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A 70-year-old man presented to the emergency department with accidental gunshot wound at left hemithorax and left shoulder/arm. Initial clinical assessment showed stable vital signs and an implantable cardioverter-defibrillator (ICD) protruding outside from large wound in the infraclavicular region. The ICD, previously implanted for secondary prevention of ventricular tachycardia, appeared burned and the battery was exploded. Urgent chest computed tomography scan was performed with evidence of left humeral fracture without significant arterial injury. The ICD generator was disconnected from passive fixation leads and removed. The patient was stabilized and the humeral fracture was fixed. Then lead extraction was successfully performed in a hybrid operating room with cardiac surgery standby. The patient was discharged in good clinical conditions after reimplantation of a novel ICD in the right infraclavicular region.Emerging technologies are promising in making lead extraction safer and more accessible for patients worldwide. This case report provides the most up-to-date indications and procedural approaches for lead extraction and insights on the future trends in this field.

Since the late 70's, the increase of knowledge about the prenatal period and the use of new methods for the study of the newborn have changed the previous image of the baby and his competences, deepening and confirming the idea of a newborn/infant capable of having an active role in his interaction with the world. The precocious cure, which has given the parents and the family contest an important part in rehabilitation, must not be limited to the baby himself, but must be extended to the whole contest in which he lives, grows up and learns. This new opportunity has made the family have a role of prime importance in preventing childhood handicap.

The long QT syndrome is characterized by the observed association of "torsade de pointes" and the prolongation of the QT interval on the electrocardiogram. Acquired long QT syndrome typically affects older individuals, being often associated with the action of some drugs. Hypokalemia is a frequent cause of QT lengthening on the electrocardiogram. Chronic assumption of licorice may be an unusual cause of hypokalemia, due to its mineralocorticoid-like action. In this paper we describe a case of cardiac arrest due to "torsade de pointes" resulting from a marked hypokalemia caused by the patient's habit of eating daily a not negligible quantity of licorice.

In this paper we describe the case of a 42-year-old man who presented with rather infrequent episodes of syncope. In view of this symptomatology, he had been repeatedly hospitalized and submitted to a complete diagnostic workup inclusive of brain computed tomography, head-up tilt test, repeated Holter monitoring, and electrophysiologic evaluation. Unfortunately, none of these tests allowed the formulation of a precise diagnosis. When, owing to further episodes of syncope, the patient came to our observation, after an inconclusive new series of noninvasive tests, we decided to implant an insertable loop recorder. This device revealed that a phase of severe bradycardia lasting 53 s, with 15 s of complete asystole, occurred during symptoms thus allowing us to diagnose the cause of syncope.

Basal glycemic oscillations in 3 type I-diabetics treated with continuous subcutaneous insulin infusion (CSII) and without endogenous insulin secretion have been studied. Insulin infusion with different frequencies of square wave-form basal insulin delivery (1 min and 10 min) have been utilized. Aim of the present investigation was to observe whether basal blood glucose oscillations could be affected by the frequency of basal square wave-form insulin delivery. Blood glucose has been measured at 3 min intervals for 90 min for each frequency. The glycemic patterns obtained did not show any periodism in relationship with the two frequencies engaged, hence the glycemic fluctuation, similar between the two experiments, cannot be considered as dependent on the different frequency of insulin pulses.