Early prognostic evaluation of abdominal sepsis is desirable to select high-risk patients for more aggressive therapeutic procedures and to provide objective classification of the severity of disease. The reliability of the Mannheim peritonitis index was assessed and its predictive power for different populations examined in a study of 2003 patients from seven centres in three European countries. The prevalence of risk factors varied considerably between the groups. For a threshold index score of 26, the sensitivity was 86 (range 54-98) per cent, specificity 74 (range 58-97) per cent and accuracy 83 (range 70-94) per cent in predicting death. For patients with a score less than 21 the mean mortality rate was 2.3 (range 0-11) per cent, for score 21-29 22.5 (range 10.6-50) per cent and for score greater than 29 59.1 (range 41-87) per cent. The mean index score and mean mortality rate correlated in the different groups, reflecting a homogeneous standard of therapy for peritonitis. The Mannheim peritonitis index provides an easy and reliable means of risk evaluation and classification for patients with peritoneal inflammation.

The study supports the view that these bacteria continue to play a minor role in secondary peritonitis. The point has to be emphasized, however, that the patients under study were in relatively good condition (APACHE II median 9 for cephalosporins and 10 for penicillins) and that postoperative cases of peritonitis were excluded.

In a retrospective study, 376 paragliding accidents have been analysed. Leg injuries were most common, but a large number of spinal injuries also occurred. The causes were either misjudgement by the pilot or the influence of weather and terrain. Improvements in the instructor's knowledge and the pilot's training could have prevented most of the accidents. Analysis of the mechanisms of the crashes and the pattern of trauma help to produce an efficient approach to diagnosis and treatment.

In order to define rational criteria for "planned relaparotomies" (PR) in the treatment of critical intra-abdominal infections we have analysed characteristics and the clinical course of 377 patients with diffuse peritonitis 152 of whom were treated by PR. More detailed prognostic aspects and data of the clinical course were prospectively investigated in 111 cases. Patient's age and an underlying malignoma revealed to be of prognostic significance in both univariate and multivariate analysis. The number of organs involved in septic organ failure during the treatment was a further indicator of risk. 40% of our patients, however, survived even an impairment of 5 organ-systems. The successful eradication of the source of peritonitis either with the 1st operation or only with consecutive operations resulted in a crucial difference of the mortality rate with 14% and 64% respectively. The failure to accomplish a definite operative resolution was accompanied by a mortality rate of 90%. The systematical application of PR facilitated control and completion of the eradication of the source of peritonitis. In one third of the patients treated by PR this technique led to early detection of relevant complications and adequate operative treatment. Patients in whom primarily a definitive eradication of the source of peritonitis had been accomplished did not benefit from PR. In patients with persisting or relapsing peritonitis, however, PR was accompanied by a 27% reduction of mortality.

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