The diagnosis and management of aortic dissection

Article Abstract:

Acute aortic dissection, a condition in which the wall of the aorta (the blood vessel that carries blood from the heart to the body) splits longitudinally, is a catastrophic occurrence. Aortic dissection can also occur chronically. Recent advances in treatment and diagnosis of this disorder are reviewed and evaluated. Aortic dissection is classified as Type I, II, III (A or B) depending on its location, with type I closest to the heart in the ascending aorta, extending into the aortic arch. It begins with a tear in the wall of the vessel, which expands under the pressure of the blood pumping past. The tear usually continues to the iliac arteries (the terminal branches of the aorta in the pelvis), creating a ''false lumen,'' or vascular opening, that can compress the true lumen. Several types of complication can ensue: aortic rupture or insufficiency (because blood is not moved effectively through the body); blood flow back from the aorta to the heart; or obstruction of the aorta or its branches. Aortic dissection occurs most often in connection with disease of the aortic media (the blood vessel layer that tears away) and in people with high blood pressure. Some diseases of connective tissue, such as Marfan syndrome, are also associated with a high incidence of aortic dissection. People of all ages can develop this condition; males are affected more often than females. Pain that begins at a high level, rather than building more gradually (as in a heart attack) is a common symptom. However, the pain often subsides, only to be followed as long as days later by death or more pain from rupture. This latent period creates diagnostic confusion. Diagnosis is aided by chest X-rays, computed tomography (X-ray of the soft structures in the chest), invasive imaging techniques, and physician awareness. Medical therapy aims to control pain, reduce blood pressure, and prevent rupture. Acute cases require prompt surgical intervention. Mortality for proximal dissections (nearer the heart) is now less than 10 percent; for distal dissections, it is even better. Patients are never cured, and require constant monitoring. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diagnosis, Development and progression, Surgery, Dissecting aneurysm, Aortic dissection

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Ethical values at stake in health care reform

Article Abstract:

Policymakers need to consider six key values in making decisions associated with health care reform. Three key values that are important to health care reform are intrinsic values, and the other three are instrumental values. Intrinsic values are those related to human relationships and caring between people. Instrumental values are those that enable society to attain intrinsic values. The first intrinsic value is that of human dignity and the right of every individual to have adequate health care. Caring should be the basis of all therapeutic relationships, and society should care for those who are least able to help themselves. The first instrumental value is that the new health care system should be designed to benefit all members of society. Costs associated with health care should be contained, and the organization of the new health care system should be simple with a minimum amount of bureaucracy.

Ethical aspects, Health care reform

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