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Coronary artery fistula is a rare condition that can be congenital or acquired. Most patients with these anomalies remain asymptomatic, but symptoms and complications may develop with increasing age. We discuss the clinical presentation, diagnostic work-up, and management options for this condition. (Level of Difficulty: Intermediate.), Graphical abstract, Coronary artery fistula is a rare condition that can be congenital or acquired. Most patients with these anomalies remain asymptomatic, but symptoms…

Metastatic cancers to the heart are rare neoplasms. The right side of the heart is more commonly involved in metastasis than the left side. We report a case of left ventricular metastasis from primary lung cancer, which was detected on whole body PET/CT imaging and on Transthoracic Echocardiography

Objective . We present a case of chronic total occlusion (CTO) approached with LASER endovascular intervention by radial artery approach using a 5 French sheath. Case report . A 57-year-old man presented to our hospital having had retrosternal chest pain for two days. Physical examination was normal at the time of presentation. The laboratory tests were within normal limits, including cardiac enzymes except the lipid panel which showed hypertriglyceridemia. The patient underwent a myocardial perfusion scintigraphy stress test that revealed inferior wall ischemia, with normal left ventricular ejection fraction. A 5-French vascular sheath was placed in the right radial artery. Selective coronary artery angiography was performed, which showed right coronary artery (RCA) CTO. A 5-French JR4 guide catheter successfully engaged the RCA and Laser angioplasty was performed across the CTO into the RCA. A marked improvement of flow was evident thereafter. Conclusion . To best of our knowledge this is the first case report showing the feasibility of laser atherectomy using the 5 French sheath system in a coronary arterial CTO.

Stress-induced cardiomyopathy is a syndrome of transient cardiac dysfunction with no clear pathophysiology. It is thought to be secondary to catecholamine surge. The mechanism by which catecholamine can induce transient cardiac dysfunction is unknown. We present a case of a patient who developed stress-induced cardiomyopathy after she was administered norepinephrine due to a nursing error.

A hydrodynamic energy model is efficiently used for the simulation of a dual-gate lattice matched MODFET at room temperature. The results obtained give a good insight of the device physics and permit through the systematic use of the model to predict the equivalent circuit elements. A simplified model is suggested where these elements as well as d.c. and a.c. characteristics could be precisely characterized depending only on electrodes potential.

Peace and reconstruction in 1996 dramatically altered the landscape of Bosnia and Herzegovina (BiH) and brought many tangible benefits to its people. Sustaining and broadening the positive developments of the past year will be the key task for the country and the international community in 1997-98. This report looks at the near-term reform issues that are essential to generating employment and providing a firm institutional and policy foundation for reconstruction and sustained economic growth. Key areas of focus include policies and expenditure reforms, including institutions for macroeconomic management, bank and enterprise privatization, and pensions and the social safety net. The report concludes with a discussion of BiH's medium-term growth prospects and financing requirements.

The study reviews the performance of four transition countries - Albania, Azerbaijan, the Kyrgyz Republic, and Moldova - in the areas of private, and financial sector development, identifying both their achievements, and challenges, to extract beneficial reform efforts, and alternative approaches, setting the pace for sustainable growth. These countries were selected because they are among the poorest in the region, whose problems are seemingly intractable, and have been largely detached from the international marketplace until the transition began. Thus, in terms of history, resource endowment, and proximity to markets they are viewed as "late reformers" in economic development, and competitiveness, despite policy reforms. Enterprise arrears, and soft budget constraints have been a significant problem in many transition economies, more often than not, manifested as some fiscal tightening occurred to offset budget constraints. Hence, a core challenge of the transition is to reduce the role of government from all encompassing presence, towards a professionally managed model, and one which provides high service delivery, strengthens civil institutions, and plays an effective regulatory role in a market economy. This requires improved financial discipline, reasonable fiscal policy, and structural adjustment, while privatization that promotes concentrated outsider ownership, and foreign participation, should be favored.

Many of the distortions in poorly performing economies do not originate in the banking sector, but where state banks still control a large share of the resources in the banking system, they continue to pose a risk to macroeconomic and fiscal stability. State banks are typically vehicles for patronage that worsen the prospects for competitive market development. Alternatively, these state banks can be ineffective shells that fail to perform a useful intermediation role once the government imposes effective hard budget constraints and a modern supervisory system. The most problematic state banks have been agricultural and industrial banks, whose original role was to finance state farms and industrial enterprises that employed large numbers of people and served as the backbone of the socialist economic mode. Banks now show stronger growth in deposits and capital in many countries in Central and Eastern Europe and the Baltics, suggesting that these countries have put into place structures that have helped to restore confidence in banking systems among creditors, investors, and the public. Recommended strategies are that Governments need to design strategies to reduce state banking in order to help create a stable banking environment. Governments should take measures to improve the business environment as part of a broad overall strategy to strengthen the financial system and end state ownership of banks. Such measures include providing support to improve corporate governance, reform judicial systems, build registries of collateral, reinforce creditors' rights and contract enforcement, modernize accounting and auditing practices, reduce administrative obstacles to business registration, and modernize bankruptcy laws.