Ultrasound contrast agents (UCA), in conjunction with contrast specific imaging techniques, are increasingly accepted in clinical use for diagnostic imaging and post-interventional workup in several organs. Presently, there is no guidance document providing a description of essential technical requirements, proposed investigator qualifications, suggested investigational procedures and steps, guidance on image interpretation, recommended and established clinical indications and safety considerations.The need for these guidelines was highlighted following the EFSUMB Board of Directors (Delegates) meeting at the EUROSON Congress at Copenhagen in March, 2003. During their development these guidelines were presented at the EFSUMB special consensus meeting for the use of contrast agents in ultrasound

BACKGROUND: Sibutramine, an inhibitor of serotonin and noradrenaline uptake, reduces appetite to cause weight loss. This study tested the hypothesis that an increase in energy expenditure also contributes to this weight loss. In addition, the effects of sibutramine on adrenaline induced changes in heart rate and cardiac output were determined METHODS: Nineteen obese females randomly received either sibutramine 15 mg daily or placebo for 12 weeks along with dietary advice. Resting energy expenditure (REE) was measured and then energy expenditure was measured during a 30 min infusion of adrenaline (25 ngaminakg IBW). Cardiac output and heart rate, measured by Duplex Colour Doppler ultrasonography, were similarly measured in the basal state and post adrenaline. All measurements were recorded at baseline and then after 12 weeks. RESULTS: Ten patients who received sibutramine reduced their weight by 8.1 AE 3.8% while 9 placebo treated subjects reduced their weight by 5.1 AE 4.4%, P 0.13. In absolute terms, REE decreased in placebo subjects from 1500 AE 201 kcala24 h to 1357 AE 231 kcala24 h (9.4 AE 9.9%) and in sibutramine subjects from 1540 AE 184 kcala24 h to 1444 AE 128 kcala24 h (5.3 AE 12.0%), P 0.77. The increased weight loss in the sibutramine group was associated with an increase in the FFM adjusted REE (2.2 AE 16.1%) unlike the expected decrease (5.8 AE 9.5%) in the placebo group (P 0.11). There was some suggestion (P 0.09) that the usual positive correlation between loss of weight and decline in REE was lost in the sibutramine group (r 7 0.30) compared with placebo (r 0.35). There was a negative correlation between loss of FFM and decline in REEakg FFM and (P 0.029) which was not evident in placebo (P 0.83). Adrenaline induced energy expenditure was similar in the two groups at the end of the 12 week period and there were no signi®cant cardiovascular changes between the two groups. CONCLUSIONS: Sibutramine limits the decline in REE associated with weight loss, equivalent to about 100 kcalad. This could allow greater numbers of people to maintain a greater degree of weight loss.

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