Perianal Ecchymosis as a Clinical Sign

Tamvakopoulos, S.K.

doi:10.1001/archsurg.1969.01340170064014

Cited by 7 publications

(1 citation statement)

References 4 publications

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“…An approach that is increasingly promising is mass spectrometry (MS) combined with chromatographic separation; using this approach, the CoA and acetyl-CoA are subjected to analysis either directly or after derivatization. [20][21][22][23][24] However, owing to numerous challenges including poor chromatographic separation, ion suppression and signal losses, further advances in MS based approaches are required for reliable analysis of CoA and acetyl-CoA. 25 An altogether different approach that enables quantitative analysis of metabolites noninvasively, reproducibly and with no need for separation, is nuclear magnetic resonance (NMR) spectroscopy.…”

Section: Introductionmentioning

confidence: 99%

Extending the Scope of ¹H NMR Spectroscopy for the Analysis of Cellular Coenzyme A and Acetyl Coenzyme A

2019

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Coenzyme A (CoA) and acetyl-coenzyme A (acetyl-CoA) are ubiquitous cellular molecules, which mediate hundreds of anabolic and catabolic reactions including energy metabolism. Highly sensitive methods including absorption spectroscopy and mass spectrometry enable their analysis, albeit with many limitations. To date, however, NMR spectroscopy has not been used to analyze these important molecules. Building on our recent efforts, which enabled simultaneous analysis of a large number of metabolites in tissue and blood including many coenzymes and antioxidants [Anal Chem. 2016, 88:4817-24; ibid 2017, 89:4620-4627], we describe here a new method for identification and quantitation of CoA and acetyl-CoA ex vivo in tissue. Using mouse heart, kidney, liver, brain and skeletal tissue, we show that a simple 1 H NMR experiment can simultaneously measure these molecules. Identification of the two species involved a comprehensive analysis of the different tissue types using 1D and 2D NMR, in combination with spectral databases for standards, as well as spiking with authentic compounds. Time dependent studies showed that while the acetyl-CoA levels remain unaltered, CoA levels diminish by more than 50% within 24 h, which indicates that CoA is labile in solution; however, degassing the sample with helium gas halted its oxidation. Further, interestingly, we also identified endogenous coenzyme A glutathione disulfide (CoA-S-S-G) in tissue for the first time by NMR and show that CoA, when oxidized in tissue extract also forms the same disulfide metabolite. The new ability to simultaneously visualize absolute concentrations of CoA, acetyl-CoA and endogenous CoA-S-S-G along with redox coenzymes (NAD + , NADH, NADP + , NADPH), energy coenzymes (ATP, ADP, AMP), antioxidants (GSH, GSSG) and a vast pool of other metabolites using a single 1D NMR spectrum offers a new avenue in the metabolomics field for investigation of cellular function in health and disease.

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Section: Introductionmentioning

confidence: 99%

Extending the Scope of ¹H NMR Spectroscopy for the Analysis of Cellular Coenzyme A and Acetyl Coenzyme A

2019

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Perianal haematoma: An unusual feature of a leaking aortic aneurysm

Antrum

1984

Journal of British Surgery

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A 73-year-old man, previously active and well, .presented with acute abdominal pain radiating through to the back. Examination revealed that he was shocked, had impalpable femoral pulses and had a tender aortic aneurysm. His perineum revealed a tense, bulging, dark blue perianal haematoma with peau d'orange (21 h had elapsed between the onset of his symptoms and the discovery of this haematoma).At laparotomy the aneurysm was found to be 8 cm in diameter, infrarenal and extending into both internal and external iliac arteries. There was an extensive retroperitoneal haematoma, particularly on the left side, with obvious extension under the sigmoid mesentery into the pelvis. There was a small amount of free intraperitoneal blood. The sigmoid colon was normal. The aneurysm was seen to have ruptured posteriorly, just above the sigmoid mesentery.The aorta was controlled proximally and the groins explored. The aneurysmal involvement of the iliac arteries was dealt with by proximal oversewing and ligation of both common femoral arteries. A woven Dacron graft was then inserted fro& below the renal arteries to both common femoral arteries below the sites of ligature with end-to-end anastomoses.The following day the haematoma had developed into a diamondlike shape, 6 x 7 cm ( Figure I), gradually disappearing over the course of a month.The patient made a good recovery and was not affected by the enforced loss of both internal iliac arteries. DiscussionThe diagnosis of a ruptured aortic aneurysm may be difficult and accessory physical signs are helpful. Superficial bruising is an occasional feature of the acute presentation, though it is more likely to be observed in patients apparently making satisfactory progress after an acute extraperitoneal leak'. The scrotum, penis, umbilicus (cf. Cullen's Sign') and left flank (cf. Grey Turner's Sign3) are the sites at which bruising is usually observed'. Left flank haematomata have also been seen in ruptured aneurysms that have leaked into the tissue planes created by previous renal surgery4.Perianal haematoma as a physical sign of an acutely leaking aneurysm has only rarely been reported in the literature5-'. It is caused by extraperitoneal rupture of the aneurysmal sac into the sigmoid mesocolon6. The haematoma produced then extends into Waldeyer's fascia, traverses the levator ani sling and eventually presents as a bulging diamond-shaped perianal ecchymosis identical to the case illustrated by Tamvakopoulos et aL5. It would appear that the haematoma initially takes the shape of the ischiorectal fossae, which are probably involved, and then seeps through the perianal fascia into the shallow subcutaneous perianal space described by Last *. The haematoma then dissipates into the skin overlying the urogenital triangle and therefore still retains a diamond-like appearance.

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The blue scrotum sign of Bryant: A diagnostic clue to ruptured abdominal aortic aneurysm

Ratzan

Donaldson

Foster

et al. 1987

The Journal of Emergency Medicine

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Perianal Ecchymosis as a Clinical Sign

Cited by 7 publications

References 4 publications

Extending the Scope of ¹H NMR Spectroscopy for the Analysis of Cellular Coenzyme A and Acetyl Coenzyme A

Extending the Scope of ¹H NMR Spectroscopy for the Analysis of Cellular Coenzyme A and Acetyl Coenzyme A

Perianal haematoma: An unusual feature of a leaking aortic aneurysm

The blue scrotum sign of Bryant: A diagnostic clue to ruptured abdominal aortic aneurysm

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Perianal Ecchymosis as a Clinical Sign

Cited by 7 publications

References 4 publications

Extending the Scope of 1H NMR Spectroscopy for the Analysis of Cellular Coenzyme A and Acetyl Coenzyme A

Extending the Scope of 1H NMR Spectroscopy for the Analysis of Cellular Coenzyme A and Acetyl Coenzyme A

Perianal haematoma: An unusual feature of a leaking aortic aneurysm

The blue scrotum sign of Bryant: A diagnostic clue to ruptured abdominal aortic aneurysm

Contact Info

Product

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Extending the Scope of ¹H NMR Spectroscopy for the Analysis of Cellular Coenzyme A and Acetyl Coenzyme A

Extending the Scope of ¹H NMR Spectroscopy for the Analysis of Cellular Coenzyme A and Acetyl Coenzyme A