Are non invasive predictors of esophageal varices reliable?

Background: One of the most serious complications of portal hypertension is the development of esophageal varices and variceal bleeding due to the rupture of varices. The purpose of the study was to assess the efficacy of various clinical and laboratory parameters in predicting the presence and severity of esophageal varices in cirrhotic patients.Methods: This is an observational cross-sectional study done in the department of medicine in Vydehi Institute of Medical Sciences, Bengaluru over a period of one year. Total of 76 patients above the age of 18years with the diagnosis of cirrhosis of any etiology were included. Multivariate Backward method was applied and Portal vein diameter, Platelet count, PT INR, FIB-4 score, APRI, AST/ALT ratio were included as predictors in the model.Results: No statistically significant correlation was found between platelet count, portal vein diameter, FIB 4 score, APRI, AST/ALT ratio and presence of esophageal varices.Conclusions: Present study showed that the non invasive markers such as platelet count, portal vein diameter, FIB 4 score, APRI and AST/ALT ratio are not reliable in predicting the presence of esophageal varices.

Functional parathyroid cystic adenoma: A rare cause of hypercalcemic crisis with primary hyperparathyroidism.

We discuss a case of primary hyperparathyroidism caused by a giant cystic parathyroid adenoma presenting with neck swelling and hypercalcemic crisis. Fine‑needle aspiration cytology of presumed thyroid swelling from one of the two sites aspirated yielded clear fluid but was not attributed to parathyroid pathology. Elevated serum calcium and intact parathormone (iPTH) levels suggested preoperative parathyroid pathology. Ultrasound neck and sestamibi scan for parathyroid localization were not conclusive. Due to resistant hypercalcemia, the patient underwent emergency bilateral neck exploration and excision of the identified left superior parathyroid cyst along with total thyroidectomy. Monitoring of intra‑operative iPTH helped complete removal of hyperfunctioning parathyroid tissue. Histopathological examination confirmed the parathyroid cyst. Cystic parathyroid adenoma should be considered in the differential diagnosis of cystic neck lesions.