Inflammation and coagulation in atherosclerosis.

Cardiovascular diseases remain to be the leading cause of death in Western societies. Despite major findings in vascular biology that lead to a better understanding of the pathomechanisms involved in atherosclerosis, treatment of the disease has only changed slightly within the last years. A big body of evidence suggests that atherosclerosis is a chronic inflammatory disease of the vessel wall. Accumulation and peroxidation of LDL-particles within the vessel wall trigger a strong inflammatory response, causing macrophage and T-cell accumulation within the vessel wall. Additionally, B-cells and specific antibodies against LDL-particles, as well as the complement system are implicated in atherogenesis. Besides data from clinical trials and autopsy studies it was the implementation of mouse models of atherosclerosis and the emerging field of direct gen-modification that lead to a thorough description of the pathophysiological mechanisms involved in the disease and created overwhelming evidence for a participation of the immune system. Recently, the cross-talk between coagulation and inflammation in atherogenesis has gained attention. Serious limitations and disparities in the pathophysiology of atherosclerosis in mice and men complicated the translation of experimental data into clinical practice. Despite these limitations, new anti-inflammatory medical therapies in cardiovascular disease are currently being tested in clinical trials.

Transtemporal ultrasound application potentially elevates brain temperature: results of an anthropomorphic skull model.

PURPOSE: Transtemporal sonothrombolysis is a tool for a more effective treatment in acute stroke patients. However, some reports revealed side effects, which might be potentially connected to temperature elevation. To gain better insight into cerebral temperature changes during transtemporal sonication, diagnostic and therapeutic ultrasound (US) applications were evaluated using an anthropomorphic skull model. MATERIALS AND METHODS: The impact of diagnostic (PW-Doppler, 1.8-MHz, 0.11 W/cm², TIC 1.2) and therapeutic (1-MHz and 3-MHz, 0.07 - 0.71 W/cm², continuous and pulsed mode) US application on temperature changes was evaluated at the level of muscle/temporal bone (TB), TB/brain, brain and at the middle cerebral artery (MCA) using 4 miniature thermocouples along the US beam. Sonication lasted 120 minutes. RESULTS: Diagnostic ultrasound revealed a maximum temperature increase of 1.45°/0.60°/0.39°/0.41°C (muscle/TB, TB/brain, brain, MCA) after 120 minutes. Therapeutic-1-MHz ultrasound raised temperature by 4.33°/2.02°/1.05 °C/0.81°C (pulsed 1:20) and by 10.38°/4.95°/2.43°/2.08°C (pulsed 1:5) over 120 minutes. Therapeutic-3-MHz US raised temperature by 4.89°/2.56°/1.24/1.25°C (pulsed 1:20) and by 14.77°/6.59°/3.56°/2.86°C (pulsed 1:5) over 120 minutes, respectively. Continuous application of therapeutic US (1-MHz and 3-MHz) led to a temperature increase of 13.86°/3.63°/1.66°/1.48°C and 17.09°/4.28°/1.38/0.99°C within 3 minutes. CONCLUSION: Diagnostic PW-Doppler showed only a moderate temperature increase and can be considered as safe. Therapeutic sonication is very powerful in delivering energy so that even pulsed application modes resulted in significant and potentially harmful temperature increases.

Thermal effects of diagnostic ultrasound in an anthropomorphic skull model.

PURPOSE: Exposure to diagnostic ultrasound (US) can significantly heat biological tissue although conventional routine examinations are regarded as safe. The risk of unwanted thermal effects increases with a high absorption coefficient and extended insonation time. Certain applications of transcranial diagnostic US (TC-US) require prolonged exposure. An anthropomorphic skull model (ASM) was developed to evaluate thermal effects induced by TC-US of different modalities. The objective was to determine whether prolonged continuous TC-US application results in potentially harmful temperature increases. MATERIALS AND METHODS: The ASM consists of a human skull with tissue mimicking material and exhibits acoustic and anatomical characteristics of the human skull and brain. Experiments are performed with a diagnostic US device testing four different US modalities: Duplex PW (pulsed wave) Doppler, PW Doppler, color flow Doppler and B-mode. Temperature changes are recorded during 180 minutes of insonation. RESULTS: All measurements revealed significant temperature increases during insonation independent of the US modality. The maximum temperature elevation of + 5.25° C (p < 0.001) was observed on the surface of the skull exposed to duplex PW Doppler. At the bone-brain border a maximum temperature increae of + 2.01 °C (p < 0.001) was noted. Temperature increases within the brain were < 1.23 °C (p = 0.001). The highest values were registered using the duplex PW Doppler modality. CONCLUSION: TC-US induces significant local heating effects in an ASM. An application duration that extends routine clinical periods causes potentially harmful heating especially in tissue close to bone. TC-US elevates the temperature in the brain mimicking tissue but is not capable of producing harmful temperature increases during routine examinations. However, the risk of thermal injury in brain tissue increases significantly after an exposure time of > 2 hours.

