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The syndrome of headache and neurologic deficits with CSF lymphocytosis (HaNDL) is a self-limited, benign entity, characterized by one or more episodes of severe headache, transient neurologic deficits and lymphocytic pleocytosis in CSF [1]. Functional imaging studies have shown changes in blood flow and brain activity whose temporal and spatial characteristics are similar to those of CSD, mechanism similar to that proposed for migraine with aura [2,3,4]. Recently, was described the clinical utility of a prominent vein named index vein, found on SWI during migraine aura that drains the cortical area responsible for patient´s symptoms [5,6]. Our paper reports a patient with HaNDL and index vein, adding further evidence for spreading depression-like mechanism, similar to that proposed for migraine.

Management of delayed (within 30 days) postpolypectomy bleeding (DPPB) has not been standardized. Patients often undergo colonoscopies that do not provide any benefit. We aimed to identify factors associated with therapeutic intervention and active bleeding after DPPB.We performed a retrospective study of 548 patients with bleeding within 30 days after an index polypectomy (DPPB; 71.9% underwent colonoscopy, 2.6% underwent primary angiographic embolization, and 25.5% were managed without intervention) at 6 tertiary centers in Spain, from January 2010 through September 2018. We collected demographic and medical data from patients. The primary outcomes were the need for therapeutic intervention and the presence of active bleeding during colonoscopy.A need for therapeutic intervention was associated independently with the use of antithrombotic agents, hemoglobin decrease greater than 2 g/dL, hemodynamic instability, and comorbidities (P.05). The bleeding point during colonoscopy was identified in 344 patients; 74 of these patients (21.5%) had active bleeding. Active use of anticoagulants (odds ratio [OR], 2.6; 95% CI, 1.5-4.5), left-sided polyps (OR, 1.95; 95% CI, 1-3.8), prior use of electrocautery (OR, 2.6; 95% CI, 1.1-6.1), and pedunculated polyp morphology (OR, 1.8, 95% CI, 1-3.2) significantly increased the risk of encountering active bleeding. We developed a visual nomogram to estimate the risk of active bleeding. Overall, 43% of the cohort did not require any hemostatic therapy. Rebleeding (6%) and transfusion requirements were low in those managed without intervention.In a study of patients with DPPB, we found that almost half do not warrant any therapeutic intervention. Colonoscopy often is overused for patients with DPPB. We identified independent risk factors for active bleeding that might be used to identify patients most likely to benefit from colonoscopy.

Supplemental material for Rate of missed oesophageal cancer at routine endoscopy and survival outcomes: A multicentric cohort study by Enrique Rodríguez de Santiago, Nerea Hernanz, Héctor Miguel Marcos-Prieto, Miguel Ángel De-Jorge-Turrión, Eva Barreiro-Alonso, Carlos Rodríguez-Escaja, Andrea Jiménez-Jurado, María Sierra-Morales, Isabel Pérez-Valle, Nadja Machado-Volpato, María García-Prada, Laura Núñez-Gómez, Andrés Castaño-García, Ana García García de Paredes, Beatriz Peñas, Enrique Vázquez-Sequeiros and Agustín Albillos in United European Gastroenterology Journal

Intestinal subocclusion is a clinical picture characterized by an incomplete interruption of the distal progression of the intestinal contents, and it may be due to multiple causes. We present here the case of a 20-year-old male with severe hemophilia A who developed symptoms of periumbilical abdominal pain and intestinal subocclusion. The CT scan revealed submucosal hemorrhage in the jejunum and dilatation of the proximal segments. A conservative treatment with plasmatic factor VIII was applied and the patient showed good response to the treatment and resolution of the intramural hematoma. With this case we want to highlight this intestinal manifestation of hemophilia, its atypical clinical behavior as intestinal subocclusion and its good response to a conservative treatment with factor VIII, as opposed to surgery as the first therapeutic option. We also offer a review of the last cases of hematomas in the gastrointestinal tract in hemophiliac patients.

PURPOSE To evaluate visual pathway structure and function in patients with clinical isolated syndrome (CIS) by using spectral-domain optical coherence tomography (OCT) and multifocal visual-evoked potentials (mfVEP), predicting CIS conversion to clinically definite multiple sclerosis (MS). METHODS This observational, longitudinal study assessed the eyes with no previous history of optic neuritis of 29 consecutive patients with CIS according to the McDonald criteria. The relationships of the mfVEP results with the clinical findings, and psychophysical (Humphrey perimetry) and structural (OCT) diagnostic test data were investigated. RESULTS The mfVEP amplitude responses (interocular and monocular probability analysis) showed abnormal cluster visual field defects in 48.3% of the CIS eyes, whereas mfVEP latency analysis showed significant delays in 20.7%. The OCT average retinal nerve fiber layer thickness (RNFLT) was significantly reduced compared with the control group (P = 0.02). Significant differences between CIS eyes with abnormal and normal mfVEP latencies were found for the OCT RNFLT (P < 0.001) with a longer latency being linked to more severe axonal damage. Using multivariate logistic regression analysis, OCT average RNFLT was found to be an independent predictor of clinically definitive MS diagnosis at 12 months. CONCLUSIONS The combined use of OCT and mfVEP is helpful to detect significant subclinical visual pathway abnormalities and axonal loss in CIS patients. Retinal axonal loss measured by OCT is an important prognostic factor of conversion to MS in patients with CIS in absence of symptomatic optic neuritis.

Treballs Finals de Grau d'Educació Social, Facultat de Pedagogía, Universitat de Barcelona, Any: 2012-2013, Tutor: Maria Padrós

Malignant fibrous histiocytoma (MFH) was only recognized as a primary bone tumor a few years ago. Although it is much rarer than malignant fibrous histiocytoma of soft tissues, it is not extremely uncommon. It predominantly affects long bones; however, it has been reported to occur in many different sites and at any age. MFH are aggressive tumors that can appear in association with other bone lesions, and they have a poor prognosis. We present our experience with 13 cases of MFH and review the literature to describe the main characteristics of this tumor.

Presentamos el caso de un varon de 48 anos derivado a la consulta por un cuadro clinico de diarrea cronica (> 6 semanas) junto con alteracion de las pruebas de funcion hepatica consistente en un patron de colestasis. La presencia de diarrea cronica y colestasis nos obligaron al diagnostico diferencial entre las siguientes entidades: enfermedad celiaca, enfermedad inflamatoria intestinal, enfermedades infecciosas cronicas (tuberculosis intestinal, micobacterium avium en inmunodeprimidos), causas metabolicas como la amiloidosis, obstruccion de la via biliar intrahepatica (ductopenia del adulto, colangitis esclerosante primaria o secundaria), toma de farmacos y finalmente causas tumorales (colangiocarcinoma, linfoma de Hodgkin, adenocarcinoma colon). En el caso que presentamos, la colangio resonancia magnetica nuclear fue la herramienta diagnostica fundamental para el diagnostico de la entidad

Tracheobronchomegaly is characterized by tracheal and main bronchial dilatation usually associated with pulmonary parenchymatous disease. It is a rare condition and less than a hundred cases have been reported so far. Two cases of tracheobronchomegaly are here reported, one of them in an asymptomatic patients who came to medical attention because of pneumothorax (a previously non reported association); the other case was in a female patient with advanced age and history of recurrent pneumonic episodes and with marked parenchymatous involvement. In both cases the diagnostic confirmation was made by CT.