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Single malt

William Bromberg brombwi1 at memorialhealth.com
Tue Jan 27 13:16:52 GMT 2015


I knew you were kidding. You ever look into the Scotch Malt Whisky
Society (SMWSA.com)? They buy single casks and bottle them without any
blending (so each bottling is unique). Very cool. 

William J. Bromberg, MD, FACS
Sent from my iPhone

> On Jan 27, 2015, at 05:28, Mary Langcake <mezza58 at gmail.com> wrote:
> 
> Hi Bill, A fellow single malt purist I presume.
> Once again my slightly warped sense of humor has proven obtuse. I take
my
> malt straight, peaty and preferably from Islay. Tho the addition of a
wee
> dram of pure spring water does wonders for many expressions.
> Slainte mhaith
> 
> On Tuesday, January 27, 2015, William Bromberg
<brombwi1 at memorialhealth.com>
> wrote:
> 
>> Anyone who uses cool-aid and single malt in the same sentence needs
>> re-education. That is all.
>> 
>> Bill Bromberg
>> 
>>>>> Mary Langcake <mezza58 at gmail.com <javascript:;>> 1/26/2015 2:25 PM
>>>
>> Hi Pret,
>> My comment was meant as a light-hearted response well and truly in
>> favor of
>> Karim's erudite post that as you point out replaced rhetoric with
fact
>> and
>> critical analysis. We are often counselled on this blog not to "drink
>> the
>> Kool Aid" which in a sense stifles debate. Karim argues so cogently
>> that
>> his "Kool Aid" is one I would happily taste (albeit with a dash of a
>> good
>> smokey single malt).
>> And you are indeed right, he needs no-one to defend him, and had
there
>> been
>> a "like" button as you suggested I too would have posted a thumbs up!
>> Regards,
>> Mary
>> 
>> On Tuesday, January 27, 2015, Bjorn, Pret <pbjorn at emhs.org
<javascript:;>>
>> wrote:
>> 
>>> Not that Dr. Brohi needs anyone to defend him -- least of all me;
but
>> is
>>> the Kool Aid reference intended to imply that he's doing the
>> serving?
>>> 
>>> I rather thought the opposite.  Indeed, I found myself wishing that
>> the
>>> List had a "like" button.
>>> 
>>> Bravo, Karim.  I find debates far more enjoyable when they involve
>> factual
>>> arguments and critical thinking.
>>> 
>>> 
>>> 
>>> -----Original Message-----
>>> From: trauma-list-bounces at trauma.org <javascript:;> <javascript:;>
>> [mailto:
>>> trauma-list-bounces at trauma.org <javascript:;> <javascript:;>] On
Behalf
>> Of Mary
>> Langcake
>>> Sent: Monday, January 26, 2015 4:52 AM
>>> To: Trauma-List [TRAUMA.ORG]
>>> Subject: Re: Returned mail: delivery problems encountered
>>> 
>>> Ah Karim,
>>> I can taste the Kool Aid now!
>>> Regards,
>>> Mary
>>> 
>>> On Monday, January 26, 2015, Karim Brohi <karim at trauma.org
>> <javascript:;>
>> <javascript:;>>
>>> wrote:
>>> 
>>>> ​Ken​
>>>>>>>> Unfortunately a lot of what you have written below is
>> disinformation.
>>>> 
>>>> TXA is off patent and has been for decades.  There is no pharma
>>>> marketing associated with TXA.
>>>> 
>>>> Trasylol was Aprotinin not TXA.  It was indeed withdrawn by the
>>>> manufacturer after a study showed increased thrombotic events in
>>>> cardiac surgery patients. Most cardiac anaesthetists believe this
>> to
>>>> have been a mistake.  But anyway, TXA (Tranexamic Acid) is not
>> Aprotinin.
>>>> 
>>>> There is plenty of science to show that trauma patients get a
>> severe
>>>> fibrinolysis (and probably fibrinogenolysis).  This could even be
