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J A Coffey

Publications and source records attributed to J A Coffey.

11 recordsLinked to original sources
PubMed2001

New antigenic regions of streptokinase are identified by affinity-directed mass spectrometry.

Streptokinase (SK) is a bacterial protein used for the treatment of myocardial infarction, which is immunogenic in humans. Here we report the use of an affinity-directed MS approach to determine the minimal epitopes involved in the binding between SK and patient antibodies. Using this method we have identified two novel epitopes and mapped these to the minimal recognition regions formed by the amino acids D96-E99 and F323-D328. We have also located three previously identified antigenic regions and have now mapped them and shown that they can be defined more precisely as residues P4-L8, P171-P177 and K334-N338.

Antigens↗
PubMed1995

A comparison of factors affecting aesthetic outcomes of TRAM flap breast reconstructions.

The aesthetic results of TRAM flap breast reconstructions were assessed in 237 consecutive breast cancer patients. Nine independent judges, none of whom were plastic surgeons or members of the reconstructive team, assigned an aesthetic score to each patient after viewing postoperative photographs. We found that bilateral reconstructions were aesthetically superior to unilateral reconstructions (p = 0.0013), that immediate reconstructions were aesthetically superior to delayed reconstructions (p = 0.0001), and that previous irradiation of the chest wall reduced the mean aesthetic score (p = 0.0010). We also found that the mean aesthetic score assigned to patients who had reconstructions with free TRAM flaps was superior to that assigned to those who had reconstructions with conventional TRAM flaps, but when tested by multiple regression analysis, this trend was not statistically significant (p = 0.2972).

Breast↗
PubMed1992

Secondary craniomaxillofacial deformities. Current principles of management.

This article focuses on secondary reconstruction of naso-orbital frontal injuries. Pertinent clinical anatomy, physical examination/documentation, and radiographic imaging are examined first. Pretreatment planning, operative exposures, and case examples are discussed in the second part of the article.

Adult↗
PubMed1991

Celiac axis and superior mesenteric artery injury associated with left radical nephrectomy for locally advanced renal cell carcinoma.

The superior mesenteric artery and celiac axis were inadvertently ligated during left radical nephrectomy for a large upper pole renal carcinoma with massive perihilar and periaortic adenopathy. Computer-generated 3-dimensional illustrations created from the computerized tomography scan demonstrated the close proximity between these visceral branches and the adenopathy mass complex, and showed how this bulky disease may interfere with surgical anatomy. When left radical nephrectomy is performed for locally advanced and/or bulky node-positive renal neoplasms, surgeons must be cognizant of the location of the major visceral arterial branches and possible anatomical distortions.

Carcinoma, Renal Cell↗
PubMed1989

Abnormalities of lymphatic drainage in lower extremities: a lymphoscintigraphic study.

Chronic lower-leg edema in patients with venous disorders was studied by means of lymphoscintigraphy. Lymphatic patterns of flow were evaluated prospectively in 26 patients with technetium 99m antimony trisulfide colloid injected subcutaneously in the interdigital web spaces on the feet. Most patients in this study had postphlebitic syndrome, and all of these patients had abnormal lymphoscintigraphic flow patterns. Nine had evidence of lymphatic obstruction, and one had an enhanced flow pattern. Three patients had veins used for distal arterial bypass, and all these veins showed decreased lymphatic flow. Two patients with Klippel-Trenaunay syndrome (congenital varicose veins associated with limb elongation, a capillary nevus, and an abnormal deep venous system) had obstruction to lymphatic flow, and two others had normal and enhanced patterns. Normal studies were seen in four of five patients who had veins used for coronary artery bypass grafting. The finding of decreased lymphatic flow in patients appears to be the result of the length of time from an episode of deep venous thrombosis, the occurrence and number of episodes of cellulitis and lymphangitis, and mobilization of the vein for use in distal arterial bypass surgery. This study shows that the edema attributed previously to primary venous disorders may have a significant lymphatic component. The degree of lymphatic obstruction can be determined by lymphoscintigraphy with technetium-labeled antimony trisulfide colloid.

Adult↗
PubMed1981

Regional lymph node dissection for malignant melanoma of the extremities.

Seven hundred thirty-nine patients with malignant melanoma of the extremities were treated with a uniform surgical approach that included wide and deep excision of the primary site and regional node dissection therapeutically and electively for invasive lesions (Clark's levels III, IV, and V). Of the 490 patients who underwent lymph node dissections, follow-up was available for 457 (93%). Life-table comparison of 362 patients with histologically negative nodes to 95 with histologically proved lymph node metastases yielded statistically significant differences in survival (P less than 0.001). Five-year cumulative survival rates were 91% in the group without and 48% in the group with nodal metastases. Among histologically positive patients, differences in life-table survival curves for the 60 clinically negative patients compared to the 35 clinically positive patients were also statistically significant (P = 0.004); 5-year cumulative survival rates were 57% for the former group and 33% for the latter. Although there appears to be an advantage to regional lymph node dissection for micrometastases as opposed to gross nodal involvement, for the majority of patients metastatic melanoma in these nodes is the major indicator of systemic disease.

Actuarial Analysis↗