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Collins JD, Disher AC, Shaver ML, Miller TQ. Imaging the hepatic lymphatics: experimental studies in swine. J Natl Med Assoc 1993; 85:185-91. [PMID: 8474131 PMCID: PMC2571887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Magnetic resonance (MR) imaging augmented with 3-D MR reconstruction provides an excellent display of the soft tissues and surface anatomy of the human body. The excellent anatomical detail of MR images makes this radiographic modality an ideal tool to teach anatomy to all health-care professionals. Previous studies of the lung and liver in swine revealed that the hepatic lymphatics communicated with the visceral pleural lymphatics via the so-called pulmonary ligament, which appears as a sheet of visceral pleura containing lymphatics and small blood vessels in the swine model. A review of the surgical operative reports at the UCLA School of Medicine revealed that the hepatic lymphatics are not connected or even ligated during hepatic resections and transplantations. Therefore, the authors hypothesized that the unattached lymphatics may be a cause of postoperative complications and that interruption of these important lymphatic pathways may specifically result in immediate ascites and right pleural effusions. Cannulation of the hepatic lymphatics is proposed as a method to reduce postoperative complications. The purpose of this research is to demonstrate the visual and radiographic display of the hepatic lymphatics in a swine model and to provide a means to teach anatomical-pathological correlation.
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Collins JD, Shaver ML, Disher AC, Miller TQ. Fluoroscopic chest tube insertion and patient care. J Natl Med Assoc 1992; 84:869-72. [PMID: 1404463 PMCID: PMC2571805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Catheters and chest tubes may be placed under fluoroscopic control to reduce pleural effusions. This procedure has been adopted as a routine procedure at the UCLA School of Medicine in Los Angeles, California to improve patient care. This technique was modified for the placement of large chest tubes, which can be placed by a radiologist without multiple attempts or complications. Our experience with 2234 patients who underwent this procedure between 1977 and 1990 is described.
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Reed DN, Collins JD, Wyatt WJ, Hull JE, Patton ML, Dahm SO, Dabideen HH, Hudson JC, Allen DB. Can general surgeons perform colonoscopy safely? Am J Surg 1992; 163:257-9. [PMID: 1739182 DOI: 10.1016/0002-9610(92)90112-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The purpose of the current study was to review the safety of colonoscopy performed by nonfellowship-trained general surgeons. To address this issue, we reviewed more than 1,000 consecutive diagnostic and therapeutic colonoscopies and recorded the complications. This was a multi-institutional study involving seven general surgeons, none of whom had had formal fellowship endoscopic training. Perforation was confirmed by laparotomy, bleeding was defined as that requiring hospitalization and/or transfusion, and cardiopulmonary arrest was self-explanatory. There was one perforation in the diagnostic group and none in the therapeutic group, for a rate of 0.10% overall and 0.12% in diagnostic colonoscopy. There were no instances of bleeding or cardiac arrest. This complication rate of 1 per 1,025 colonoscopic procedures by general surgeons compares favorably with that previously reported by other specialties (p less than 0.001). We conclude that postgraduate endoscopy fellowship is not necessary for general surgeons to become safe colonoscopists.
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Batra P, Brown K, Collins JD, Holmes EC, Steckel RJ, Shapiro BJ. Mediastinal masses: magnetic resonance imaging in comparison with computed tomography. J Natl Med Assoc 1991; 83:969-74. [PMID: 1766020 PMCID: PMC2571609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Seventy-eight patients with mediastinal abnormalities were imaged with magnetic resonance imaging (MRI) to evaluate mediastinal masses and associated lung, pleural, or chest wall disease. Magnetic resonance images were compared with computed tomography (CT) scans, which were available in 45 patients. While MRI and CT were equally effective in demonstrating mediastinal lesions, CT was superior for displaying calcification within a mass in eight patients and for demonstrating associated lung abnormality in four patients. Computed tomography should remain the imaging procedure of choice after chest radiography to evaluate mediastinal masses, although MRI may be indicated in selected patients.
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Collins JD, Shaver M, Batra P, Brown K, Disher AC. Magnetic resonance imaging of chest wall lesions. J Natl Med Assoc 1991; 83:352-60. [PMID: 1920509 PMCID: PMC2627055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Magnetic resonance imaging (MRI) demonstrates surface anatomy, nerves, and soft tissue pathology. Selective placement of the cursor lines in MRI displays specific anatomy. The MR images can then be used as adjunct in teaching surface anatomy to medical students and to other health professionals. Because the normal surface anatomy could be imaged at UCLA's radiology department, it was decided to image soft tissue abnormalities with MR to assist in patient care. Patients imaged were scheduled for special procedures of the chest or staging lymphangiograms. Patients were placed into categories depending on known diagnosis or interesting clinical presentation. The diagnostic categories included Hodgkin's disease, melanoma, carcinomas (eg, lung or breast), lymphedema, sarcomas, dermatological disorders, and neurological disorders. All images were orchestrated by the radiologist. This article discusses both the teaching and clinical impact on patient care.
