Visceral artery aneurysms are rare with an incidence of only 0.01–0.1% of the population. Open surgical or endovascular elimination should be performed for aneurysms greater than 2 cm in size. The risk of aneurysm rupture is then approximately 25–40%. If the aneurysm ruptures the mortality can be as high as 76%. For mycotic aneurysms or spurious aneurysms there is no lower limit to the diameter size for the need of treatment. Sudden abdominal pain during pregnancy can be caused by visceral artery aneurysms and must be further clarified. The indications for surgery during pregnancy should be made generously. The clinical symptoms (abdominal complaints) of visceral artery aneurysms are manifold. The treatment can be either an open surgical approach or endovascular treatment. In the emergency setting, if endovascular treatment is no longer possible, an open surgical treatment needs to be performed. There are so far no randomized studies which could identify one of the procedures (open surgery vs. endovascular surgery) as clearly being superior. The prognosis after treatment is satisfactory with a 5–10 year survival rate of approximately 90%.

Haemodialyzed (HD) patients have been found to have an increased bile cholesterol level and an increased saturation index in bile. These changes were markedly enhanced in the presence of a low-protein diet. To evaluate whether such changes influence the prevalence of cholelithiasis in patients with end-stage renal failure, real-time sonography was performed to detect the presence of gallstones (GS) in 54 HD (28 males, 26 females, mean age 52.4 ± 15.4 years) and 39 continuous ambulatory peritoneal dialysis (CAPD; 22 males, 17 females, mean age 59.1 ± 14.9 years) patients. No patient had diabetes. The patients’ charts were reviewed for the following data: age, sex, primary renal disease, obesity (20% above ideal weight), history suggestive of gallbladder disease or previous cholecystectomy, duration of dialysis, and serum cholesterol levels. Overall, cholelithiasis was documented in 12 of 93 (12.9%) patients, 7 HD and 5 CAPD. When comparing the factors outlined above, no significant difference was found between HD and CAPD patient groups, either with or without cholelithiasis. Gallbladder disease was asymptomatic in all except 1 patient who required cholecystectomy. Using a healthy control group consisting of local age- and sex-matched inhabitants, GS were found in 8 of 134 (6%) of them (p > 0.05). We conclude that the prevalence rate of GS in our dialysis population (HD and CAPD) is similar to that of a local general population following a western-style diet, irrespective of dialysis mode.

Nonocclusive mesenteric infarction has recently been diagnosed with increasing frequency in dialysis patients. Although most reports have concerned patients on hemodialysis, the condition has also been reported to occur in patients on continuous ambulatory peritoneal dialysis. This report describes such a case developing in a woman whose end-stage renal failure was due to adult polycystic kidney disease. Associated predisposing factors were the presence of orthostatic hypoxemia, postural hypotension and extensive atheromatous changes of the abdominal aorta. In keeping with the known difficulty of establishing the diagnosis of mesenteric ischemia, the diagnosis in our patient was also delayed. She was initially thought to suffer from an episode of peritonitis and/or colonic perforation secondary to the performance of a cleansing enema. Only upon showing pneumatosis coli of the right colon on abdominal computerized tomography was the correct diagnosis made. Laparotomy revealed extensive necrosis of the ascending and transverse colon. A total colectomy and ileorectal anastomosis were performed. The patient died on the 17th day following surgery. This case serves to illustrate that mesenteric infarction should be considered in predisposed patients on continuous ambulatory peritoneal dialysis. The presence of peritonitis may mask the underlying pathology and waylay the unwary physician.

Background: The autologous arteriovenous fistula is the primary choice to establish hemodialysis access without high failure rates. Intraoperative ultrasound flow measurements of newly created autologous arteriovenous fistulas represent a possibility of quality control and may therefore be a tool to assess their functionality. The aim of our study was to correlate intraoperative blood flow with access patency. Methods: Between March 2012 and March 2015, intraoperative transit time flow measurements were collected on 89 patients. Measurements were performed 5–10 min after the creation of a standardized anastomosis using 3–6 mm flow probes. To examine the correlation between intraoperative blood flow and access patency, groups of patients with high (> 200 mL/min) versus low flow (< 200 mL/min) were enrolled. Patients were assessed clinically and with ultrasound every 3 months. Data were analyzed retrospectively. Results: In the current short-term follow-up, including 89 patients (age 62 ± 3 years), 61 (68.5%) of the autologous arteriovenous fistulas were currently being used in an observation period ranging from 3 months to 3 years (mean observation period 546 ± 95 days) postoperatively. The intraoperative blood flow in patients with functioning autologous arteriovenous fistula (78) was significantly higher than that of patients without functioning autologous arteriovenous fistulas (407 ± 25 vs 252 ± 42 mL/min, respectively; p < 0.005) (11). Conclusion: The intraoperative measurement of blood flow is a useful tool to predict the outcome of maturation in autologous arteriovenous fistula. With this method, technical problems can be detected and corrected intraoperatively. Routine implementation of intraoperative flow measurements has to be examined by prospective controlled trials.

Our results showing increased HCV seropositivity in Ashkenazi Jews compared to Sephardi Jews and Arabs, suggest that ethnic factors might predispose to HCV transmission and infectivity.