A Billing

Publications (35)25.2 Total impact

• Article: [Economic aspects of intensive care medicine--cost and reimbursement according to diagnosis related grouping].

  A Billing, M Thalhammer, H-J Eissner, K-W Jauch, D Inthorn
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  ABSTRACT: We analyse relevant modifications of the new German diagnosis related reimbursement system for 2004. It is difficult to judge the consequences of financing intensive care systems by such flat rates. In our surgical ICU total treatment costs were 1 050.-euro /day and 11 530.-euro /patient. Comparison of our total costs and German federal calculation 2003 for long-term ventilation revealed that our costs resulting from a tertiary unit topped the average by 36-60 %. Already the present reimbursement was not cost rewarding. Evaluation according to the 2003 criteria resulted in profound further deterioration to a cost covering of only 49 %. The 2004 system, however, allows for better differentiation of patients and should result in improved reimbursement of long-term ventilation. Further professional analysis of the DRG system is essential for its "learning" development.
  Zentralblatt für Chirurgie 01/2005; 129(6):440-6. · 1.02 Impact Factor
• Article: [DRG and maximal care hospitals. Extent and causes of underfinancing].

  A Billing, M Thalhammer, H Hornung, H-J Eissner, K-W Jauch, G Auburger
  Der Chirurg 10/2004; 75(9):M249-52. · 0.70 Impact Factor
• Article: [Potential effects of the DRGs in vascular surgery. Results of a systematic grouping].

  A Billing, H Hornung, H J Eissner, G J Hänseler, F W Schildberg
  Der Chirurg 01/2003; 73(12):M361-3. · 0.70 Impact Factor
• Article: [Ileus in extensive intra-abdominal calcinosis after peritonitis].

  M Angele, M Busch, A Billing
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  ABSTRACT: We report on a case of extensive intraabdominal calcifications resulting from previous bacterial peritonitis. The patient suffered from an obstructive ileus. Relaparotomy was performed and the calcifications resected. To avoid recurrence, radiotherapy (15 Gy) and indomethacin were given. A literature review revealed only two cases of intraabdominal calcifications following peritonitis.
  Der Chirurg 07/1997; 68(6):646-8. · 0.70 Impact Factor
• Article: Perioperative pattern of peritoneal interleukin 8, tumour necrosis factor-alpha, and granulocyte elastase release in human secondary peritonitis.

  D Fröhlich, R M Eiber, M Jochum, A Billing
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  ABSTRACT: Cytokine levels during infection and sepsis have been extensively studied in the past. In contrast to the excellent data on tumour necrosis factor alpha (TNF-alpha), interleukin 8 (IL-8), and polymorphonuclear (PMN) granulocyte elastase (PMN-E) concentrations in blood, little is known about cytokine and PMN-E levels in tissue or local fluids like abdominal exudate in secondary, purulent peritonitis of man. Therefore, the authors studied perioperative intra-abdominal levels of TNF-alpha, IL-8 and PMN-E in 21 patients with severe purulent peritonitis. The average pre-operative levels of TNF-alpha were 694 +/- 239 pg/ml in exudate and 26 +/- 6 pg/ml in plasma, for IL-8 100 +/- 34 ng/ml and 0.7 +/- 0.5 ng/ml, and for PMN-E 68 +/- 14 microg/ml and 0.7 +/- 0.1 microg/ml, respectively. Standard surgical procedures reduced the intra-abdominal concentrations of cytokines and PMN-E to as low as one tenth of the pre-operative levels. Postoperatively, TNF-alpha and IL-8 levels recovered rapidly and pre-operative levels of IL-8 were reached again after 1 h and for TNF-alpha after 8 h. PMN-E concentration remained below the initial baseline within 8 h of observation. TNF-alpha concentration, but not IL-8 or PMN-E, depended on the microbiological load of the abdominal exudate (< or > 10(3) cfu/ml). There were no significant differences in the intra-abdominal or plasma levels of cytokines or PMN-E between survivors and non-survivors at any observation time.
  Cytokine 04/1997; 9(4):288-92. · 3.02 Impact Factor
• Article: Ileus bei ausgedehnten intraabdominellen Verkalkungen nach Peritonitis