High soluble Fas and soluble Fas Ligand serum levels before stent implantation are protective against restenosis.

Percutaneous coronary intervention (PCI) represents the most important treatment of coronary artery stenosis today. But instent restenosis (ISR) is a limitation for the outcome. Fas and Fas Ligand have been implicated in apoptosis and vessel wall inflammation. Their role in ISR is not known so far. In this prospective study we studied 137 patients with stable coronary artery disease who underwent elective PCI. Blood samples were taken directly before and 24 hours after PCI. Soluble (s)Fas and sFas Ligand serum levels were measured by ELISA. Restenosis was evaluated six to eight months later either by coronary angiography or by exercise testing. During the follow-up period, 18 patients (13%) developed ISR. At baseline, patients with ISR had significantly lower median sFas, as well as sFas Ligand levels compared to patients without ISR (sFAS: ISR 492 pg/ml, no ISR 967 pg/ml, p=0.014; sFAS Ligand: ISR: 26 pg/ml, no ISR: 42 pg/ml, p=0.001). After PCI median sFas levels significantly decreased in patients with ISR compared to patients without ISR [ISR: -152 pg/ml (IQR -36 to -227), no ISR: -38 pg/ml (IQR -173 to +150 pg/ml), p=0.03]. sFas Ligand levels after PCI significantly increased in ISR patients compared to patients without ISR [ISR: 14 pg/ml (IQR -3 to +26 pg/ml), no ISR -6 pg/ml (IQR -22 to +21 pg/ml), p=0.014]. In conclusion, sFas and sFas Ligand seem to be associated with the development of ISR. Determination of serum levels before and after PCI might help identifying patients at higher risk of ISR.

Complement in atherosclerosis: friend or foe?

Atherosclerosis is a chronic inflammatory disease and the complement system plays a central role in innate immunity. Increasing evidence exists that the complement system is activated within atherosclerotic plaques. However, the role of complement in atherogenesis is not fully understood. Whereas complement activation by the classic and lectin pathway may be protective by removing apoptotic cells and cell debris from atherosclerotic plaques, activation of the complement cascade by the alternative pathway and beyond the C3 convertase with formation of anaphylatoxins and the terminal complement complex may be proatherogenic and may play a role in plaque destabilization leading to its rupture and the onset of acute cardiovascular events. In this review article we present evidence for complement activation within atherosclerotic plaques and we discuss recent data derived from experimental animal models that suggest a dual role of complement in the development of the disease. In addition, we summarize the role of complement components as biomarkers for cardiovascular disease.

Plasminogen activator inhibitor-1 predicts coronary in-stent restenosis of drug-eluting stents.

BACKGROUND: We tested the hypothesis that plasma levels of plasminogen activator inhibitor-1 (PAI-1) are influenced by percutaneous coronary intervention (PCI) with the implantation of drug eluting stents (DES) and are able to predict the occurrence of in-stent restenosis (ISR). METHODS AND RESULTS: PAI-1 active antigen plasma levels were determined in 75 patients before and 24 h after PCI with DES implantation. Patients with ISR after six to eight months (16%) showed significantly lower PAI-1 plasma levels before PCI (ISR, 11.7 +/- 8.1 ng mL(-1); non-ISR, 22.8 +/- 18.8 ng mL(-1); P <0.05). PAI-1 levels in the lowest tertile were associated with a 9.5-fold increased risk of ISR, independent of clinical risk factors, angiographic or procedural characteristics, compared to the highest tertile (P < 0.05). The induced change of PAI-1 active antigen 24 h after PCI was significantly higher in patients with ISR (ISR, +5.6 +/- 8.0 ng mL(-1); non-ISR, -3.2 +/- 12.1 ng mL(-1); P < 0.05) with positive correlation to late lumen loss (r = 0.30; P < 0.05). CONCLUSIONS: ISR after DES implantation is significantly related to plasma levels of PAI-1 active antigen before and after PCI. If confirmed by larger multicenter studies, the determination of PAI-1 plasma levels might be clinically helpful in the identification of patients at high risk of developing of ISR, even after DES implantation.

