[The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis]. / Der Mannheimer Peritonitis-Index. Ein Instrument zur intraoperativen Prognose der Peritonitis.

Based on the experience with 1243 patients suffering from purulent peritonitis 255 patients of two surgical departments were studied prospectively in a cohort study. Lethality was 24%. For intraabdominal infection an index is established that allows for the first time to predict lethal outcome of the disease in the individual patient. For each index-score the expected mortality is given by a modern mathematical calculation. The 'Mannheim Peritonitis Index' includes only clinical risk-factors that are routinely documented pre- and intraoperatively. Methods of evaluation, validation and the comparison with other prognostic indices are presented.

[Drug therapy of peritonitis. 6-year experience with the chemotherapeutic agent and anti-endotoxin taurolin]. / Medikamentöse Therapie der Peritonitis. 6 Jahre Erfahrung mit dem Chemotherapeutikum und Anti-Endotoxin Taurolin.

Since 1976 Taurolin is applied in clinical trials in several European states. The results being submitted show a very good activity of this substance against bacteria and endotoxin. Evaluating all clinical and experimental studies in our opinion the use of antibiotics postoperatively together with Taurolin seems to be an effective treatment of peritonitis. In our hospital taurolin has become an important part of the surgical management of severe forms of peritonitis. A development of resistant bacteria is not known up to now.

[Surgical therapy of enterovaginal fistulae following gynecologic primary procedures (author's transl)]. / Chirurgische Therapie entero-vaginaler Fisteln im Gefolge gynäkologischer Primäreingriffe.

This is a report on 14 enterovaginal fistulae following gynecologic operations. The fistulae were caused by a hysterectomy in 8 cases. There were 3 other enterovaginal fistulae following exploratory laparotomy for ovarian tumors, which proved to be pseudotumors caused by diverticulitis of the sigmoid colon. Rare causes for fistulae were cesarian section, episiotomy, and incision of an abscess of Bartholins' gland. The time interval between operation and manifestation of the fistula was usually about 10 days. The operative management required a two-or three-step procedure. Only 2 of 14 patients were treated by a colostomy, and a bowel resection was performed in 4 cases. After dissection of the fistula either peritoneum or omentum was interposed in 8 patients. No recurrences were observed.

[Treatment of chronic osteomyelitis with Taurolin-Gel (author's transl)]. / Behandlung der chronischen Osteomyelitis mit Taurolin-Gel-Stäben.

A study was made to ascertain the effect of Taurolin [Bis-(1-dioxo-perhydro-1, 2, 4-thiadiazinyl-4)-methan]*-Agarose resp. Taurolin -Collagen, using as model a chronic osteomyelitis in a dog's femur. The result was verified by means of X-rays, bone scans, intermittent bacteriological checks and, finally, histology. Taurolin, a chemotherapeuticum derived from the aminosulfonic acid, Taurin, was proven to be compatible. It led to regression of the osteomyelitis.

[Recognition and management of perforation of the gastro-intestinal tract during endoscopy (author's transl)]. / Erkennung und Versorgung endoskopischer Perforationen am Gastrointestinaltrakt.

In the course of 71/2 years there occurred 37 cases of perforation of the gastro-intestinal tract after endoscopic investigation or operation in the abdominal region. Analysis of the therapeutic results indicates that immediate laparotomy in case of confirmed perforation provides the best survival chance. In individual cases with pneumoperitoneum and no symptoms careful supervision in a surgical intensive care unit before surgical intervention can be justified.

[Peritonitis in acute appendicitis: prognostic aspects, personal results]. / Peritonitis bei akuter Appendizitis: Prognostische Faktoren, eigene Ergebnisse.

One of the most frequent causes for peritonitis is acute appendicitis. Extent and degree of peritonitis determine the further course of the disease. A retrospective analysis of acute appendicitis with concomitant peritonitis relates pre- and intraoperative findings to the postoperative development. Resulting aspects may simplify therapy in special cases and permit a more reliable prognosis.

