving over a thousand subjects that establish this value to be much higher, at 10-11 ng / mL. Furthermore, I've shown you three medical journal articles that detail how prolactin at levels below 5 ng / mL actually are associated with pathology such as infertility and the metabolic syndrome. By preventing me from updating, not only are you in violation of Wikipedia's guidelines, you could actually be misinforming people in such a way that could ultimately be harmful to their health, as is the case with the forum I previously mentioned. I find this very frustrating.

Speaking of Wikipedia's guidelines, I would like to point out that your editing etiquette is quite nonstandard. For example, when you are the author of unsourced statements, and you insist upon their inclusion despite evidence that they are incorrect, then you are guilty of original research (see WP:NOR). By preventing anyone from updating your information, you are guilty of ownership (WP:OWN). By deleting the section entirely instead of letting someone update the incorrect information with sourced information, you're doing a little of both. I'm not stating this to personally attack you, I'm simply identifying what is happening.

I actually do assume that you are acting in good faith; you obviously believe strongly that you are right, and that you are providing good information. However, the information is simply inaccurate, and in this case, downright harmful. I hope you can see where I am coming from, and you take the time to work with me and read the sources that I've provided you. StructureWiki (talk) 23:22, 13 March 2011 (UTC)


 * you should be more cautious considering your level of knowledge. I do strongly suggest to pay more attention to WP:AGF and WP:NPA. Regarding the values, they are correct as I have reported them and were in use since late 1980s. Your assertion that you did demonstrate evidence to the contrary is lacking any substance, if you do not know how to read medical texts do not try to read them or ask someone who understands them for assistance. Dealing with circadian hormone cycles is admittedly one of the more complex issues.


 * I am not surprised that some guys tried to lower their prolactin levels, wikipedia has never endorsed self medication or even self diagnosis but what really surprises me how did these guys get their prolactin values measured? Its not exactly easy to do at home and as far as I know most labs do not accept samples for prolactin testing from John Doe, not to mention the problematic transportation of frozen blood samples. Richiez (talk) 19:00, 17 March 2011 (UTC)


 * There's really not much left to say about this. To be honest, I'm not really concerned about whether or not you actually acknowledge your mistake; this has never been personal from my perspective (again, I don't even know you).  2-4 ng/mL is obviously neither normal nor typical for a morning serum prolactin measurement in a man, regardless of what you say (e.g. on the prolactin talk page you mention that you've read "thousands" of articles that state this, and you've stated that all the article's I've cited that say otherwise are "bogus", etc.).


 * My intention has always been just to correct this misinformation so that men don't think they need to lower their prolactin levels after reading your unsourced statement. Whether we use sources that say the most common level is 7, 8, 10, etc. is irrelevant; what is important is that it is not 2-4 (this is hypoprolactinemia).  Even the Sieman's source that you've recently brought to our attention make this clear (e.g. the Sieman's source puts 2-4 ng/mL in the 2.5% and below range).  I am (sincerely) sorry that my editing of these statements was so unpleasant for you; I still don't understand why you were so insistent about keeping them (there's just so much evidence that the statements are incorrect).  I was honestly surprised by your reaction.  In any case, after looking at your editing history and comments, it looks like I'm not the first person to complain about unsourced edits that you've made, and it looks like you've been insistent about keeping those as well.  In any case, I'm happy we were able to move forward and find common ground.  This benefits all of our readers. StructureWiki (talk) 04:46, 23 March 2011 (UTC)

This US MRI technique is not widely avaliable
Thus moved down and put more common methods first. Doc James (talk · contribs · email) 23:37, 3 June 2011 (UTC)
 * Availability and coverage is not a problem in Germany and I suspect many other EU places so if it is less available in other parts of the world this should not justify moving it all the way down. Furthermore some methods that are currently above it - foremost endometrial ablation are only applicable and effective under very special circumstances for fibroids. In fact they are mentioned mostly to outline their limitations. Richiez (talk) 10:14, 4 June 2011 (UTC)

