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Background Gastric schwannomas (Gs) are rare mesenchymal neoplasms of the gastrointestinal tract. Diagnosis is commonly achieved by pathological examination of resected specimen. In most cases surgical resection of submucosal gastric lesions is performed with wide margins. New minimally invasive techniques are described in an increasing number of cases. Methods A Pubmed, Cochrane and Embase systematic review of the literature has been performed. Original papers, review articles, case reports published between 1988 and 2019 were considered eligible. Only papers written in English with full text available have been included. Articles reporting a follow up period, the type of treatment of the primary tumor and the appearance of local or distant recurrence were compared and analysed. Statistical analysis of data has been performed using GraphPad Prism 7 software. Results 328 articles were found and a total of 102 were included in the analysis. Fifty-three papers reported the follow-up information, ranging from 1-417 months across different studies. Among them, 31 patients underwent endoscopic removal of the gastric lesions, 140 patients local surgery, including wedge resection or partial gastrectomy and 148 patients underwent subtotal or total gastrectomy. The median follow-up was of 27-38-33 months respectively. No recurrence or distant metastasis were detected in endoscopic group. Among local surgery group, liver metastasis was reported in one case; in extended surgery group one patient died for multiple liver metastases. Conclusions In comparison with endoscopic group, local or more extended surgery involved a larger cohort of patients and reported satisfactory long-term results. Surgical approach in absence of a definite pre-operative diagnosis is considered the gold standard treatment for resectable Gs due to the excellent long-term outcome. Further studies are warranted to define the role of endoscopic treatment. Keywords : Schwannoma, neurinoma, gastric neurinoma, gastric schwannoma.

Over the past 20 years, the number of patients with pacemakers (PM) or implantable cardioverter defibrillators has risen markedly; consequently, an increasing number of lead-removal procedures have become necessary. A 64-year-old woman presenting with an infected device pocket and positive bacterial cultures ( Staphylococcus aureus ) was admitted to our department for lead removal; in 1991, she underwent VVI PM implantation for atrioventricular II degree Mobitz 1 block, and a unipolar lead was introduced via the left jugular vein. The procedure was performed in our Electrophysiology Lab with a cardiac surgeon on standby, using an excimer laser system emitting the energy at the tip of a flexible, fibre-optic 12 F sheath, developed by Spectranetics, Inc., Colorado Springs, CO, USA.

Cardiac resynchronization therapy (CRT) can be considered as the standard treatment for patients suffering from heart failure (NYHA III–IV), severely reduced left ventricular (LV) function, and wide QRS complexes. Over the past years, the lead systems used to stimulate the left ventricle have evolved technically from epicardial approaches to a transvenous access accompanied by a significant reduction of procedure-related complication rates [1]. However, even today, LV dislodgement rates ranging 5–10% and the instability of thresholds over time remain the greatest challenges with transvenous LV leads in CRT. Therefore, a special LV lead utilizing active fixation (the Attain StarFix® active fixation unipolar lead, Model 4195) was developed. At the target location, three lobes at the distal end of the lead can be deployed, which compress gently against the vein wall and thereby provide enhanced fixation of the LV lead [1]. This lead is safe and highly efficacious. It affords the physician more choices in lead placement location and has a remarkably low dislodgement rate [2,3]. We describe the case of a patient implanted in 2008 with a cardiac resynchronization therapy-defibrillator (CRT-D) device and an “active-fixation” coronary sinus lead (Attain StarFix®, Model 4195 Medtronic Inc., Minneapolis, MN, USA), who underwent transvenous lead