In patients with acute coronary syndrome or obstructive coronary artery disease, stents, especially drug-eluting stents (DESs), are used for percutaneous coronary interventions (PCI). DES prevents abrupt closure of the stented artery. Stent thrombosis is an uncommon but serious complication of PCI, especially with the recent advancement of stent technology. We present a case of a 75-year-old male who initially suffered a non-ST segment elevation myocardial infarction (NSTEMI) treated appropriately with PCI and subsequently developed stent thrombosis after 10 days of initial stent placement. He then underwent emergent repeat PCI with successful replacement of stents overlapping previous stents. The patient did well following the procedure. His clopidogrel was changed to a more potent antiplatelet ticagrelor. He remained stable throughout the hospital stay and was discharged home without any further complications following the next 90 days.
Pneumothorax ex vacuo (PEV) is a rare type of pneumothorax that occurs when air enters the pleural space in the chest cavity due to an increase in the volume of the lungs or a reduction in the volume of the surrounding lung tissue. Unlike a typical pneumothorax, which involves the collapse of the lung due to air accumulation, pneumothorax ex vacuo occurs when the lung itself cannot expand properly, often due to underlying lung disease or conditions such as pulmonary fibrosis or atelectasis. The mechanism is compensatory to the lung entrapment. PleurX catheter (Pleur-Evac; Teleflex, Wayne, PA, USA) insertion can cause pneumothorax ex vacuo in patients with cancer histories, as shown in this case. It is important to understand if pneumothorax ex vacuo needs observation or quick intervention. Pleural manometry is also an important part of diagnosis of pneumothorax ex vacuo and we discuss that in our case report.
Multifocal motor neuropathy (MMN) is a peripheral nerve disorder characterized by progressive, predominantly distal, asymmetric limb weakness with minimal or no sensory impairment, and characterized by the presence of antibodies (30-80% cases), mostly IgM, to the gangliosides, mainly ganglioside monosialic acid (GM1). We describe a case of MMN in a patient who developed symptoms of paresthesia and extremity weakness a few days after receiving the influenza vaccine and was found to have high titers of anti-GM1 IgM antibody levels. He was initially treated with intravenous immune globulin (IVIG) which is one of the mainstays of treatment but relapsed and was then successfully treated with plasma exchange.
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