Background. Although vascular damage in the noncoronary circulation is a major cause of complications in hypertension, relatively little is known of the in vivo geometry and function of the arterial circulation in patients with uncomplicated hypertension or of their relation to left ventricular hypertrophy, a marker of enhanced risk of cardiovascular complications.Methods and Results. Wall thickness and internal diameter of the common carotid artery and the presence of atherosclerosis within the extracranial carotid arteries were determined by ultrasound in 43 asymptomatic hypertensive patients and 43 normotensive subjects matched for sex, age, and body size. Vascular stiffness was estimated from simultaneous superimposed carotid pressure waveforms obtained with an external solid-state transducer. Left ventricular size and function were determined echocardiographically. Compared with normal subjects, hypertensive patients had greater left ventricular absolute and relative wall thicknesses, left ventricular mass, and carotid absolute and relative wall thicknesses

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The present study indicates that generalized aortic root dilation is a potent marker of an increased risk for subsequent aortic complications in Marfan syndrome.

Pericardial cysts are rare mediastinal abnormalities, which are usually congenital but may also be acquired after cardiothoracic surgery. Cysts frequently occur in the right cardiophrenic angle and their diagnosis is usually suspected after an abnormal chest X ray is obtained. The presence of a pericardial cyst in this typical location or, less frequently, in an unusual location, poses a diagnostic challenge in distinguishing it from other intracardiac or mediastinal abnormalities. Two-dimensional echocardiography and transesophageal echocardiography are extremely valuable in diagnosing the presence of a pericardial cyst. Although most pericardial cysts are asymptomatic, patients may present with chest pain and dyspnea. In addition, life-threatening complications such as pericardial tamponade have been reported in association with pericardial cysts. The following cases illustrate the usefulness of two-dimensional echocardiography in making an accurate diagnosis of a pericardial cyst, as well as in follow-up of these patients for the development of possible complications.

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The field of health literacy has evolved over the decades. While early work focused on individual skills (and deficits) and specific products (brochures and documents, for example), we, the authors, have come to a greater appreciation that health literacy is multidimensional-it includes both system demands and complexities as well as the skills and abilities of individuals. The individuals may be patients or family members, and the providers of information may be health care providers, protocol developers, insurance organizations, pharmaceutical companies, and others. To personalize and attach the study of health literacy to a variety of disciplines, various experts have come up with such terms as "oral health literacy" and "environmental health literacy," which help to connect specific content to the central concept. But we believe it is important to generate a renewed and focused discussion about the definition of health literacy to ensure that the definition actually reflects today's understanding of health literacy as multidimensional. Furthermore, health literacy operates in a wide variety of settings and mediums. So, we believe a definition should include a description of this multidimensionality; an explanation of a variety of settings and modes and media; and the unique psychological impact of health literacy on empowerment and health decisions. It should also be tangible, and, finally, it should be testable. In this paper we present an argument for why the field of health literacy needs to come to a new level of consensus on the components of a definition of health literacy. Our goals are to contribute to increasing the effectiveness of the field of health literacy in preventing disease, eliminating health inequity, increasing treatment and medical care diagnosis and effectiveness, lowering barriers to access, and improving health outcomes at a lower cost overall. LIMITATIONS OF CURRENT DEFINITIONS The most obvious complication with having multiple and often conflicting definitions of health literacy may be the simple confusion to researchers, health and health care practitioners, and policy makers who need to process and select among the many options-a complex literacy task in and of itself. This is a particular challenge in that definitions of health literacy vary significantly. To date, what appears to be the most cited definition in the United States is that originally put forth by Ratzan and Parker in 2000-"The capacity of individuals to obtain, process, and understand basic health information and services needed to make appropriate health decisions"-which was then picked up by the U.

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