Vascular endothelial growth factor is induced by the inflammatory cytokines interleukin-6 and oncostatin m in human adipose tissue in vitro and in murine adipose tissue in vivo.

OBJECTIVES: It is believed that adipose tissue acts as an endocrine organ by producing inflammatory mediators and thereby contributes to the increased cardiovascular risk seen in obesity. A link between adipose tissue mass and angiogenesis has been suggested. Vascular endothelial growth factor (VEGF) seems to be implicated in this process. Members of the glycoprotein (gp)130 ligand family regulate VEGF expression in other cells. METHODS AND RESULTS: We used tissue explants as well as primary cultures of preadipocytes and adipocytes from human subcutaneous and visceral adipose tissue to investigate whether the gp130 ligands oncostatin M (OSM), interleukin-6 (IL-6), leukemia inhibitory factor (LIF), and cardiotrophin-1 (CT-1) regulate VEGF expression in human adipose tissue. Human subcutaneous and visceral adipose tissue responded to treatment with IL-6 and OSM with a significant increase in VEGF production. Human preadipocytes were isolated from subcutaneous and visceral adipose tissue. Adipocyte-differentiation was induced by hormone-supplementation. All cell types responded to IL-6 and OSM with a robust increase in VEGF protein production and a similar increase in VEGF-specific mRNA. Furthermore, IL-1beta synergistically enhanced the effect of OSM on VEGF production. AG-490, a JAK/STAT inhibitor, abolished the OSM-dependent VEGF induction almost completely. In mice, IL-6 and OSM increased serum levels of VEGF and VEGF mRNA and vessel density in adipose tissue. CONCLUSION: We speculate that the inflammatory cytokines IL-6 and OSM might support angiogenesis during adipose tissue growth by upregulating VEGF.

The complement component C5a induces the expression of plasminogen activator inhibitor-1 in human macrophages via NF-kappaB activation.

BACKGROUND: Atherosclerosis is considered to be a chronic inflammatory disorder. Activation of the complement cascade is a major aspect of chronic inflammatory diseases. Complement components were identified in atherosclerotic plaques, and a correlation between adverse events and C5a plasma levels was found. These findings support the notion that complement activation contributes to development and progression of atherosclerotic lesions. OBJECTIVES: We investigated whether complement components C3a and C5a regulate plasminogen activator inhibitor (PAI-1) in human macrophages. METHODS: Human monocyte-derived macrophages (MDM) and human plaque macrophages were cultured and incubated with the complement component C5a. RESULTS: C5a increased PAI-1 up to 11-fold in human MDM and up to 2.7-fold in human plaque macrophages. These results were confirmed at the mRNA level using real time-polymerase chain reaction. Pertussis toxin or anti-C5aR/CD88 antibody completely abolished the effect of recombinant human C5a on PAI-1 production, suggesting a role of the C5a receptor. Experiments with antitumor necrosis factor (TNF)-alpha antibodies and tiron showed that the effect of C5a was not mediated by TNF-alpha or oxidative burst. Furthermore C5a induced NF-kappaB binding to the cis element in human macrophages and the C5a-induced increase in PAI-1 was completely abolished by an NF-kappaB inhibitor. CONCLUSIONS: We conclude that C5a upregulates PAI-1 in macrophages via NF-kappaB activation. We hypothesize that - if operative in vivo- this effect could favor thrombus development and thrombus stabilization in the lesion area. On the other hand one could speculate that C5a-induced upregulation of PAI-1 in plaque macrophages could act as a defense mechanism against plaque destabilization and rupture.

[The "inspection jejunostomy" after complex reconstructions of the central bile ducts]. / Anlage eines inspektionsstomas bei komplexen rekonstruktionen an den zentralen gallengängen.

