NOMI, first described by Ende in 1958, is one of the diseases that affect the vasculature of the intestine. Thereafter, we recommended decreasing her ultrafiltration volume to less than 2 kg each time in order to avoid episodes of hypotension during or after HD she was treated with intravenous prostaglandin E1 10 μg/day, and the abdominal pain gradually declined after 2 weeks. The patient refused to undergo an endoscopic examination. After her CTA examination, she was treated with subcutaneous low-molecular-weight heparin (fraxiparine 5000 anti-Xa IU/ml, subcutaneously once and twice every other day). A CT angiography (CTA) was then performed, and the result showed that she had a portal vein thrombus with a normal superior mesenteric vein and a mesenteric artery stenosis suspecting NOMI (fig. Her medical condition did not improve in the following days. The patient was initially treated with intravenous antibiotics (rocephin 2.0 g once daily). An enhancement CT showed intestinal dilatation indicating a mesenteric ischemia there was no evidence of a tumor, severe intestinal infection or obstruction.
#Pian minion meaning free#
No free air and mass were noticed anywhere in the peritoneal cavity.
A plain abdominal film in the erect position disclosed abdominal distention with small fluid levels of the small intestine. The echo examination showed that her left ventricular ejection fraction was 56%. Stool cultures for bacteria, fungus and tubercle bacillus were all negative. The rest of her laboratory examination (including disseminated intravascular coagulation, C-reactive protein, erythrocyte sedimentation rate, and tumor biomarkers) was within normal limits. Laboratory findings included blood urea 30.9 mmol/l, serum creatinine 749 umol/l, serum amylase 34 IU/l, calcium 2.2 mmol/l, phosphate 2.3 mmol/l, albumin 30 g/l, iPTH 130 pg/ml, hemoglobin 114 g/l, and a white blood cell count of 11.1 × 10 9/l. A stool examination for occult blood was negative. An abdominal examination revealed that she had decreased bowel sounds with a mild tenderness to deep palpation, especially in the lower right quadrants.
#Pian minion meaning skin#
On admission, her physical examination showed that her blood pressure was 120/70 mm Hg, a heart rate of 76 beats/min and a body weight of 43 kg she had dry skin and complained of thirst. However, repeated blood tests did not show any abnormal results and an abdominal X-ray ultrasound was also normal. Her abdominal pain began and became more severe after HD (usually in the situation of hypotension). Three months prior to admission, she had several episodes of abdominal pain, each time occurring after HD. In August of 2008, she was admitted to our department because she developed mild, diffuse abdominal pain in combination with nausea and vomiting. She became anuric after maintenance HD for 2 years. The blood pressure was 120/70 mm Hg before HD and dropped to 80/60 mm Hg after HD. During HD, the occurrence of hypotension was frequent. Her body weight was 46 kg and the ultrafiltration volume was around 2.5–2.7 kg each time. The procedure of HD was 3 times per week and 4 h each time.
Her past medical history included primary hypertension, paroxysmal atrial fibrillation, atherosclerosis of the carotids and the abdominal aorta, and chronic congestive heart failure. She commenced maintenance HD in October 2001. We present a 62-year-old female with ESRD due to hypertension. In the absence of noninvasive tools with sufficient sensitivity and specificity, increased awareness and early diagnosis might improve the general understanding of the NOMI incidence and of the characteristics of patients with NOMI. This could be due in part to the increasing number of published cases as well as the increasing survival of end-stage renal disease (ESRD) patients, predisposing them to NOMI. The incidence appears to be increasing steadily during these years. The estimated incidence of mesenteric ischemia in this group is in the range of 0.3–1.9% per patient/year, in contrast to an up to 0.2% value for the general population. The dialysis population, and in particular hemodialysis (HD) patients, are especially prone to develop NOMI. Current knowledge of the epidemiology of NOMI is limited and mainly derived from published cases. Mesenteric ischemia without thromboembolic occlusions of the mesenteric arteries is known as nonocclusive mesenteric ischemia (NOMI).
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