  M. Angele, M. Busch, A. Billing
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  ABSTRACT: Wir berichten über einen 48 jährigen Patienten. In Folge einer bakteriellen Peritonitis hatten sich ausgedehnte intraabdominelle Verkalkungen gebildet. Diese hatten einen Obstruktionsileus verursacht. Im Rahmen einer Revisionslaparotomie wurden die Kalkspangen entfernt. Zur Rezidivprophylaxe veranlaßten wir eine percutane Bestrahlung mit 15 Gy. Zusätzlich erfolgte eine systemische Indometacin-Applikation. Eine Literaturrecherche ergab nur 2 vergleichbare Fälle. We report on a case of extensive intraabdominal calcifications resulting from previous bacterial peritonitis. The patient suffered from an obstructive ileus. Relaparotomy was performed and the calcifications resected. To avoid recurrence, radiotherapy (15 Gy) and indomethacin were given. A literature review revealed only two cases of intraabdominal calcifications following peritonitis.
  Der Chirurg 01/1997; 68(6):646-648. · 0.70 Impact Factor
• Article: [Necrotizing fasciitis].

  A Billing, R M Arendt, H Arnoldt, F W Schildberg
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  ABSTRACT: Necrotizing fasciitis has changed considerably over time. The disease used to be due to group A streptococci and affected otherwise quite healthy or traumatized subjects. Today we see multibacterial infections in polymorbid or immunocompromised patients. Rapid and resolute surgery is of critical prognostic value. Early clinical recognition may be difficult. Sometimes frozen-section biopsy proves helpful. Septic immune response and organ failure develop rapidly in these patients. After vigorous staged necrosectomy, extensive plastic reconstruction is mostly required.
  Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 01/1997; 114:508-12.
• Article: [Long-term intensive care in abdominal infect--who profits?].

  A Billing, M Angele, F W Schildberg
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  ABSTRACT: Fifty-one survivors of > 9 days of ICU treatment for abdominal sepsis were analysed for prognostic factors. Long term survival was achieved in 23 patients. Neither a single factor alone nor the constellation of organ failure allowed for correct prediction of outcome.
  Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1996; 113:321-2.
• Article: [Mucocele of the appendix. A rare differential diagnosis of right-sided adnexa tumor].

  C J Thaler, W Meier, A Billing, M Weiss, H Hepp
  Der Gynäkologe 05/1994; 27(2):108-10.
• Article: Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Peritonitis Study Group.

  A Billing, D Fröhlich, F W Schildberg
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  ABSTRACT: 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.
  British Journal of Surgery 03/1994; 81(2):209-13. · 4.61 Impact Factor
• Article: [Therapeutic limits and withholding treatment in multiple organ failure].

  F W Schildberg, D Inthorn, P Neumaier-Prauser, A Billing
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  ABSTRACT: Indications and limitations in intensive care medicine depend largely on the prognosis of the underlying disease. Quantity and length of therapeutic measures are of minor importance because their prospects of success can hardly be estimated. Scores may not be used for therapeutic decision-making in a given patient. According to our experience only a high number of failing organs (5-6) in very old patients (more than 80 years) as well as major cerebral defects are of significant prognostic value and suitable for decision-making in intensive care medicine.
  Zentralblatt für Chirurgie 02/1994; 119(3):175-8. · 1.02 Impact Factor
• Article: Peritonitisbehandlung mit der etappenlavage (EL): Prognosekriterien und behandlungsverlauf