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Brind AM, Codd AA, Cohen BJ, Gabriel FG, Collins JD, James OF, Bassendine MF. Low prevalence of antibody to hepatitis C virus in north east England. J Med Virol 1990; 32:243-8. [PMID: 1964476 DOI: 10.1002/jmv.1890320409] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The prevalence of antibodies to hepatitis C virus (anti-HCV) was studied in North East England in blood donors, local multiply transfused patients, local high risk individuals, and chronic liver disease patients. Anti-HCV was detected by enzyme-linked immunosorbent assay (ELISA) in 2/1120 (0.18%) blood donors; 1/84 chronic renal failure patients on haemodialysis who had received 1,992 units of blood (seroconversion rate of 0.05% per unit transfused), 1/207 cardiac patients 6 months post cardiac surgery transfused with 1,403 units of blood (1 anti-HCV pre-operatively, seroconversion rate 0.07%), 40/50 haemophilia A patients treated with commercial factor VIII, and 38/100 intravenous drug users. In addition anti-HCV was detected by ELISA in 5/35 cryptogenic chronic liver disease patients, 5/5 confirmed by recombinant immunoblot assay (RIBA) (14%); 3/30 patients with autoimmune chronic active hepatitis, 2/3 by RIBA (7%); 2/50 primary biliary cirrhosis patients, 1/2 by RIBA (2%); 0/30 alcoholic cirrhosis patients; and 2/9 patients with hepatocellular carcinoma, 1/2 by RIBA (11%). HCV is uncommon in North East England; it may be implicated in the aetiology of a minority of cases of cryptogenic liver disease and less than 5% of autoimmune chronic active hepatitis and primary biliary cirrhosis.
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Kazwala RR, Collins JD, Hannan J, Crinion RA, O'Mahony H. Factors responsible for the introduction and spread of Campylobacter jejuni infection in commercial poultry production. Vet Rec 1990; 126:305-6. [PMID: 2188414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Campylobacter jejuni and related thermophilic campylobacters were not found in a hatchery or in chicks aged less than seven days. However, an increasing proportion of chicks aged two weeks and older shed campylobacters in their droppings. It was shown that a likely source of C jejuni for young chicks was the environment in the immediate vicinity of the rearing houses, and that infection could readily be introduced on the footwear and clothing of farm staff. Thermophilic campylobacters were found in the air, litter and drinking water containers in the rearing and finishing houses.
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Collins JD, Shaver ML, Kovacs BJ, Hall T, Brown K, Batra P, Sinha S. Enhancing magnetic resonance images using water bags. J Natl Med Assoc 1990; 82:197-9. [PMID: 2319614 PMCID: PMC2626023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fascial planes between tissues are separated by connective tissue, fat, and blood vessels. Magnetic resonance imaging displays surface anatomy and soft tissues. Our team has been successful in demonstrating brachial plexus nerves as a model of magnetic resonance anatomy. Radiologists have devised methods to increase the resolution of images by suppressing noise and increasing the sharpness of the image. We added water bags to a 0.3 tesla permanent magnet suppressing the noise and increasing the signal to image our patients. The images proved to be sharper.
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Graves WA, Collins JD, Miller TQ. Why is high resolution computerized tomography scanning used in evaluating the lungs? J Natl Med Assoc 1989; 81:1041-6. [PMID: 2681799 PMCID: PMC2571573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
High resolution computerized tomography scans have been used for medical and legal purposes to evaluate patients with a history of exposure to asbestos. Some investigators argue that high resolution scanning provides a better image of the lungs than routine computerized tomography. A review of the literature shows that although high resolution scanning displays the lymphatics in the lung, it offers no new useful diagnostic information. The authors conclude that no real advantage is attained with high resolution scanning of the lung and that pathology of disease can be determined decisively only by histology.