[Therapy of purulent peritonitis. Documentation of 78 cases and experience with taurolin (author's transl)]. / Die Behandlung der eitrigen Bauchfellentzündung. Untersuchungen des Krankengutes und Erfahrung mit dem neuen Chemotherapeuticum und Antiendotoxin taurolin.

From three different surgical departments 78 patients with purulent peritonitis are analyzed according to cause, origin, and extent of peritonitis. Operative therapy is presented. As additional antibacterial therapy the new chemotherapeutic agent, Taurolin, with antiendotoxin-effect is used. The postoperative course (temperature exceeding 38 degrees C, secondary wound healing, day of discharge, and serious complications) is correlated with pre- and intraoperative parameters; for instance, 1. postoperative fever occurs in one half of the patients, more frequently following perforation of stomach and duodenum; 2. every second patient shows secondary wound healing, this happens even more often in peritonitis arising from biliary disease or appendicitis; 3. in 29.5% of the patients serious complications arise, especially in patients with peritonitis originating in stomach, small intestine or large bowel; 4. overall mortality of 11.5% is surpassed in patients with peritonitis originating from small intestine or large bowel. The so-called peritonitis-index (calculated on the basis of pre- and intraoperative factors) shows a significant difference between survivors and patients dying during the postoperative course. In 80% of the 78 patients with purulent peritonitis taurolin was effective as a substitute for the usual antibiotics.

[Two cases of perforation of the cecum following caesarean section (author's transl)]. / Zwei Fälle von Zökumperforation nach Sectio caesarea.

Two cases of perforation of the cecum following caesarean section are reviewed. Peritonitis, septic shock, and post-operative ileus are the most important causes of this life threatening complication. In addition, the operative technique is very important. The clinical signs are at first non-specific but the further course increases the likelyhood of the differential diagnosis of perforation of the Cecum. In the management, an early repeat laparotomy is important. The perforation is oversewn. Because of the possible renal and pulmonary complications post-operative intensive care is indicated.

[Antibacterial therapy of purulent peritonitis: a prospective randomized study on the effects of antibiotics and taurolin, a new chemotherapeutic and antiendotoxic agent (author's transl)]. / Die antibakterielle Behandlung der eitrigen Peritonitis: Prospektiver randomisierter Vergleich von Antibiotica mit dem neuen Chemotherapeuticum und Antiendotoxin Taurolin.

A prospective randomized study on the value of additional antibacterial therapy in surgically treated, purulent peritonitis (69 patients) is presented. A new chemotherapeutic agent Taurolin with antiendotoxin activity is tested against conventional antibiotic therapy. There was an increased rate of secondary wound healing and overall complications in the Taurolin group (especially bronchopneumonia). Local complications and lethality due to peritonitis occur similarly frequently in both groups. The bactericidal and antiendotoxic effects of Taurolin, its lacking toxicity (possibility of higher dosage), and the choice of combination with antibiotics make it a most interesting substance for additional antibacterial therapy for purulent peritonitis following surgical treatment.

[An index of peritonitis originating in the biliary tract: correlation with the postoperative course (author's transl)]. / Ein Peritonitis-Index bei der von den Gallenwegen ausgehenden Bauchfellentzündung: Korrelation mit dem postoperativen Verlauf.

Peritonitis originating in the biliary tract is analyzed in 41 patients (1973--1977). Cholelithiasis was the underlying disease in 90% of the cases, and one patient suffered from carcinoma of the biliary tree. Early cholecystectomy was performed in 95% of the patients. Peritonitis was localized in two-thirds and diffuse in one-third of the patients. A perforation was present in 63%. The grade and extent of peritonitis could be correlated with the postoperative course. One-half of the patients with turbid or purulent exudate developed postoperative fever; one fifth showed secondary wound healing. The diffuse form of peritonitis was followed more often by postoperative fever than the localized form. Although the presence or absence of perforation did not influence this parameter in the diffuse form, it did influence cases of localized peritonitis. Only the diffuse forms of peritonitis were followed by secondary wound healing. A peritonitis index was established from age, risk factors, and several preoperative and intraoperative findings. It could also be correlated with the postoperative course. The peritonitis index may classify the disease state of patients with peritonitis and may be found useful in evaluating prognosis at the time of the operation.