Critical Care and Shock

Chronic myeloid leukemia (CML) is a myeloproliferative disease characterized by clonal expansion of myeloid cells, with the aberrant BCR-ABL fusion gene as the pathognomonic cytogenetic anomaly. (1) Leukemic cells are minimally invasive and their proliferation is largely confined to hematopoietic tissues: primarily to the blood, bone marrow, spleen and liver. (2) Although rare, renal involvement in CML has also been reported. (3-5)

Cardiogenic shock is the primary cause of death in hospitalized patients with acute myocardial infarction, particularly when left ventricle failure occurs. The best management of shock secondary to right or left ventricle failure is reestablishing blood flow in the infarct-related artery. (1) Despite quick treatment, cardiogenic shock causes 50% of deaths within the first 24 hour of the event.

Induced hypothermia (IH) has been used for over 60 years (1) as an adjuvant therapy in a group of critically ill patients. Described by Fay in the 1940s, (2) IH has been used in operating rooms since the early 1950s for patients undergoing cardiac surgery and neurosurgery. The use of IH after cardiac arrest was first reported in 1957 by Benson et al. (3) The beneficial effects of hypothermia in animal tests during periods of ischemia result in a wide range of biological effects and it is not a simple mechanism of action. When IH is used in any clinical

Diaphragmatic rupture occurs in 0.8-5% of patients with major blunt thoraco-abdominal trauma and up to 70% of diaphragmatic tears are missed initially. Elevation of a single hemi diaphragm can be attributed to adjacent pleural, pulmonary or subphrenic disease, or it can occur secondary to a phrenic nerve palsy. (1) Rarely, it is related to an intrinsic weakness of the diaphragm or eventration. Because diaphragmatic rupture is often associated with thoracic or abdominal injuries that require surgical treatment, the diagnosis is usually made intraoperatively in many cases.

In the Intensive Care Unit (ICU), patients are vulnerable to develop psychomotor disturbances with increase in both motor and psychological activities, often accompanied by loss of action control and disorganization of thought. Various terms have been used including agitation, anxiety and delirium. (1) Predisposing factors such as alcohol and substance abuse, male gender, advancing age, dementia and sensory impairment can further aggravate the symptoms.