Fiscal Watchdogs and Sound Fiscal Policy: Is the Barking Loud Enough to Tame Politicians?

The chapter revisits the potential contribution of politically independent fiscal watchdogs (“Fiscal Councils”, or FCs) to improve fiscal performance. A simple theoretical model first illustrates that FCs cannot credibly exert a direct constraint on day-to-day policy choices. It is by contributing to the broader public debate on fiscal policy—through the provision of unbiased quantitative and qualitative analysis, forecasts, and possibly, recommendations—that these institutions can reduce informational asymmetries hindering voters’ ability to reward good policies and penalize bad ones. The chapter explores the empirical relevance of this argument by looking at the media impact of FCs in relation to “real-time” fiscal developments. It appears that FCs activity and media impact increase in times of budget slippages or relative fiscal activism, a necessary condition for the validity of the theory. However, FCs’ media impact is only weakly correlated with subsequent policy changes

Fiscal Watchdogs and Sound Fiscal Policy: Is the Barking Loud Enough to Tame Politicians?

The chapter revisits the potential contribution of politically independent fiscal watchdogs (“Fiscal Councils”, or FCs) to improve fiscal performance. A simple theoretical model first illustrates that FCs cannot credibly exert a direct constraint on day-to-day policy choices. It is by contributing to the broader public debate on fiscal policy—through the provision of unbiased quantitative and qualitative analysis, forecasts, and possibly, recommendations—that these institutions can reduce informational asymmetries hindering voters’ ability to reward good policies and penalize bad ones. The chapter explores the empirical relevance of this argument by looking at the media impact of FCs in relation to “real-time” fiscal developments. It appears that FCs activity and media impact increase in times of budget slippages or relative fiscal activism, a necessary condition for the validity of the theory. However, FCs’ media impact is only weakly correlated with subsequent policy changes

Carotid body tumors managed with preoperative embolization Report of two cases

✓ Two patients with large vascular carotid body tumors underwent preoperative intravascular embolization of the major arterial feeders. The tumor vascularity was reduced markedly, and complete surgical extirpation was accomplished without difficulty. The literature on carotid body tumors is briefly reviewed. The role of preoperative embolization in the treatment of these difficult tumors is emphasized

Inadvertent middle cerebral artery embolism by a detachable balloon: management by embolectomy Case report

✓ A case of middle cerebral artery embolism by a detachable intra-arterial balloon is presented. The balloon migrated after being detached in an effort to occlude the internal carotid artery proximal to an unclippable giant paraclinoid aneurysm. Volume expansion, induced hypertension, anticoagulation therapy, rapid middle cerebral artery embolectomy, and good collateral circulation are factors that may have contributed to the patient's complete recovery from hemiplegia

Construction of experimental “giant” aneurysms

Giant aneurysms were produced in dogs by initially producing a fistula between the common carotid artery and the external jugular vein. One week later the vein was ligated above and below the fistula to create a blind aneurysmal pouch. This model has been found useful in testing experimental techniques of aneurysmal obliteration by direct injection into the sac while the lumen of the parent vessel is temporarily protected by an endovascular balloon inflated at the neck of the aneurysm

Aneurysm of the ICA petrous segment treated by balloon entrapment after EC-IC bypass Case report

✓ A 44-year-old man experienced the sudden onset of horizontal diplopia and hemifacial numbness. Arteriography demonstrated a left intrapetrous carotid artery aneurysm. The patient was successfully treated with a left superficial temporal artery to middle cerebral artery bypass followed by balloon entrapment of the aneurysm. There have been at least 40 previously reported cases of aneurysms of the petrous portion of the carotid artery. These aneurysms can be mycotic, traumatic, or developmental in origin. They can present with massive otorrhagia or epistaxis from acute rupture or with decreased hearing and paresis of the fifth through eighth cranial nerves and, less frequently, of the ninth, 10th, and 12th cranial nerves caused by direct pressure. They can also produce pulsatile tinnitus, and sometimes they are discovered as a retrotympanic vascular mass during otological examination. The treatment of choice is carotid artery occlusion. Trapping of the aneurysm by detachable balloons eliminates immediately the risk of hemorrhage, offers the possibility of test occlusion of the internal carotid artery with the patient awake prior to permanent occlusion, and should also reduce the risk of thromboembolism. It should be preceded by a bypass procedure when preliminary evaluation indicates that the patient will not tolerate internal carotid artery occlusion

Large and Giant Paraclinoid Aneurysms: Surgical Techniques, Complications, and Results

Abstract Twenty-five patients with giant (>25 mm in diameter) and 9 patients with large (15 to 25 mm in diameter) aneurysms of the internal carotid artery in the ophthalmic or paraophthalmic region are reviewed. In 23 of these patients the aneurysm was clipped directly. There was 1 death in this group, and none of the survivors had disabling neurological complications outside the visual system. The other 11 patients were treated by a trapping procedure or by either common carotid ligation or internal carotid ligation in the neck. Of the 5 patients treated by internal carotid ligation preceded by an extracranial to intracranial bypass graft, 3 developed embolic complications, which in 1 patient resulted in death. One of the 4 patients treated by ligation of the common carotid artery died 1 year later from a recurrent subarachnoid hemorrhage. Of the total group, 18 patients had visual loss preoperatively as a result of aneurysmal compression; in 10 the vision was improved by operation, in 3 it was made worse, and in 2 it was unchanged. In another patient the vision continued to deteriorate slowly after common carotid occlusion, and the other 2 patients died postoperatively before vision could be assessed. The complications in the patients are described and analyzed in detail. Maneuvers found to be of value in the direct approach to these lesions are described. Of these, exposure of the internal carotid artery in the neck for temporary occlusion during clipping and thorough drilling of the anterior clinoid process and unroofing of the optic canal were particularly helpful. The literature on indirect methods of treatment by carotid occlusion with and without bypass graft is reviewed with special reference to the complications and effectiveness of each alternative. Based on this review of the literature and our experience, a treatment scheme is suggested for these aneurysms depending on their mode of presentation

Direct spinal arteriovenous fistula: a new type of spinal AVM Case report

✓ A patient presenting with progressive paraparesis was found to have a spinal arteriovenous fistula at the T3–4 vertebral level. The lesion consisted of a direct communication of the anterior spinal artery with a very distended venous varix that drained mostly superiorly to the posterior fossa and simulated a posterior fossa arteriovenous malformation (AVM) on vertebral angiography. The patient was treated by surgical ligation of the fistula through an anterior transthoracic approach. He deteriorated abruptly on the 4th postoperative day, probably because of retrograde thrombosis of the enlarged anterior spinal artery. Over the next few months, he improved to the point of being able to walk with crutches. He has also regained sphincter control. The different types of spinal AVM's are reviewed. Our case does not fit into any of these groups. A new category, Type IV, is proposed to designate direct arteriovenous fistulas involving the intrinsic arterial supply of the spinal cord