>> one
>>>> of those "thrombolysis syndromes" of which you speak.
>>>> 
>>>> Here's two papers to start you off:
>>>> 
>>>> ​Elevated tissue plasminogen activator and reduced plasminogen
>>>> activator inhibitor promote hyperfibrinolysis in trauma patients.
>>>> Cardenas JC, Matijevic N, Baer LA, Holcomb JB, Cotton BA, Wade CE.
>>>> Shock. 2014 Jun;41(6):514-21​
>>>> 
>>>> The incidence and magnitude of fibrinolytic activation in trauma
>>> patients.
>>>> Raza I, Davenport R, Rourke C, Hunt BJ, Stanworth S, MacCallum PK,
>> Brohi
>>> K.
>>>> J Thromb Haemost. 2013 Feb;11(2):307-14.
>>>> 
>>>> Finally, before CRASH2, there were of the order of 76 randomised
>>>> controlled trials supporting the use of TXA to reduce bleeding an>>>> now.  There is even a Cochrane review for you.  "Cloaked" as a
>>>> meta-analysis, whatever that means.
>>>> 
>>>> http://www.bmj.com/content/344/bmj.e3054
>>>> 
>>>> Karim
>>>> 
>>>> 
>>>> 
>>>> 
>>>> 
>>>> 
>>>>> 
>>>>> ---------- Forwarded message ----------
>>>>> From: KMATTOX at aol.com <javascript:;> <javascript:;> <javascript:;>
>>>>> To: trauma-list at trauma.org <javascript:;> <javascript:;>
>> <javascript:;>
>>>>> Cc:
>>>>> Date: Sun, 25 Jan 2015 10:30:01 -0500
>>>>> Subject: Re: Tranexamic acid question Yes, I made such a
>> suggestion
>>>>> that TXA may not have all of the benefits
>>>> in
>>>>> all of the areas that this family of drugs has been marketed to
>> cover.
>>>> I
>>>>> have no doubt that this family of drugs (including TXA) has
>> value
>>>>> in
>>>> some
>>>>> narrow areas, such as some patients with thrombolysis syndromes,
>>>> (Maybe),
>>>>> and in some areas of inflammation.   Remember that originally
>> Trysolol
>>>> was
>>>>> sold as an antiinflamatory agent in the treatment of
>> pancreatitis,
>>>>> but
>>>> it
>>>>> turned out to not have any statistical advantage, after almost
>> 10
>>>>> years of
>>>>> Marketing.     Remember that the SAME drug  was also WIDELY used
>> by the
>>>>> cardiac surgeons for post op bleeding to finally be  forced off
>> the
>>>> market
>>>>> for
>>>>> this indication because of an increase thrombosis  risk.
>>>>> 
>>>>> Also recall that other drugs in this same family have been
>> marketed
>>>>> for these same reasons and after a flash in the pan , have just
>> gone
>>> away.
>>>>> 
>>>>> So the literature, going back through the 1960s on this family
>> of
>>>>> drugs
>>>> is
>>>>> FULL of articles all over the map, with the final story, just
>>>>> allowing each of them to just disappear and go away because
>> there
>>>>> was  not either the benefit, nor the profit in keeping up the
>>>>> pressure  .
>>>>> 
>>>>> AND the science just did not support it.
>>>>> 
>>>>> Any simple search of the MEDLINE or even the Internet, with
>>>>> questions  on the chemicals, the sold drugs, antithrombolytic
>>> therapy,  antiinflamatory
>>>>> agents, etc. will give you undoubtedly more than 3000  articles.
>>   Or
>>>>> you can
>>>>> go to any one of several  Cochran type reviews over the decades,
>>>>> some cloaked as "meta analysis"  and  the weight of the evidence
>> for
>>>>> support for these family of drugs simply is not  there.
>>>>> 
>>>>> Thus , my comments :      "TXA is from  a family of drugs long
>> in
>>> search
>>>> of
>>>>> an indication."
>>>>> 
>>>>> k
>>>>> 
>>>>> 
>>>>> 
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