The incidence of urinary tract infections (UTI) in 299 renal graft transplantations (281 patients) was analyzed. UTI episodes were demonstrated in 185 grafts (62%), most frequently in the first month after transplantation. The infectious episodes were mostly recurrent. Persistent infection, detected in 11% of grafts, was associated with urologic complications in almost all cases. No significant correlation between the primary renal disease and the UTI rate was found, and there was no significant correlation between UTI and sex. In grafts with recurrent infectious episodes, vesicoureteral reflux was more common. No significant difference was observed in the residual bladder volume, irrespective of whether infection was present or not. The urine was infected by a number of hospital strains, particularly Klebsiella, Enterobacter and indole-positive Proteus strains. An overwhelming majority of UTI episodes (96%) were asymptomatic. Antibody-coated bacteria in urinary sediment were present in only 19% of infectious episodes. Clinically severe courses were observed in infections associated with urologic complications (especially urinary fistulae); these were difficult to treat and were often a source of sepsis and a risk factor in graft loss.

Objectives: This study was done to compare surgical tracheostomy and percutaneous dilation tracheostomy in respect to their early postoperative complications in critically ill patients. Methods: At a university hospital general intensive care unit, we studied 109 critically ill patients who underwent either elective surgical tracheostomy (n=63) or percutaneous dilation tracheostomy (n=46). The number and type of complications during operation and early postoperative period were recorded and compared. Results: When comparing the perioperative period of surgical versus percutaneous dilation tracheostomy, we recorded 2 vs 0 complications (NS difference). Average durations of postoperative observation (time until decannulation, release or death) were 16.04 and 16.09 days in group 1 and group 2, respectively; the difference in time was insignifi cant. When comparing the surgical versus percutanous groups we have found no signifi cant difference in postoperative complications in respect of bleeding and leakage through the space between the cannula and the stoma (bleeding 2 (3.2 %) vs 3 (6.5 %), NS; leakage 6 (9.5 %) vs 4 (8.7 %), NS). A signifi cant difference was found in infectious complications and disintegration of tracheostomy (infl ammation 17 (27 %) vs 0 (0 %), p<0.001, disintegration 14 (22.2 %) vs 0 (0), p<0.001, total number of complications 39 (61.9 %) vs 7 (15.2 %), p<0.001). No other complications were recorded. Conclusion: Percutaneous dilation tracheostomy is an equally safe method compared with surgical tracheostomy. While posing the same perioperative risk, it requires neither the transport to the operating theater, nor the presence of the whole surgical team. In the early postoperative period, it signifi cantly reduces the complications, mainly infections in a critically ill patient. The latter benefi ts make it a method of choice in elective tracheostomies at ICU (Tab. 2, Ref. 11).

Ten days after four-fifths nephrectomy in rats (four-fifths of the renal parenchyma removed), the total and renal elimination constants of tobramycin were lowered by one-half. The biological half-life of tobramycin doubled. These results suggest that soon after nephrectomy the residual nephrons are able to increase the rate of excretion of tobramycin. The increase in mass of the remaining renal tissue between day 10 and day 80 after nephrectomy had no effect on the biological half-life, on the total and renal elimination constants, and on the renal clearance of tobramycin. During endotoxin shock and burn shock, concentrations of tobramycin in serum decreased at a slower rate. The highest serum concentrations of tobramycin were observed in rats with shock due to burns.

A group of 44 patients with various clinical forms of urinary tract infections received a single dose of 300 mg netilmicin i.m. The treatment was efficacious in all patients with infections which were negative in the antibody-coated bacteria test and not complicated by anatomic and/or functional abnormalities of the kidneys and urinary tract. After three weeks the recurrence rate was only 19%. Single-dose treatment also proved very effective against urinary tract infections in renal transplant patients whose infection is almost always located in the lower urinary tract. In contrast, the short-term results of treatment were much poorer in complicated infections and particularly in urinary tract infections which were positive in the anti-body-coated bacteria test; here, the recurrence rate was 67%.

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