  A. Billing, D. Fröhlich, O. Mialkowskyj, P. Stokstad, F. W. Schildberg
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  ABSTRACT: Um Kriterien fr einen sinnvollen Einsatz der Etappenlavagebehandlung (EL) zu erstellen, wurde das Krankheitsbild und der Therapieverlauf von 377 Patienten mit diffuser Peritonitis untersucht, von denen 152 mittels EL behandelt wurden. Prognostische Aspekte und Einzelheiten des Therapieverlaufs wurden bei 111 Fllen prospektiv erfat und analysiert. Die vorliegenden Daten vermitteln Hinweise auf Risikogruppen bei der Peritonitisbehandlung. Das Patientenalter und das Vorliegen eines Malignoms erwiesen sich in einer univariaten und multivariaten Analyse als prognoserelevant. Auch die Anzahl der whrend des Behandlungsverlaufs auftretenden septischen Organfunktionsstrungen war prognosebestimmend. Selbst eine passagere Funktionsstrung in allen 5 untersuchten Organsystemen wurde von 40% der Patienten berlebt. Die Sanierung der Peritonitisquelle bei der Erstoperation bzw. erst im weiteren Verlauf war gefolgt von einer Letalitt von 14 bzw. 64%. War eine definitive operative Sanierung nicht mglich, so betrug die Letalitt 90%. Die gezielte Anwendung der El erlaubte eine Kontrolle und Fortfhrung der Herdsanierung. Bei 1/3 der mit EL behandelten Patienten wurden durch die programmierte Relaparotomie operationsbedrftige Komplikationen frhzeitig erkannt und versorgt. Patienten, deren Peritonitisquelle primr saniert wurden konnte, profitierten nicht von der EL-Behandlung. Bei den Patienten mit rezidivierender oder persistierender Peritonitis war der Einsatz der EL dagegen von einer Verminderung der Letalitt um 27% begleitet.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.
  Langenbeck s Archives of Surgery 08/1992; 377(5):305-313. · 1.81 Impact Factor
• Article: Der einfluß von taurolin auf die körpereigene Abwehr und die keimelimination bei der menschlichen peritonitis

  A. Billing, D. Fröhlich, G. Ruckdeschel
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  ABSTRACT: Der Einflu von Taurolin auf phagozytoserelevante physiologische Abwehrfunktionen und auf die Keimelimination bei der menschlichen Peritonitis wurde in einer kontrollierten Studie untersucht. Die Opsonierungsleistung von Serum, eine wesentliche Voraussetzung fr die suffiziente Phagozytose, wurde durch Taurolinkonzentrationen bis zu 0,1% nicht wesentlich beeintrchtigt. Die intraabdominale Taurolinapplikation bewirkte im Vergleich zu einer Kontrollgruppe einen unvernderten Leukozyteneinstrom. Die Opsonierungsleistung im Peritonealexsudat der Therapiegruppe war, vermutlich als Folge eines spezifischen Opsoninverbrauchs, erniedrigt. Die Taurolingabe fhrte zu einer wesentlichen Keimreduktion. Die konkordant wirkenden physiologischen Abwehrfunktionen wurden nicht beeintrchtigt.The influence of taurolin on phagocytosis-related defense functions and on the elimination of bacteria has been investigated in a controlled study. Particle opsonisation, a prerequisite for sufficient phagocytosis, was undisturbed in presence of up to 0.1% taurolin. Intraabdominal taurolin application did not diminish the leukocyte influx into the abdominal cavity. Opsonic capacity of peritoneal exudate was low in the taurolin group. These exudates contained more severe bacterial contamination, suggesting that this deficit was due to enhanced specific consumption of opsonins. Taurolin treatment resulted in a marked reduction of bacterial growth. Thus the substance provides antiseptic capacities without afflicting the physiological defense systems.
  Langenbeck s Archives of Surgery 04/1992; 377(3):180-185. · 1.81 Impact Factor
• Article: [The effect of taurolin on endogenous immunity and pathogen elimination in human peritonitis].

