[Sonography today: reference values in abdominal ultrasound: aorta, inferior vena cava, kidneys]. / Normwerte in der Abdomensonografie - Aorta, Vena cava inferior, Niere.

OBJECTIVE: Reference values for B-mode abdominal ultrasound are controversially discussed due to the limited data in the literature. A systematic survey of data published so far is presented for the big retroperitoneal vessels and the kidneys. METHODS: A literature review of reference values in the abdomen from 1970 to 2011 in healthy subjects 18 years of age and older was undertaken. According to the determination of reference intervals for laboratory values, reference values are generally determined using 95 % reference intervals and their associated 90 % confidence intervals. The diameters of the abdominal aorta and the inferior vena cava were evaluated as well as the length, width, thickness, parenchymal thickness and volume of the kidneys. RESULTS: 61 studies were analysed. Reference values determined for the aorta vary considerably according to age and gender of the probands, measuring position and measuring technique. The upper interval limits of the 95 % reference intervals lie between 17 and 40 mm. The diameter of the inferior vena cava depends on the position of the patient, the measuring site, respiration and the resting heart rate. Normal results up to 27 mm can be encountered. Influencing factors on the size and volume of the kidneys are the side (right/left), age, gender, anthropometric parameters and the ethnic membership of the probands. For central European women, 9 cm - 12.8 cm can be regarded as the normal range of the length of the kidney and for men 9.2 cm - 13.3 cm. For the width of the kidney, interval limits were determined between 3 cm and 7.1 cm, for the thickness between 2.9 cm and 6 cm, for the parenchymal thickness between 1.1 cm and 2.3 cm and for the volume between 59 and 230 mL. DISCUSSION: Normal values are helpful in delimiting numerous pathological changes in the respective organs.

[Reference values in abdominal ultrasound - biliopancreatic system and spleen]. / Normwerte in der Abdomensonografie - biliopankreatisches System und Milz.

OBJECTIVE: Reference values for B-mode abdominal ultrasound are controversially discussed due to the limited data in the literature. A systematic survey of the data published so far is presented for the biliopancreatic system and the spleen. METHODS: A literature review of reference values in the abdomen from 1970 to 2010 in healthy subjects 18 years of age and older was carried out. According to the determination of reference intervals for laboratory values, reference values are generally determined using 95 %-reference intervals and their associated 90 %-confidence intervals. The gallbladder, gallbladder wall, bile ducts, pancreas and the spleen were evaluated. RESULTS: 70 studies were analysed. The comparability of the data is limited, because different collectives were studied and diverse measuring techniques were used. In particular, gallbladder volume measurements reported in the literature differ substantially. Data for the size of the gallbladder are insufficient. Deducible reference values for the common hepatic duct or, respectively, the common bile duct lie between 5 and 9 mm in dependency on the measuring position and the collective analysed. The published measurement values for the size of the pancreas also vary considerably. In most of the publications the upper limit of normal for the length of the spleen amounts to around 12 cm, in young, athletic men up to 15 cm. DISCUSSION: Normal values are helpful in delimiting numerous pathological changes in the respective organs.

[Reference values in abdominal ultrasound - liver and liver vessels]. / Normwerte in der Abdomensonografie - Leber und Lebergefäße.

OBJECTIVE: Reference values for B-mode abdominal ultrasound are being controversially discussed due to the limited data in the literature. A systematic survey of data published so far is presented for liver and hepatic vessels. METHODS: A literature search for reference values in the abdomen from 1970 to 2010 in healthy subjects 18 years of age and older was carried out. In accord with the determination of reference intervals for laboratory values, reference values are generally determined with the aid of 95 % reference intervals and the associated 90 % confidence intervals. Evaluated parameters were the size and volume of the liver, the portal vein diameter and cross-section and the diameters of the hepatic veins. RESULTS: Liver size is usually determined by its longitudinal diameter in the midclavicular line. Although not sufficiently evaluated, < 16 cm can be used as a reference value. Numerous methods, which are not comparable, have been described for the determination of liver volume. For the portal vein diameter, refererence intervals could be deduced from 6 studies. Data from 4 studies on the liver veins differ depending on the exact localisation of measurement. DISCUSSION: Normal values are helpful in delineating numerous pathological changes in the respective organs. Unfortunately, data are scarce and the examination technique, so far, has not been standardised sufficiently to compare data. A multicentre trial is required to standardise examination techniques and improve the quality of the results.

Contrast-enhanced ultrasound for imaging of adrenal masses.

PURPOSE: The number of incidentally discovered adrenal masses is growing due to the increased use of modern high-resolution imaging techniques. However, the characterization and differentiation of benign and malignant adrenal lesions is challenging. This study aimed to evaluate contrast-enhanced ultrasound for the characterization of adrenal masses. MATERIALS AND METHODS: We studied 58 patients with adrenal masses detected with computed tomography, magnetic resonance imaging, or ultrasound. 7 patients had bilateral adrenal lesions. Contrast-enhanced ultrasound was performed using high-resolution ultrasound (3.5 - 7 MHz) and intravenous injection of 2.4 ml SonoVue. The contrast enhancement pattern of all adrenal lesions was documented. RESULTS: The 18 malignant adrenal tumors were significantly larger at the time of diagnosis compared to the 40 benign lesions (p < 0.03). The majority of benign adrenal lesions (37 / 40) had a nonspecific type of contrast enhancement (24 / 40) or a peripheral to central contrast filling (13 / 40) described as the iris phenomenon. Similar findings were observed in malignant adrenal tumors: most malignant lesions also showed nonspecific (6 / 18) or peripheral to central contrast filling (9 / 18). Peripheral to central contrast filling had 50 % sensitivity (26 - 74 %) and 68 % specificity (51 - 81 %) for indicating malignancy. CONCLUSION: Contrast-enhanced ultrasound facilitates the visualization of vascularization even in small adrenal masses, but it does not help to distinguish malignant and benign lesions.

Follow-up measurements of Nevirapine plasma levels over a prolonged period.

Over a period of more than four years of treatment, 177 Nevirapine plasma levels were taken from 27 patients. The values showed a high inter-patient variability and a lower intra-patient variability. Differences in body weight turned out to be the main reason for inter-patient variability. Treatment over a prolonged period did not result in any change in plasma concentrations. Adjusting dosage by means of therapeutic drug monitoring would appear to be a reasonable way of maximising patient benefit from treatment.