Mastitis merger proposal
Just a reminder:. It's been a year, so I thought you might have forgotten. Best, :) Anna Frodesiak (talk) 15:46, 4 October 2011 (UTC)


 * Thanks for the reminder, not forgotten. Any opinion, comments?Richiez (talk) 10:24, 5 October 2011 (UTC)

unblock, shared IP behind NAT
Please do not ever autoblock this IP range. It is a dynamic address of a large provider and the culprit will get a new address in another range next he connects to the internet. It does however have the potential to affect many innocent users. Richiez (talk) 16:00, 8 February 2012 (UTC)
 * It isn't possible for a normal admin to determine what IP is behind the account&mdash;the software automatically blocks the IP unless the admin explicitly unchecks the "Autoblock any IP addresses used" checkbox. Therefore, IPs are usually autoblocked to prevent the immediate recreation of another account. Only checkusers have access IP data. Reaper Eternal (talk) 20:50, 8 February 2012 (UTC)
 * As I have learned by now I should have asked to add the IP range to MediaWiki:Autoblock whitelist as it is a large pool of dynamic, partially shared IP addresses behind NAT but still have not quite figured out how to do that. Richiez (talk) 20:58, 8 February 2012 (UTC)

Sheikh of the Seychelles
Added WSJ refs to article. IP comes from UAE, natch. Gareth E Kegg (talk) 13:13, 17 February 2012 (UTC)

Phytosterols
The interaction with Statins deserves a place in the lead. If Weingaertner specifically says the health claims were misleading, that contention should be spelled out in the body text, not just mentioned in passing in the lead. The term misleading implies (at least to my ear) a deliberate deception rather than an over-optimistic hypothesis. As with any controversial issue, countervailing opinions in credible sources should also be noted. Dankarl (talk) 13:45, 20 March 2012 (UTC)


 * I am not quite sure what to do about the article but would suggest to move the discussion to the article talk page where I will explain in more length. -- Richiez (talk) 14:17, 20 March 2012 (UTC)

Invitation to events in June and July: bot, script, template, and Gadget makers wanted
I invite you to the yearly Berlin hackathon, 1-3 June. Registration is now open. If you need financial assistance or help with visa or hotel, then please register by May 1st and mention it in the registration form.

This is the premier event for the MediaWiki and Wikimedia technical community. We'll be hacking, designing, teaching, and socialising, primarily talking about ResourceLoader and Gadgets (extending functionality with JavaScript), the switch to Lua for templates, Wikidata, and Wikimedia Labs.

We want to bring 100-150 people together, including lots of people who have not attended such events before. User scripts, gadgets, API use, Toolserver, Wikimedia Labs, mobile, structured data, templates -- if you are into any of these things, we want you to come!

I also thought you might want to know about other upcoming events where you can learn more about MediaWiki customization and development, how to best use the web API for bots, and various upcoming features and changes. We'd love to have power users, bot maintainers and writers, and template makers at these events so we can all learn from each other and chat about what needs doing.

Check out the the developers' days preceding Wikimania in July in Washington, DC and our other events.

Best wishes! - Sumana Harihareswara, Wikimedia Foundation's Volunteer Development Coordinator. Please reply on my talk page, here or at mediawiki.org.

Sumana Harihareswara, Wikimedia Foundation Volunteer Development Coordinator 01:51, 4 April 2012 (UTC)

Uterine fibroids
Thank you for the note. I came across a paper relating uterine fibroids to renal cell cancer and since this seemed to be (1) important and (2) not present on the wiki page it seemed as worthwhile addition. However 'the tale grew with the telling' and Im inclined to agree with you. Im not sure if there is enough material to justify its own article. I do know how many stubs (at least vaguely) there are in WP and I'm not sure I really want to add to their number without reasonable justification. Do you think it justifies its own article based on its current length or not? If not have you any ideas on how it should be worked into the current one? DrMicro (talk) 19:05, 7 April 2012 (UTC)