  A Billing, D Fröhlich, G Ruckdeschel
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  ABSTRACT: The influence of taurolin on phagocytosis-related defense functions and on the elimination of bacteria has been investigated in a controlled study. Particle opsonisation, a prerequisite for sufficient phagocytosis, was undisturbed in presence of up to 0.1% taurolin. Intraabdominal taurolin application did not diminish the leukocyte influx into the abdominal cavity. Opsonic capacity of peritoneal exudate was low in the taurolin group. These exudates contained more severe bacterial contamination, suggesting that this deficit was due to enhanced specific consumption of opsonins. Taurolin treatment resulted in a marked reduction of bacterial growth. Thus the substance provides antiseptic capacities without afflicting the physiological defense systems.
  Langenbecks Archiv fü Chirurgie 02/1992; 377(3):180-5.
• Article: [Treatment of peritonitis with staged lavage: prognostic criteria and course of treatment].

  A Billing, D Fröhlich, O Mialkowskyj, P Stokstad, F W Schildberg
  [show abstract] [hide abstract]
  ABSTRACT: 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.
  Langenbecks Archiv fü Chirurgie 02/1992; 377(5):305-13.
• Article: Injuries in paragliding.

  T Zeller, A Billing, G Lob
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  ABSTRACT: 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.
  International Orthopaedics 02/1992; 16(3):255-9. · 2.03 Impact Factor
• Article: The role of the kininogens as cysteine proteinase inhibitors in local and systemic inflammation.

  I Assfalg-Machleidt, A Billing, D Fröhlich, D Nast-Kolb, T Joka, M Jochum, W Machleidt
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  ABSTRACT: The contribution of the kininogens and cystatin C to the functional inhibitory capacity for cysteine proteinases of blood plasma and inflammatory secretions was estimated from ex vivo experiments. 98.5% of the inhibitory capacity of blood plasma for cathepsin L (4-5 microM) is provided by the kininogens ensuring a complete control of this enzyme even at a lowered kininogen concentration. Control of cathepsin B activity by the kininogens is incomplete and depends critically on the active concentration of cystatin C (70 nM in normal plasma), which is reduced in blood plasma of polytraumatized and septic patients and very low in epithelial lining fluid of the shock lung.
  Agents and actions. Supplements 02/1992; 38 ( Pt 1):312-21.
• Article: Proteolysis of defensive proteins in peritonitis exudate: pathobiochemical aspects and therapeutical approach.

  A Billing, D Fröhlich, I Assfalg-Machleidt, W Machleidt, M Jochum
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  ABSTRACT: Peritonitis exudate reveals strong proteolytic activity which is paralleled by deficient opsonic capacity and high concentrations of lysosomal proteinases (elastase and cathepsin B). Lysosomal serine and cysteine proteinases (elastase, cathepsins B, L) were shown to degrade immunoglobulin G(IgG) and seem to be at least partially responsible for the observed proteolytic inactivation of IgG in peritonitis exudates. Intraabdominal serum application seems to restore opsonic activity by substitution of opsonins and proteinase inhibitors.
  Biomedica biochimica acta 02/1991; 50(4-6):399-402.
• Article: [Hanggliding--the Icarus syndrome].

  A Billing, G Lob, T Zeller
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  ABSTRACT: Parasailing is a new sport resulting in an increasing number of severe injuries. The analysis of 152 accidents reveals typical trauma mechanisms for the different flight positions. 87 patients (57%) had their crash during the landing approach. 68 pilots (45%) were affected during their primary training course. Spine lesions were found in 30 patients. Lower limb injuries occurred in 44 cases. Detailed trauma evaluation can give a clue for systematic prophylaxis.
  Unfallchirurgie 01/1991; 16(6):286-90.
• Article: [Spontaneous bacterial peritonitis in adults. Case observations of deficient infection immunity in ascites].

  A Billing, H Denecke
  Der Chirurg 07/1990; 61(6):466-8. · 0.70 Impact Factor