INTRODUCTION: Hutson and Russell described in 1984 a surgical technique, where a modified Roux-en-Y hepaticojejunostomy with the afferent limb brought up as jejunostomy after complex reconstructions of the central bile duct was performed [4]. It facilitates endoscopic retrograde access to the biliary tree for control examinations and biopsies in complicated reconstructive procedures after bile duct resection. We report our experience with this operative procedure. METHODS: After having performed complicated bile duct resection, the reconstruction was performed as a modified Roux-en-Y hepaticojejunostomy with the 20 cm afferent limb brought up as terminal jejunostomy in the right upper abdominal quadrant. Postoperative follow-up comprised endoscopic and radiologic controls of the biliary tree every 3 months for one year; ileostomy resection was performed one year later if the postoperative course was undisturbed. RESULTS: From 03/1995 to 07/2006 we performed this operation in 25 patients (mean age 62 yrs.). Indications were previous lesions of the common bile duct after laparoscopic (n = 10) or open cholecystectomy (n = 5), common bile duct resections in cholangiocellular carcinoma and gallbladder carcinoma with unclear intraoperative safety margins (n = 4), malignant granulosa cell tumour and simultaneous cholangiocellular carcinoma, focal nodal hyperplasia, Mirizzi-syndrome, cystadenoma of the pancreas head, cyst of ecchinococus granulosos and one patient with intrahepatic recurrent stone formation after orthotopic liver transplantation. The endoscopic and radiologic (cholangiography) diagnostic procedures--performed every 3 months postoperatively--were uneventful. CONCLUSIONS: The modified Roux-en-Y hepaticojejunostomy with the afferent limb brought up as jejunostomy permits good control and intervention possibilities in complicated bile duct surgery after bile duct lesions, tumor resection with unclear resectional margins and in recurrent intrahepatic stone formation.

Effect of orthotopic small bowel transplantation on mineral metabolism in an experimental model.

BACKGROUND: Numerous experimental models have been described for investigation of short bowel syndrome. The aim of this study was to examine the effect of orthotopic small bowel transplantation (OSBT) on universal metabolism in an inbred rat model, with particular emphasis on mineral metabolism. METHODS: Jejunoileal resection and syngeneic OSBT was performed in 12-week-old male Lewis rats. Metabolic studies were performed over the following 16 weeks. Bones were analysed by physicochemical methods, dual X-ray absorptiometry, biomechanical procedures and histomorphometry. Biochemical markers of bone turnover were also measured. RESULTS: Jejunoileal resection induced severe short bowel syndrome with profoundly reduced food efficiency, bone size, fracturing energy and bone mineral content, but no cancellous bone osteopenia. After OSBT rats showed normal growth; bones were of normal size, and bone mineral content and fracturing energy were similar to those in sham-operated controls. However, tibial, but not vertebral, cancellous bone osteopenia was found after transplantation. CONCLUSION: OSBT with portal venous drainage achieves almost optimal mineral and bone metabolism. In the absence of immunosuppressive therapy, OSBT does not appear to have major untoward side-effects on bone in rats.

Inflammatory cytokines interleukin-6 and oncostatin m induce plasminogen activator inhibitor-1 in human adipose tissue.

BACKGROUND: Adipose tissue is a prominent source of plasminogen activator inhibitor-1 (PAI-1), the primary physiological inhibitor of plasminogen activation. Increased PAI-1 expression acts as a cardiovascular risk factor, and plasma levels of PAI-1 strongly correlate with body mass index (BMI). Elevated serum levels of interleukin-6 (IL-6), an inflammatory cytokine and a member of the glycoprotein 130 (gp130) ligand family, are found in obese patients and might indicate low-grade systemic inflammation. Another gp130 ligand, oncostatin M (OSM), upregulates PAI-1 in cardiac myocytes, astrocytes, and endothelial cells. We used tissue explants and primary cultures of preadipocytes and adipocytes from human subcutaneous and visceral adipose tissue to investigate whether IL-6 and OSM affect PAI-1 expression in fat. METHODS AND RESULTS: Human subcutaneous and visceral adipose tissue responded to treatment with IL-6 and OSM with a significant increase in PAI-1 production. Human preadipocytes were isolated from subcutaneous and visceral adipose tissue. Adipocyte differentiation was induced by hormone supplementation. All cell types expressed receptors for IL-6 and OSM and produced up to 12-fold increased levels of PAI-1 protein and up to 9-fold increased levels of PAI-1 mRNA on stimulation with IL-6 and OSM. AG-490, a janus kinase/signal transducer and activator of transcription inhibitor, abolished the OSM-dependent PAI-1 induction almost completely. CONCLUSIONS: We have for the first time established a link between the gp130 ligands, the proinflammatory mediators IL-6 and OSM, and the expression of PAI-1 in human adipose tissue. Thus, we speculate that IL-6 and OSM, by upregulating PAI-1 in adipose tissue, can contribute to the increased cardiovascular risk of obese patients.

[Inspection jejunostomy after complex reconstruction of the central bile duct. Indication, description, and personal experience]. / Das Inspektionsstoma nach komplexen Rekonstruktionen an den zentralen Gallengängen. Indikationen, Beschreibung der Operationsmethode und Erfahrungsbericht.