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Collins JD, Shaver ML, Batra P, Brown K. Anatomy of the abdomen, back, and pelvis as displayed by magnetic resonance imaging: part three. J Natl Med Assoc 1989; 81:857-61. [PMID: 2769789 PMCID: PMC2626049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In April 1986, magnetic resonance imaging (MRI) of the thorax and shoulder girdle was presented at the 99th Annual Meeting of the American Association of Anatomists. These images were the authors' first attempt to correlate the magnetic resonance display of the muscles and soft tissues of the chest in the coronal plane with surface gross anatomy. The original purpose of this study was to introduce the role of magnetic resonance imaging to anatomists, medical students, and the specialty of radiology. However, this approach has been expanded by imaging other sections of the body and applying the display of surface anatomy to augment the teaching of anatomy to surgical oncology, pathology, and kinesiology. This three-part article will display magnetic resonance images and will explain how magnetic imaging of the soft tissues can visually augment the teaching of gross anatomy without dissecting surface tissues.
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Collins JD, Shaver ML, Batra P, Brown K. Anatomy of the abdomen, back, and pelvis as displayed by magnetic resonance imaging: Part Two. J Natl Med Assoc 1989; 81:809-13. [PMID: 2754751 PMCID: PMC2625920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In April 1986, magnetic resonance imaging (MRI) of the thorax and shoulder girdle was presented at the 99th Annual Meeting of the American Association of Anatomists. These images were the authors' first attempt to correlate the magnetic resonance display of the muscles and soft tissues of the chest in the coronal plane with surface gross anatomy. The original purpose of this study was to introduce the role of magnetic resonance imaging to anatomists, medical students, and the specialty of radiology. However, this approach has been expanded by imaging other sections of the body and applying the display of surface anatomy to augment the teaching of anatomy to surgical oncology, pathology, and kinesiology. This three-part article will display magnetic resonance images and will explain how magnetic imaging of the soft tissues can visually augment the teaching of gross anatomy without dissecting surface tissues.
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Collins JD, Shaver ML, Batra P, Brown K. Anatomy of the abdomen, back, and pelvis as displayed by magnetic resonance imaging: Part One. J Natl Med Assoc 1989; 81:680-4. [PMID: 2746690 PMCID: PMC2625813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In April 1986, magnetic resonance imaging (MRI) of the thorax and shoulder girdle was presented to the 99th Annual Meeting of the American Association of Anatomists. These images were the authors' first attempt to correlate the magnetic resonance display of the muscles and soft tissues of the chest in the coronal plane with surface gross anatomy. The original purpose of this study was to introduce the role of magnetic resonance imaging to anatomists, medical students, and the specialty of radiology. However, this approach has been expanded by imaging other sections of the body and applying the display of surface anatomy to augment the teaching of anatomy to surgical oncology, pathology, and kinesiology. This three-part article will display magnetic resonance images and will explain how magnetic imaging of the soft tissues can visually augment the teaching of gross anatomy without dissecting surface tissues.
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Collins JD, Shaver ML, Batra P, Brown K. Nerves on magnetic resonance imaging. J Natl Med Assoc 1989; 81:129-34. [PMID: 2733051 PMCID: PMC2625971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Nerves are often visualized on magnetic resonance imaging (MRI) studies of the soft tissues on the chest and shoulder girdle. To learn the reasons for the contrast between the nerves and adjacent tissues, the authors obtained a fresh specimen containing part of the brachial plexus nerves from the left axilla and compared MRI with x-ray projections and photomicrographs of histologic sections. The results suggest that the high signals from the nerves stand out in contrast to the low signals from their rich vascular supply.
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Brown K, Collins JD, Batra P, Steckel RJ, Kagan AR. Mediastinal germ cell tumor in a young woman. MEDICAL AND PEDIATRIC ONCOLOGY 1989; 17:164-7. [PMID: 2704337 DOI: 10.1002/mpo.2950170218] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Primary mediastinal germ cell malignancies are uncommon neoplasms, usually presenting in young men. We review a case of a primary mediastinal seminoma occurring in a 23-year-old woman. The differential diagnosis, work-up and therapy for these lesions is discussed with emphasis on the role of magnetic resonance imaging in the evaluation of anterior mediastinal masses.
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Collins JD, Graves WA, Shaver ML. The importance of the "sloping rib" in interventional radiology procedures of the chest. J Natl Med Assoc 1988; 80:1293-6. [PMID: 3249332 PMCID: PMC2625895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Invasive procedures of the chest in radiology require anatomical awareness of variations in thoracic rib anomalies. The "sloping rib" is a descriptive term the authors use to describe an entity that may present a problem when attempting to remove fluid from the pleural space and/or tissue from the lung. The anomaly has been observed in muscle-wasting disorders, severe osteoporosis, metabolic diseases, and in idiopathic scoliosis of the thoracic spine. The significance to patient care and diagnosis will be discussed.
