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Contrast-enhanced ultrasound (CEUS) has long been present in important guidelines and recommendations for the diagnostic work-up of focal liver lesions in patients with cirrhosis. These guidelines have included the guidelines of the American Association for the Study of Liver Diseases (AASLD) 2005, the Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma, the recommendations of the Japanese Society of Hepatology, and the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines 2004, 2008 and 2012 (in preparation). Recently, the AASLD removed CEUS from their guidelines in part because of the perceived possibility of false-positive hepatocellular carcinoma (HCC) diagnosis in patients with intrahepatic cholangiocarcinoma (ICC), and in part because CEUS is not available in the USA. This latter factor means that published results are not entirely applicable to a North American population. The present manuscript discusses the diagnostic algorithm of hepatocellular carcinoma and provides information on the differential diagnosis between HCC and ICC., (© Georg Thieme Verlag KG Stuttgart · New York.)

The focus of this article is the emergent and potential indications of contrast-enhanced ultrasound (CEUS). Emergent applications of CEUS techniques include extravascular and intracavitary contrast-enhanced ultrasound, quantitative assessment of microvascular circulation for tumor response assessment, and tumor characterization using dynamic contrast-enhanced ultrasound (DCE-US). Potential indications for microbubble agents include novel molecular imaging and drug and gene delivery techniques, which have been successfully tested in animal models. "Comments and Illustrations of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Non-Liver Guidelines 2011" which focus more on established applications are published in the same supplement to Ultraschall in der Medizin (European Journal of Ultrasound)., (© Georg Thieme Verlag KG Stuttgart · New York.)

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) introduced the first guidelines on the use of contrast-enhanced ultrasound (CEUS) in 2004. This EFSUMB document focused mainly on liver applications. However, new applications extending beyond the liver were subsequently developed. Therefore, in the update of the clinical recommendations on the use of CEUS by the EFSUMB, applications in other organs were also described and published in 2008. Increased interest in recent years in the CEUS technique and in the application of CEUS in novel fields has resulted in CEUS indications and applications for nearly all organ systems. As a result, the EFSUMB initiated a new update of the guidelines in 2011 to include this additional knowledge. Some of the indications are established, whereas others are preliminary. The latter indications are categorized as emergent CEUS applications since the available evidence is insufficient for general recommendation. This article focuses on comments, illustrations and examples of the application of CEUS in the pancreas, spleen, gastrointestinal tract, kidney, adrenals, lymph nodes, perineum, and hepatobiliary system. The potential for endoscopic ultrasound to highlight the importance of CEUS in the daily routine is also addressed., (© Georg Thieme Verlag KG Stuttgart · New York.)

Multicenter trials to assess contrast-enhanced ultrasound (CEUS) for the imaging of focal liver lesions (FLLs) have included more than 1000 patients. This article reviews the published literature pertaining to these trials to determine the role of CEUS in the characterization of FLL., (© Georg Thieme Verlag KG Stuttgart · New York.)

Gastrointestinal stromal tumours (GIST) are rare tumours of the gastrointestinal tract. Dealing with these tumours requires a profound knowledge of the nature of the lesions and their malignant potentials. Modern ultrasound techniques provide the necessary tools to give the clinician the information he needs to diagnose and treat the patient. This article reviews the actual pathophysiological knowledge of GIST and provides a broad spectrum of ultrasound findings to introduce the reader into modern ultrasound investigation methods of subepithelial tumours. It covers the transcutaneous as well as the endoscopic ultrasound approach. Different conditions of GIST like the low risk or high risk form as well as the metastatic form will be discussed in diagnosis and treatment with plenty of examples. Special attention is paid to contrast-enhanced ultrasound techniques and elastography from the transcutaneous as well as the endoscopic route. Other diagnostic methods like CT, MRI and PET CT are additionally reviewed and their role in clinical practice is compared with that of ultrasound. The aim of the article is to introduce the reader into the new ultrasound techniques and special diagnostic behaviour of GIST and outline clinical pathways to deal correctly with different stages of the disease., (© Georg Thieme Verlag KG Stuttgart · New York.)

Biliary papillomatosis (BP) is a rare disorder of the biliary tract with a significant risk of malignant transformation and a high recurrence rate after operation due to the diffuse distribution of the disease. Preoperative diagnosis is difficult also by reason of the low sensitivity and specificity of conventional ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiography (ERC) and positron emission tomography (PET). Therefore, the introduction of new diagnostic imaging methods is of importance to improve the preoperative diagnosis of this originally as benign described disease which is reflected in the term of "benign papillomatosis of the biliary tree". The present review summarizes the literature and discusses new sonographic imaging techniques including contrast-enhanced ultrasound (CEUS), contrast-enhanced low mechanical endoscopic ultrasound (CELMI-EUS) and endoscopic ultrasound elastography., (© Georg Thieme Verlag KG Stuttgart · New York.)

Influenza and pneumococcal vaccination rates among Hawaii long-term-care facilities (LTCFs) statewide during the 1996/97 through the 1998/99 influenza seasons revealed that resident influenza vaccination rates remained over 89%, but pneumococcal vaccination was underutilized. LTCF staff influenza vaccination rates over the same time period were low.

Objective: To identify metabolic and body composition changes associated with HIV-1 infection in a cross-sectional study of individuals stratified by immunologic status and body mass., Design: Metabolic abnormalities including glucose intolerance and changes in body morphology have recently been described in HIV-1-infected individuals following therapy with protease inhibitor-containing highly active anti-retroviral therapy. Although this is suggestive of a direct drug effect, the possibility that HIV infection may induce a tendency towards such underlying derangements should be considered. HIV-infected patients are heterogeneous with respect to immunologic status and body mass. In examining the underlying effect of HIV-1 on metabolic and body composition parameters, stratification by various immunologic and body mass categories may give divergent results that would not be detected otherwise., Methods: Thirty male participants were categorized into four cohorts: non-wasting HIV-seronegative controls, non-wasting HIV-infected patients with relatively intact immune function (CD4 cell count > 500 x 10(6)/l); non-wasting individuals with AIDS (CD4 cell count < 200 x 10(6)/l); and individuals with AIDS wasting., Results: Increased fasting plasma insulin and waist-to-hip ratios were found specifically in non-wasting individuals with AIDS compared with HIV-negative controls., Conclusions: Our study emphasises the importance of both body mass and immune function in studying metabolic and body composition abnormalities associated with HIV-1 infection. The association of increased waist-to-hip ratios and hyperinsulinemia suggestive of insulin resistance in non-wasting individuals with AIDS suggest that the tendency towards these metabolic abnormalities may be related to the HIV infectious process or to factors associated with immunologic dysfunction.