INTRODUCTION: A modified Roux-en-Y hepaticojejunostomy that allows postoperative endoscopic access was first described in 1984. We report our experience with this operative procedure. METHODS: After complicated bile duct resection, reconstruction was performed as a modified Roux-en-Y hepaticojejunostomy, with the 20 cm afferent limb brought up as in terminal jejunostomy in the right upper abdominal quadrant. Postoperative follow-up consisted of endoscopic and radiologic control of the biliary tree every 3 months for 1 year; ileostomy resection was performed 1 year later if the postoperative course was undisturbed. RESULTS: From March 1995 to February 2002, we performed this operation in 17 patients (mean age 56 years). The endoscopic and radiologic (cholangiography) diagnostic procedures--every 3 months postoperatively--were uneventful. CONCLUSIONS: The modified Roux-en-Y hepaticojejunostomy described here permits good control and intervention in complicated surgery for bile duct lesions, tumor resection with unclear resectional margins, and recurrent intrahepatic stone formation.

[Interdisciplinary surgery of the thorax-from the general surgeon's point of view]. / Operative Interdisziplinarität - Thorax. Aus der Sicht des Allgemeinchirurgen.

Interdisciplinary professional management is the most important basic principle for successfully mastering thoracic operations including the thoracic wall and adjacent regions such as neck, axilla, mediastinal vessels, upper limb, and spine. Extended oncological resection in advanced malignant diseases, side-effects of radiotherapy and trauma explain the diversity of possible operative procedures. For technical success, the necessity of vascular grafting, reconstruction of the brachial plexus, spine surgery, cardiac surgery, plastic thoracic wall reconstruction, stabilization of the thoracic wall, modern equipment, and know-how are mandatory. We chose some show-cases which-in our opinion-might be appropriate for demonstrating interdisciplinary therapy management. Functional, oncological, and cosmetic/reconstructive aspects should be considered when approaching these cases.

[Partial ischemia. Occlusive and nonocclusive mesenteric ischemia, ischemic colitis, systemic lupus erythematosus]. / Partielle Ischämien Okklusive und nichtokklusive Darmischämie, ischämische Kolitis, systemischer Lupus erythematodes.

Partial mesenteric ischemia is defined as an incomplete occlusion of the superior mesenteric artery resulting in acute abdominal pain, distended abdomen,and bowel hypomotility on auscultation. This disease can be acute or chronic and is caused by vascular occlusion or non-occlusive mechanisms. CT scan and ultrasound show a thickening of the ischemic bowel wall. On endoscopy, initially mucosal edema is observed which may proceed to necrosis. Therapy modalities depend upon the clinical findings: prevailing acute abdominal pain and peritonitis result in emergency laparotomy; prevailing cramping abdominal pain without clinical signs of peritonitis allows time for further diagnostic steps such as mesenteric angiography and interventional procedures. Laparoscopy should be performed in exceptional situations only.

Small bowel resection in the rat: the effect upon bone and mineral metabolism.

BACKGROUND AND AIMS: We analyzed bone and mineral metabolism after long-segment small bowel resection in the rat to detect functional and morphological alterations and to determine the development of osteopathy. METHODS: Twelve-week-old male Lewis rats were randomized into short (8-week) or long (16-week) follow-up groups. Sham operation, resection of the proximal third of the small bowel, resection of the distal third of the bowel and resection of the entire jejunum and ileum were carried out. Nineteen days before the end of the experiment the animals were transferred into a metabolic cage to analyze weight gain/loss, food intake, and fecal excretion/24 h. At the end of the experiment the animals were killed; blood samples and bowel and bone specimens were collected, length, weight, volume, density, mineral content, and fracturing energy were determined, and bone histology was examined. The calcium/phosphorus ratio, nonmineralized tissue content and the ratio fracturing energy/mean bone density were calculated. RESULTS: After 8 weeks there were significant differences to the control group in body weight, weight gain, food efficiency, femur length, weight, volume, mineral content, mineral density, fracturing energy per bone volume, and bone density but not in bone calcium or magnesium. After 16 weeks there were differences in body weight, weight gain, food efficiency, femur length, weight, volume, bone mineral content and density, bone minerals, and nonmineralized tissue but not in fracturing energy; the average values of all these parameters were lower in the resected groups, and lowest in the group after resection of the entire jejunum and ileum. Bone histology showed a reduction in trabecular bone mass after long-segment small bowel resection. CONCLUSIONS: Long-segment small bowel resection causes a significant loss of body weight despite of a comparable mean chow ingestion resulting in a significant decreased food efficiency. We conclude that there is no inverse relationship of bone calcium content and the fracture risk, and that there is no severe mineralization defect after long-segment small bowel resection.