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Masih S, Bakhda RK, Collins JD. Pelvic fused kidneys: magnetic resonance imaging and intravenous pyelogram correlation. J Natl Med Assoc 1988; 80:925-7. [PMID: 3246706 PMCID: PMC2625714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This is a case presentation of pelvic fused kidneys as demonstrated by intravenous pyelogram and magnetic resonance imaging (MRI). The authors wish to stress the importance of anatomical imaging with MRI in the coronal plane. No reconstruction is required as with computerized tomography.
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Batra P, Brown K, Collins JD, Ovenfors CO, Steckel RJ. Evaluation of intrathoracic extent of lung cancer by plain chest radiography, computed tomography, and magnetic resonance imaging. THE AMERICAN REVIEW OF RESPIRATORY DISEASE 1988; 137:1456-62. [PMID: 3202383 DOI: 10.1164/ajrccm/137.6.1456] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A comparison was made of the ability of plain chest radiography, computed tomography (CT), and magnetic resonance imaging (MRI) to detect and assess the intrathoracic extent of lung cancer in 46 patients. The chest radiographs (CXR) were obtained with a high kilovoltage phototimed technique. The CT scans were obtained with a GE 9800 machine and the MRI studies with a 0.3 Tesla permanent magnet imaging system. The primary tumor was well demonstrated by all 3 imaging techniques; however, the configuration of lesions was best demonstrated by CT. MRI was superior to CXR and CT for demonstrating hilar involvement in 4 cases. CT and MRI were generally comparable for demonstrating mediastinal involvement but were superior to CXR. In 2 cases, small normal size nodes seen on CT were considered to be a single large abnormal node on MRI. Because of the paucity of signal from flowing blood, compression and displacement of vessels were easier to identify with MRI. In 1 case, a small pleural effusion was better seen with CT than with CXR or with MRI. Direct chest wall involvement in 1 case was not seen by CXR. Vertebral body abnormality in another case was seen only by MRI and not by CXR or CT. At present, MRI, with its long scanning time, motion degradation of the image, and poor spatial resolution, is inferior to CT for imaging lung cancer. For evaluation of intrathoracic extent of lung cancer, CT remains the procedure of choice after performing plain chest radiography.
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Badian M, Malerczyk V, Collins JD, Dixon GT, Verho M, Eckert HG. Safety, tolerance and pharmacokinetics of 2.0 g cefpirome (HR 810) after single and multiple dosing. Chemotherapy 1988; 34:367-73. [PMID: 3180904 DOI: 10.1159/000238594] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
After intravenous injection of a single dose of 2.0 g cefpirome (HR 810) and multiple doses of 2.0 g b.i.d. (11 doses) to 10 healthy male volunteers in an open design, concentrations of unchanged drug were measured at various times in serum and urine over 24 and 96 h, respectively. Cefpirome concentrations were determined using high-pressure liquid chromatography (HPLC). The biological half-life (t1/2, beta) found by fitting a two-compartment open model to the data was 2 h. No accumulation of the serum levels could be detected during the multiple-dose phase. Urinary concentrations of unchanged cefpirome effective against most clinically relevant bacteria were detected for at least 36 h. The drug was safe and well tolerated. No drug-related changes were observed for blood pressure, heart rate, ECG, haematology, clinical chemistry or urinalysis, including beta 2-microglobulin in serum and creatinine clearance.
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Batra P, Brown K, Steckel RJ, Collins JD, Ovenfors CO, Aberle D. MR imaging of the thorax: a comparison of axial, coronal, and sagittal imaging planes. J Comput Assist Tomogr 1988; 12:75-81. [PMID: 3335675 DOI: 10.1097/00004728-198801000-00014] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We performed direct multisection coronal and sagittal magnetic resonance (MR) images in addition to axial images to determine the value and limitations of coronal and sagittal planes compared with axial planes. Ninety-four MR examinations of the thorax were performed with a 0.3 T permanent magnet system (Fonar) by spin echo technique. The MR axial images were found superior to coronal in demonstrating prevascular adenopathy (one case), pretracheal nodes (nine cases), left paraaortic nodes (three cases), subcarinal nodes (three cases), and small pleural effusions (three cases). The coronal or sagittal planes were better to determine relationship of a mass at the lung apex (five cases) or an abnormality at the lung base (five cases). The anteroposterior displacement or compromise of great vessels and bronchi was best displayed on the axial plane whereas craniocaudal displacement of above structures was best seen on the coronal plane. The axial images were found most informative and we suggest that they be performed routinely. Coronal or sagittal planes may be added in selected cases.