I have added a little more to this section. Having thought about this a little more and with the additional material I am inclined to agree with you that this is now too much for this section and probably deserves a page of its own. I will get around to creating this shortly.DrMicro (talk) 07:13, 8 April 2012 (UTC)

Thank you for your work on the familial uterine fibroids. I concur with you over the Mesh system for rare diseases - its not the easiest to determine what to place in the infoboxes. DrMicro (talk) 11:34, 12 April 2012 (UTC)

The new version of the statement of treatment is an improvement. However as I have said on the talk page I am unaware of any studies showing a significantly increased risk of malignancy over that in sporadic cases. If you are aware of such a study I would be most grateful if you could reference it.DrMicro (talk) 11:51, 12 April 2012 (UTC)

Thank you for your comments. I agree that the position is unclear at present and that this condition should be kept under review. DrMicro (talk) 15:00, 16 April 2012 (UTC)

Many thanks for your message
Many thanks for the message which you left on my userpage today (Wednesday 16 May 2012) on the references related to magnesium -  I thought at first you might also be advising me with references relating to osteoporosis (you may notice that I have left some references on the talk page of the article on osteoporosis). I have not read the reference to the Wikipedia guidelines on medical sources in depth yet (I just had a quick glance at it) but it will, I am sure, prove helpful. Once again, thank you for your help, ACEOREVIVED (talk) 14:43, 16 May 2012 (UTC)

The Vagina article
Hello, Richiez. I started a section on the Vagina talk page about your recent changes. See Talk:Vagina. Flyer22 (talk) 19:32, 25 May 2012 (UTC)
 * Please comment on my recommendation.Thanks. Axl  ¤  [Talk]  10:58, 6 June 2012 (UTC)

Catholic sex abuse cases
Hi, I posted a new section at Talk:Catholic sex abuse cases, which you might be informed on. You were engaged in the issue in the past and I's like to see if there is any consensus on how to move forward. Insomesia (talk) 04:02, 20 July 2012 (UTC)


 * I think I've cleaned up all the Plante content, please let me know if there is something else that should be addressed. The article needs a lot of work and sometimes just focussing on one aspect helps. Insomesia (talk) 20:39, 20 July 2012 (UTC)

Help! Collateral block
- I have been hit by "open proxy" block by User:Dennis_Brown - all I get is "Editing from 82.113.122.166 has been blocked (disabled) by Dennis Brown for the following reason(s): Open proxy".

This is a known issue - large mobile operator with NAT and needs to be finally whitelisted. Absolutely no open proxy because as mentioned this is behind a NAT. Richiez (talk) 13:12, 6 September 2012 (UTC)


 * You should be contacting the Admins. I have changed your 'help' to 'admin help' Gavin Perch  talk  13:32, 6 September 2012 (UTC)


 * Thanks. Richiez (talk) 13:42, 6 September 2012 (UTC)

Richiez (talk) 13:42, 6 September 2012 (UTC)


 * I've changed the block to allow registered users and new account creation, so that should fix the current problem. If this is happening too often, perhaps we need to consider granting IP block exempt status for you. Dennis Brown -  2&cent;    &copy;   Join WER 14:59, 6 September 2012 (UTC)

IP block exempt
I have granted your account an exemption from IP blocking. This will allow you to edit through full blocks affecting your IP address when you are logged in.

Please read the page IP block exemption carefully, especially the section on IP block exemption conditions.

Note in particular that you are not permitted to use this newly-granted right to edit Wikipedia via anonymous proxies, or disruptively. If you do, or there is a serious concern of abuse, then the right may be removed by any administrator.

Appropriate usage and compliance with the policy may be checked periodically, due to the nature of block exemption, and block exemption will be removed when no longer needed (for example, when the block it is related to expires).

