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Primary cardiac tumors are extremely rare and constitute only about 5% of all cardiac tumors. Cardiac myxomas are noncancerous primary tumors of the heart and constitute about of 50% of all primary heart tumors. Left-sided atrial myxomas are more common than right-sided atrial myxomas. Atrial myxomas can lead to a triad of complications. The most common symptoms are associated with obstruction due to the size and location of the tumor. The next most common symptoms are associated with pulmonary and systemic embolization. Patients may also present with constitutional symptoms. Diagnosis is made via means of transesophageal echocardiography and magnetic resonance imaging. Early diagnosis and surgical resection remain the treatment of choice to prevent complications. Patients usually have a good prognosis after resection.

Drug-eluting stents have previously been shown to be superior to bare metal stents. Second-generation everolimus-eluting stents have proven to have superior outcomes compared with first-generation paclitaxel- and sirolimus-eluting stents, and the second-generation zotarolimus-eluting stents appear to be similar to the everolimus-eluting stents, though with a lesser degree of evidence. Stents with biodegradable polymers have not been shown to be superior to everolimus-eluting stents. Bioabsorbable scaffolds have not demonstrated better outcomes than current standard treatment with second-generation drug-eluting stents but have showed a concerning signal of late and very late stent thrombosis. Everolimus-eluting stents have the most favorable outcomes in terms of safety as well as efficacy in patients undergoing percutaneous coronary intervention. Newer innovations such as biodegradable polymers and bioabsorbable scaffolds lack clinical data to replace second-generation drug-eluting stents as standard of care.

on ventilator support. Unfortunately, her clinical condition did not improve and she was extubated after 11 days. She expired in hospice care within a few hours.Immune checkpoint inhibitors modulate the immune system and may cause immune-related adverse events (irAE) (Naidoo et al. 2015). Neurologic manifestations of irAE's are extremely rare. A few cases of ipilimumab-induced Guillain-Barré syndrome (GBS) have been reported in the literature (Gaudy-Marqueste et al. 2013;Wilgenhof and Neyns 2011). To our knowledge, this is the first case of nivolumab-induced GBS. Immune response directed against the myelin or axon of the peripheral nerve is implicated in the pathogenesis of GBS (Yuki and Hartung 2012). Nivolumab can cause disruption in normal immune checkpoint molecule function resulting in decreased peripheral tolerance to ganglioside-related epitopes and unchecked immune responses (Csurhes et al. 2005). With increasing use of nivolumab in advanced malignancies, physicians should be aware of rare adverse events like GBS, which can be effectively treated with rapid initiation of corticosteroids, IVIG or plasma exchange along with discontinuation of anti-PD1 antibody therapy. Compliance with ethical standardsConflict of interest None. ReferencesCsurhes PA, Sullivan A-A, Green K, Greer JM, Pender MP, McCombe PA (2005) Increased circulating T cell reactivity to GM1 ganglioside in patients with Guillain-Barré syndrome. J Clin Neurosci 12(4):409-415 Gaudy-Marqueste C, Monestier S, Franques J, Cantais E, Richard M-A, Grob J-J (2013) A severe case of ipilimumab-inducedEditor, A 68-year-old woman with stage III squamous cell carcinoma of the lung was treated with carboplatin, nabpaclitaxel, and concurrent radiation. A year later, she was diagnosed with brain metastases and nivolumab, an anti-PD1 monoclonal antibody, was initiated at a dose of 3 mg/ kg given every 2 weeks. Three months later, she presented with fatigue and bilateral lower extremity weakness of 4 days duration. Her most recent dose of nivolumab was administered 9 days ago. Physical examination revealed decreased strength in both legs. A CT scan of the brain revealed partial response to nivolumab therapy. An MRI scan of the spine was normal. Twelve hours later, she reported tingling sensation in her feet and profound weakness in lower extremities. Soon, she experienced progressive loss of motor and sensory function in arms and legs. Physical examination revealed loss of deep tendon reflexes in all four extremities associated with complete lack of strength. Cerebrospinal fluid (CSF) analysis showed clear appearance, with no nucleated cells, normal glucose and elevated protein levels (85 mg/dL; normal range 15-45). CSF Gram stain test, microbiological cultures and herpes simplex virus (HSV) DNA test were negative. The clinical finding of acute areflexic paralysis and the CSF finding of albuminocytologic dissociation were consistent with a diagnosis of GBS. She was started on intravenous immunoglobulin (IVIG) and plasma exchange. Within 2 hours, she developed ...

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