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AIM:To evaluate portal hypertension parameters in liver cirrhosis patients with and without esophageal varices (EV). METHODS:A cohort of patients with biopsy confirmed liver cirrhosis was investigated endoscopically and with color Doppler ultrasonography as a possible noninvasive predictive tool. The relationship between portal hemodynamics and the presence and size of EV was evaluated using uni-and multivariate approaches. RESULTS:Eighty five consecutive cirrhotic patients (43 men and 42 women) were enrolled. Mean age (± SD) was 47.5 (± 15.9). Portal vein diameter (13.88 ± 2.42 vs 12.00 ± 1.69, P < 0.0005) and liver vascular index (8.31 ± 2.72 vs 17.8 ± 6.28, P < 0.0005) were found to be significantly higher in patients with EV irrespective of size and in patients with large varices (14.54 ± 1.48 vs 13.24 ± 2.55, P < 0.05 and 6.45 ± 2.78 vs 10.96 ± 5.05, P < 0.0005, respectively), while portal vein flow velocity (13.25 ± 3.66 vs 20.25 ± 5.05, P < 0.0005), congestion index (CI) (0.11 ± 0.03 vs 0.06 ± 0.03, P < 0.0005), portal hypertensive index (2.62 ± 0.79 vs 1.33 ± 0.53, P < 0.0005), and hepatic (0.73 ± 0.07 vs 0.66 ± 0.07, P < 0.001) and splenic artery resistance index (RI) (0.73 ± 0.06 vs 0.62 ± 0.08, P < 0.0005) were significantly lower. A logistic regression model confirmed spleen size (P = 0.002, AUC 0.72) and portal hypertensive index (P = 0.040, AUC 0.79) as independent predictors for the occurrence of large esophageal varices (LEV). CONCLUSION:Our data suggest two independent situations for beginning endoscopic evaluation of compensated cirrhotic patients: Portal hypertensive index > 2.08 and spleen size > 15.05 cm. These factors may help identifying patients with a low probability of LEV who may not need upper gastrointestinal endoscopy.

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Parapelvic cysts are uncommon conditions that are usually found during autopsy. Their ultrasonographic appearance is similar to hydronephrosis. We report the case of a 46-year-old female with a 4-year history of vague flank pain and a previous history of bilateral moderate hydronephrosis. The patient was investigated by ultrasonography and non-enhanced CT scan, and finally diagnosed as bilateral parapelvic cysts by a contrast-enhanced CT scan. For any patient with hydronephrosis detected by sonography, the possibility of parapelvic cysts should be kept in mind, especially if no underlying cause is detected and other routine imaging is inconsistent with hydronephrosis. In such circumstances a CT scan with contrast enhancement should not be refused, and relying on sonographic signs, previously mentioned in literatures, can be misleading.

About 5 mg/day of LET is associated with better follicular phase parameters, endometrial development, serum E2 and LH levels in women with unexplained infertility who failed to get pregnant following frequent CC-treated cycles.