I hope this will enhance your editing, and allow you to edit successfully and without disruption. James F. (talk) 15:09, 6 September 2012 (UTC)


 * Thanks for the IP block exemption, I was already considering getting it last time it happened. I hope it could be made last until there is a very good reason to remove it. The current block will almost certainly expire or get removed pretty soon but other will be imposed - the mobile operator (O2 Germany) has a pretty good share in Germany ~ some 20 mio customers and the various IP ranges will suffer that kind of blocks very often. Richiez (talk) 15:28, 6 September 2012 (UTC)

Breast thermography
If you check the history and also the redirect target you'll see why I redirected it. The article was started by the proprietor of a company making breast thermography equipment, and breast thermography is being touted as a quack diagnostic tool for breast cancer. This is reasonably complex and is covered in detail in the redirect target, to do it twice would involve substantial redundancy - especially since the same conflicted individual also made substantial changes to, also in support of his business interests. "Thermography has been around for many years, and some scientists are still trying to improve the technology to use it in breast imaging. But no study has yet shown that it is an effective screening tool for finding breast cancer early. It should not be used as a substitute for mammograms."American Cancer Society (emphasis added). And you'll see from the article histories that this is precisely what it's being promoted for here. Don't be confused by the redlinked user page, see here. Guy (Help!) 13:14, 9 January 2013 (UTC)


 * Thanks for the explanation. Of course breast themrography can not replace routine mammogram screening and everyone claiming that on WP should be blocked. Did you read my comment on Talk:Thermography? Richiez (talk) 23:07, 9 January 2013 (UTC)


 * I have now... Guy (Help!) 23:13, 9 January 2013 (UTC)


 * Ok, maybe one article is enough for now but it must be clear that there are cases where it is useful. Mammography is generally pretty useless in women under 35 because of breast density and if you look at the mammography article even routine mammography is not without heavy controversy. Richiez (talk) 23:43, 9 January 2013 (UTC)

brca
Hi thanks for working with me. I worked over the section. The expansion of the lede became essay-like with the speculative, unsourced screening/treatment plans, and the other matter was redundant. I think it flows better now. Jytdog (talk) 14:30, 14 January 2013 (UTC)

IUD with progestogen - WP:MEDRS
Thankyou for notifying me of WP:MEDRS. I didn't know about it. I just added the link as there wasn't a link referring to "Mirena". Sorry about that. -- Inland mamba   (fruitful thought) 15:13, 19 January 2013 (UTC)

Gynecomastia
Part of the definition of gynecomastia is that it is enlargement of the male glandular breast tissue. It is not referring to the enlargement of breast tissue in females. Please see here (http://www.ncbi.nlm.nih.gov/pubmed/19880691) and here: (http://europepmc.org/articles/PMC2276281) Early breast development in girls is known as premature thelarche. Also, please do not remove well-sourced information such as the concept that neonatal gynecomastia is from the maternal transfer of placental hormones. If there is anything you should have gathered from our discussion, it is that it may be a correct, albeit an incomplete explanation for it. This means you should add to it, not remove it and it is acceptable for things to be repeated in different sections in a wikipedia article. That information belongs in the causes or pathophysiology section and it deserves brief mention in the epidemiology section since it is self-limited. Please refrain from further changes like this or discuss them on the talk page before removing well-sourced information. Thank you. Sincerely TylerDurden8823 (talk)

No.
I will not be told how to write whatever it is I have to say. I would appreciate it if you would refrain from posting on my talk page any further. If you do, rest assured it will not be read.TylerDurden8823 (talk) 22:32, 7 March 2013 (UTC)


 * All I want is WP:CIVIL, I was asking for it here. I consider it highly uncivil to revert good will suggestions as you have done [here]. Richiez (talk)
 * Consider it whatever you like. I'll remove from my talk page whatever I please and refuse to be lectured on what, in your view, constitutes civility. I don't have to keep anything there that I don't want. I also do not like your tone; what you wrote was written as an order, not a suggestion. If you want to be civil, then consider honing your diplomatic skills and make sure we've reached a resolution before undoing my edits (which was to the original article, the burden of evidence is on you to prove that what is in the article currently is incorrect even though I have provided evidence. Still waiting on yours.) I think that perhaps you could use a review of WP:Civil regarding how you speak to other people on Wikipedia. As I said, please do not write on my talk page again. It will go unread. I have been civil up to this point but I am convinced that you have ignored high-quality evidence that I have presented and on your own decided that it is unreliable in your view and changed the article accordingly and I find that unacceptable. TylerDurden8823 (talk) 22:51, 7 March 2013 (UTC)