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Abstract
This paper reviews those studies which investigated the absorption, distribution, metabolism and elimination of roxatidine acetate (formerly HOE 760) following its single and multiple oral administration to healthy male and female volunteers. Roxatidine acetate is almost completely (greater than 95%) absorbed after oral administration and is rapidly converted to roxatidine, its major active plasma and urinary metabolite. In common with many other prodrugs, the parent substance is not detectable in either plasma or urine and therefore all pharmacokinetic studies have been evaluated using measurements of roxatidine. A powder capsule formulation of the drug showed rapid absorption (tmax = 1 hour) and linear pharmacokinetics across the dose range 25 to 100mg, but produced some gastrointestinal intolerance. However, a granulated capsule formulation showed a much slower release (tmax = 3 hours) and was well tolerated. There was no evidence of any food interaction or interaction with other drugs such as antipyrine and propranolol. The plasma terminal half-life of the granulated capsule averaged 6 hours and between 55 and 60% of the dose was recovered in the urine as roxatidine. Following repeated daily administration of the prodrug, steady state plasma levels of roxatidine were reached on average by the fourth dose.
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Collins JD. Therapeutic approach in patients with concomitant disease/drug--drug interactions (roxatidine acetate). SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1988; 146:89-99. [PMID: 2906472 DOI: 10.3109/00365528809099135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Possible mechanisms of drug interactions with H2-antagonists are outlined. The mode of action of roxatidine acetate on hepatic microsomal enzymes is contrasted with those of cimetidine and ranitidine, and their differing structure-activity relationships are discussed. In the light of the mechanisms of drug interactions with H2-antagonists, clinical studies with roxatidine acetate are contrasted with published interaction data of cimetidine and ranitidine. The therapeutic consequences of these data are considered.
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Collins JD, Batra P, Brown RK, Winter J, King W. Computerized chest tomography in asbestos workers suspected of having pleural disease. J Natl Med Assoc 1987; 79:273-7. [PMID: 3573057 PMCID: PMC2571514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Forty-five computerized tomographic (CT) chest studies were performed on workers suspected of having pleural disease after being exposed to asbestos material. Ten of the 45 reviewed were court cases, and 32 workers acutely exposed at University of California-Los Angeles (UCLA) were studied with routine four views of the chest. CT confirmed the initial interpretation of chest films obtained at UCLA.
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Collins JD, Bassett LW, Snow HD, Ross NA, Patin T. False-positive thromboscintigram resulting from lymphedema--a roentgen pathological model. J Natl Med Assoc 1986; 78:875, 878-81. [PMID: 3783761 PMCID: PMC2571375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Abnormal thromboscintigrams were observed in patients with lymphatic obstruction. This syndrome was reproduced by surgically ligating the lymphatic drainage of the lower extremity of a dog prior to thromboscintigraphy.
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Bassendine MF, Collins JD, Stephenson J, Saunders P, James OF. Platelet associated immunoglobulins in primary biliary cirrhosis: a cause of thrombocytopenia? Gut 1985; 26:1074-9. [PMID: 4054707 PMCID: PMC1432957 DOI: 10.1136/gut.26.10.1074] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Thrombocytopenia in cirrhotic patients is usually attributed to splenic pooling whereas in idiopathic thrombocytopenic purpura it is related to platelet bound immunoglobulin (PA-IgG). Since primary biliary cirrhosis (PBC) is an autoimmune disorder we have undertaken a prospective study to assess the frequency and possible relationship of PA-IgG to thrombocytopenia in this condition. Sixty-two primary biliary cirrhosis patients (28 precirrhotic; 34 cirrhotic) were studied. Twenty-five patients (40%) had raised PA-IgG of whom 18 had cirrhosis. There was a significant inverse correlation between platelet count and PA-IgG (p less than 0.001) and between platelet count and spleen size (p less than 0.001). Thrombocytopenia (platelets less than 100 X 10(9)/l) was found in nine patients (15%); all nine had raised PA-IgG and eight were cirrhotic with an enlarged spleen. Two cirrhotic patients with persistent thrombocytopenia and bleeding episodes were treated with prednisolone and showed a useful therapeutic response. These results suggest that immune mediated platelet destruction and splenic pooling of platelets may both play a part in the thrombocytopenia observed in primary biliary cirrhosis.
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