In recent years the use of immunomodulating therapy to treat various cancers has been on the rise. Three checkpoint inhibitors have been approved by the Food and Drug Administration (ipilimumab, pembrolizumab and nivolumab). The use of these drugs comes with serious adverse events related to excessive immune activation, collectively known as immune-related adverse events (irAEs). We conducted a system-based review of 139 case reports/case series that have described these adverse events between January 2016 and April 2018, found in the PubMed database. There was a broad spectrum of presentations, doses and checkpoint inhibitors used. The most common check point inhibitor observed in our literature review was nivolumab. The most common adverse effects encountered were colitis (14/139), hepatitis (11/139), adrenocorticotropic hormone insufficiency (12/139), hypothyroidism (7/139), type 1 diabetes (22/139), acute kidney injury (16/139) and myocarditis (10/139). The treatment most commonly consisted of cessation of the immune checkpoint inhibitor, initiation of steroids and supportive therapy. This approach provided a complete resolution in a majority of cases; however, there were many that developed long-term adverse events with deaths reported in a few cases. The endocrine system was the mostly commonly affected with the development of type 1 diabetes mellitus or diabetic ketoacidosis being the most frequently reported adverse events. While immunomodulating therapy is a significant advance in the management of various malignancies, it is capable of serious adverse effects. Because the majority of the cases developed pancreatic dysfunction within five cycles of therapy, in addition to the evaluation of other systems, pancreatic function should be closely monitored to minimize adverse impact on patients.

Duplication of the inferior vena cava (DIVC) is an uncommon embryological anatomic phenomenon.We report a 63-year-old woman with extensive right leg deep vein thrombosis who required an IVC filter due to contraindications for anticoagulation, but was found to have DIVC which required the placement of two IVC filters with good result. This report will review and summarise past reports of DIVC management to provide a guide for future clinicians, and review the embryological development, diagnosis and IVC filter placement options as they are based on the type of anatomic malformation encountered.

This study finds that nearly one-third of the patients undergoing transradial percutaneous coronary interventions have advanced chronic kidney disease. Because many of these patients may require dialysis, the use of radial artery to conduct percutaneous coronary interventions must be carefully considered in chronic kidney disease population.

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INTRODUCTION: Primary pleural sarcomas are rare causes of pleural effusions and histopathological diagnosis is key in identifying, diagnosing and differentiating the various types. Histologically, four subtypes of liposarcomas exist: well differentiated, myxoid, lipoplastic, and pleomorphic. Pleural liposarcomas originate from primitive mesenchymal cells and are known to occur predominantly in older men with myxoid histology being the most common. CASE PRESENTATION:A 76 year old hispanic male former smoker with a history of laryngeal cancer post laryngectomy presented with progressive shortness of breath, orthopnea and bilateral lower extremity pitting edema over the course of five months. Chest x-ray showed a large right sided pleural effusion. A thoracentesis was performed with removal of 1800 ml exudative monocyte/macrophage predominant fluid, which provided him with symptomatic relief. All Infectious and rheumatologic workup was negative. Pathology of pleural fluid showed calretinin positive mesothelial cells. Within 2 weeks, he demonstrated a re-accumulation of his right sided pleural effusion. CT scan revealed stable right sided effusion with partially calcified pleural nodules. He underwent medical thoracoscopy with pleural biopsies and was noted to have 3 discrete tumors on the parietal pleura. Each of these lesions were biopsied and showed myxoid liposarcoma with low mitotic rate on pathology. Immunohistochemically, the tumor cells were focally positive for vimentin, and negative for S100, AE1/ AE3.DISCUSSION: Myxoid liposarcomas are most commonly extrapulmonary and pleural involvement is usually metastatic disease. Primary pleural malignancies tend to be diagnosed in the later stages. A thorough review of history, occupational exposure, radiographic, and immunohistochemical examination must be performed to rule out more common and likely diagnosis. In well-differentiated tumors, radiopaque foci caused by calcification and ossification may be seen. Pathologically determined grades of differentiation, site and size of tumor are the only known reliable sources to predict prognosis or outcomes. There is a lack of consensus and recommendations for treatment, which includes surgery (impractical if used as the only treatment modality due to high rates of local recurrence and irregular borders), adjuvant radiation and chemotherapy. Due to the rarity of this disease and limited information available, challenges in timely clinical diagnosis are encountered.CONCLUSIONS: Recognizing clinical presentations, radiographic, immunohistochemical, and pathological findings is paramount in understanding the prognosis of this possibly fatal condition. The atypicality of primary pleural myxoid sarcomas as a cause of recurrent pleural effusions reinforces the importance of obtaining a pathological diagnosis. Improved reporting and research may aid in supplementing additional crucial information and guide treatment.