Accuracy and precision of bone mineral density and bone mineral content in excised rat humeri using fan beam dual-energy X-ray absorptiometry.

The aim of this study was the evaluation of fan beam dual-energy X-ray absorptiometry (DXA) for measuring bone mineral density (BMD) and bone mineral content (BMC) of isolated rat humeri. Defleshed rat humeri from male Lewis rats were examined with a Hologic QDR 4500 A (Hologic, Inc., Bedford, MA) high-resolution densitometer both in water and 0.9% saline solution. The small animal scan protocol with the regional high-resolution mode was used. BMC measured by DXA was compared with bone dry weight, ash weight, and bone calcium content. Furthermore, DXA BMD and BMC precision were determined. We also evaluated the effect of salinity of the water bath in which the bones were measured. Correlations (r(2)) of BMC, as determined by DXA with dry weight, ash weight, and bone calcium content, were 0.978, 0.988, and 0.890, respectively. DXA overestimated ash weight by 5%-9%. Precision errors for BMC (BMD) were 0.90% (0.76%) without and 1.3 (0.86) with repositioning. Changes in the salinity of the water bath had a significant influence on the DXA results: At the 0.9% physiological level, BMC (-4.4%) and area (-4.1%), but not BMD, values were significantly lower (p < 0.005) compared with measurements in tap water. Fan beam DXA is a highly accurate and precise technique for measuring BMC and BMD in excised small animal bones. A physiological saline concentration in the water bath had a significant impact on BMC and area, but not on BMD, and should therefore be strictly controlled to avoid an underestimation of BMC.

[Quality management in surgery: treatment of pancreatic carcinoma--What is evidence-based?]. / Qualitätsmanagement in der Chirurgie: Behandlungsmöglichkeiten des Pankreaskarzinoms - Was ist Evidenz-basiert? -

Summary. The term "evidence-based medicine" (EBM) - an Anglicism in common use in modern medicine - has of the nature of a catchword, the actual meaning of which is not always clear to all who use it. Generally speaking it is taken to mean that decision-making in the areas of diagnosis and treatment is based on data obtained from randomized, preferably double-blind and controlled, studies involving sufficient numbers of cases. This, however, is not always automatically equatable with arriving at a decision at the highest level of confirmed scientific knowledge, including the most recently acquired facts. Taking account of the current literature, the present article attempts an analysis of the following four aspects of surgical treatment of pancreatic carcinoma: the required extent of lymph node dissection, the relevance of multimodal treatment concepts, the significance of pylorus-preserving partial duodenopancreatectomy and the relevance of portal vein resection.

[CT-guided percutaneous core biopsy: Effective accuracy, diagnostic utility and effective costs]. / CT-gesteuerte perkutane Schneidbiopsie: effektive Genauigkeit, diagnostischer Nutzen und effektive Kosten.

PURPOSE: The value of a diagnostic technique does not only depend on its sensitivity, specificity and accuracy, but also on how its results affect clinical management. This effect is represented by the values effective accuracy and the diagnostic utility which were determined for CT-guided coaxial core biopsies in this study. MATERIALS AND METHODS: 180 consecutive biopsies were analyzed. The results were analyzed with the help of a logistic regression analysis with regard to the organ regions biopsied, the size of the needle used, and the number of tissue cores taken. Correct results that were not accepted as diagnostic clinically and resulted in additional biopsies were scored together with the false results under negative utility coefficients. RESULTS: The sensitivity, specificity and accuracy of all the tests amounted to 91.1 %, 100 %, and 93.3 %, respectively. The diagnostic utility of the biopsies varied between 66 % for the liver and pancreatic lesions, and 88 % for the non-organ related retroperitoneum. In those cases where more than three tissue cores were taken the results were statistically significantly better in terms of effective accuracy and diagnostic utility. No significant differences were found with regard to different needle sizes in the biopsied organ regions. The lowest clinical acceptance was observed for the histological findings "scar tissue" and "inflammation". CONCLUSION: CT-guided coaxial biopsies offer a high degree of sensitivity, specificity and accuracy, as well as a low rate of therapeutically relevant complications. With increasing use of differentiated strategies in therapy for malignomas percutaneous biopsies play a very important role in the management of these diseases. Prospective studies should further evaluate the effective accuracy and diagnostic utility of core biopsies also in comparison to fine needle aspiration biopsies (FNAP).