 * WP:CIVIL IS AN ORDER. Another ignorant post and see you at WP:ANI. Richiez (talk) 23:02, 7 March 2013 (UTC)
 * I'll refer you to Etiquette (here: http://en.wikipedia.org/wiki/Wikipedia:Etiquette#How_to_avoid_abuse_of_talk_pages) which says not to label or personally attack other editors. Calling someone ignorant, as you have plainly done, is hardly an example of civility or etiquette not to mention threatening people is not how to act civil either. This is the second time you have called me ignorant (which I do not take kindly to) as well (once on the Wikiproject talk page through implication that I am not using common sense, ( I was going to let that slide in good faith) and here again). I ask that you don't escalate this further, but I will defend myself if you do. I follow Wikipedia's rules; I do not take orders directly from you about how to write your name, how to conduct myself, or about anything else.TylerDurden8823 (talk) 00:07, 8 March 2013 (UTC)
 * If you interpret this as claiming that you are ignorant than it is your problem. Richiez (talk) 00:31, 8 March 2013 (UTC)


 * With respect to gynecomastia please use secondary source from the last 5-7 years per WP:MEDRS. Thanks Doc James  (talk · contribs · email) (if I write on your page reply on mine) 00:20, 8 March 2013 (UTC)

ISBN
Regarding User:Richiez/wiki-fref: what does refer to? --  Gadget850talk 22:45, 23 June 2013 (UTC)


 * It should generate a citation for a book with the ISBN-id xxx . Having said that I did not use this code for a long time, so it may need some fixing. Most of the time I am now using one of the citation techniques described here: User:Richiez/Medical references quick and easy . As much as I prefer offline editing and tools like my scripts wikipedia is not well suited for this mode of operation. It was mostly helpful for long texts written from scratch. Richiez (talk) 11:39, 25 June 2013 (UTC)

Disambiguation link notification for November 1
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WP:BURDEN
Per policy, someone wishing to restore challenged content must provide an appropriate inline source. Please revert yourself or provide the sourcing required by policy. -- TRPoD aka The Red Pen of Doom  13:09, 3 May 2014 (UTC)


 * Please specify more precisely what you think needs additional proof. Is it one of
 * the Greeks credited several mythological figures with athletic accomplishments,
 * male gods (especially Apollo and Herakles, patrons of sport)
 * ... were commonly depicted as athletes
 * Richiez (talk) 13:45, 3 May 2014 (UTC)
 * All of the claim AND its relevance to the subject of the article: Nudity in sports. --  TRPoD aka The Red Pen of Doom  15:05, 3 May 2014 (UTC)


 * Not impressed. You would have more joy editing articles where you have more understanding of the subject if are unwilling to do the research yourself. Asking for for basic facts that can be expected to be common knowledge is not the way to go and if something seems not obvious you could also ask for references before deleting content. Anyway, I have rewritten the section adding a source. Richiez (talk) 20:04, 3 May 2014 (UTC)

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ArbCom elections are now open!
MediaWiki message delivery (talk) 16:05, 23 November 2015 (UTC)

Dorsolateral listed at Redirects for discussion
An editor has asked for a discussion to address the redirect Dorsolateral. Since you had some involvement with the Dorsolateral redirect, you might want to participate in the redirect discussion if you have not already done so. Thryduulf (talk) 23:12, 30 July 2016 (UTC)

Dutroux
Hey, I just wanted to thank you for helping to keep the content in the article on Dutroux up.-- Sparrow (麻雀)     🐧   16:30, 20 December 2019 (UTC)