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"Depression is a significant problem that is common among elderly patients. The prevalence is quite high, effecting approximately 15% of the population of over 65 years.1 Among patients with chronic diseases and those with a longer care the prevalence of depression is even higher, which is 10% to 60%. Several studies demonstrate that the comorbidity of depression and physical diseases a patient suffers creates a worse prognosis and increases mortality.2'3 Disease management becomes more difficult and not optimal because depression could cause the patient to eat less and become less cooperative in following the treatment, thus resulting in a poorer medical condition.Depression is generally commonly found in the elderly. Nevertheless, diagnosing depression in the elderly is not easy. Approximately 60% of depression patients have a co-morbid physical disease.2Detection of depression among geriatric patients is often delayed due to unspecific symptoms. Delayed detection results in delayed management, which has a bad impact on the patient's medical condition and response to treatment. This is also why co-morbidity of diseases and depression has a higher mortality rate. The following are several cases of hospitalized patients suffering from depression and a co-morbid illness"

"Gout adalah sekelompok penyakit heterogen yang disebabkan oleh pengendapan kristal Na-urat dalam jaringan akibat kadar asam urat dalam cairan ekstra -selular yang lewat jenuh."

"Incidence of esophageal adenocarcinoma is increasing in western countries and has poor prognosis due to late diagnosis. Barren's esophagus is considered as premalignant lesion in which some of squamous epithelium in distal esophagus has been replaced by metaplastic columnar ephithelium. It occurs as complication of longstanding gastroesophageal reflux.Endoscopic examination is very important for early detection especially in patients with chronic symptoms of gastroesophageal reflux disease (GERD) for more than 5 years. Aggressive antireflux treatment may reduce the risk of esophageal carcinoma. However, no single therapeutic modality had been proven superior compare to others, but until now surgery remains the most popular treatment of choice in the management of Barren's esophagus."

"Gout adalah sekelompok penyakit heterogen yang disebabkan oleh pengendapan kristal Na-urat dalam jaringan, akibat kadar asam urat dalam cairan ekstra-seluler yang lewat jenuh. Manifestasi klinis dapat berupa 1) Artritis gout akut, 2) Deposit kristal Na-urat dalam jaringan (tofus), 3) Batu asam urat pada traktus urinarius dan 4) Nefropati interstitialis atau nefropati gout. Dalam praktek sehari-hari, yang dimaksud dengan gout ialah artritis gout baik akut maupun kronik. Kelainan metabolik yang mendasari gout ialah hiperurisemia. Hiperurisemia terjadi akibat peningkatan produksi asam urat dalam tubuh (overpoducers) atau berkurangnya ekskresi asam urat melalui ginjal (underexcreters). Lama dan beratnya hiperurisemia berkorelasi secara langsung dengan kemungkinan timbulnya artritis gout dan batu asam urat traktus urinarius, dan dengan umur awitan manifestasi klinis gout. Kristal urat menginduksi sel fagosit dan sel sinovium untuk memproduksi dan melepaskan mediator inflamasi seperti metabolit asam arakhidonat, phospholipase A2-activating protein, protease lisosom, tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6 dan IL-8. Pada gout sering ditemukan komorbiditas misalnya obesitas, hipertensi, penyakit ginjal dan dislipidemia. Diagnosis pasti gout dapat ditegakkan jika ditemukan kristal urat dalam cairan sendi atau tofus. Tujuan pengobatan adalah mengobati serangan akut, meredakan nyeri dan inflamasi dengan cepat dan aman, mencegah serangan dikemudian hari dan mencegah komplikasi seperti pembentukan tofus, batu ginjal dan artropati destruktif. Obat yang dipakai untuk artritis gout akut ialah kolkisin, obat antiinflamasi non-steroid atau kortikosteroid. Kolkisin juga dipakai sebagai terapi pencegahan. Diet dan perubahan cara hidup merupakan komponen yang penting dalam penatalaksanaan gout karena menurunkan kadar asam urat serum. Dengan pengobatan dini, pemantauan yang ketat disertai pendidikan terhadap penderita, prognosis umumnya baik.

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AbstractGout is a heterogeneous group of diseases resulting from monosodium urate (MSU) crystal deposition in tissues or from supersaturation of uric acid in extracellular fluids. Clinical manifestations include 1) Recurrent attacks of articular and periarticular inflammation, also called gouty arthritis; 2) Accumulation of articular, osseous, soft tissue, and cartilaginous crystalline deposits, called tophi; 3) Uric acid calculi in the urinary tract; and 4) Interstitial nephropathy with renal function impairment, called gouty nephropathy. Gout predominantly is a disease of adult men, with a peak incidence in the fifth decade. In women usually found after menopause. The metabolic disorder underlying gout is hyperuricaemia. The duration and magnitude of hyperuricemia directly correlate with the likelihood of developing gouty arthritis and uric acid urolithiasis, and with age at onset of initial clinical gouty manifestations. The urate crystals induce phagocytes and synovial cells to generate and release such mediators as cyclooxygenase and lipoxygenase metabolites of arachidonic acid, phospholipase A2-activating protein, lysosomal proteases, tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, and IL-8. Definitive diagnosis of gout needs the demonstration of MSU crystals in synovial fluid or tophus. Gout is frequently associated with comorbidity such as obesity, hypertension, renal disease and dyslipidaemia. Therapeutic goals include terminating acute attacks; providing rapid, safe relief of pain and inflammation; averting future attacks; and preventing such complications as formation of tophi, kidney stones, and destructive arthropathy. Colchicine, nonsteroidal anti-inflammatory drugs and corticosteroid are drugs used for treating acute gouty arthritis. Colchicine is also used for prophylaxis. Urate lowering drugs also play a role in prophylactic management of gout. With early intervention, careful monitoring, and patient education, the prognosis is excellent."

"Images in urology is a unique book that integrates images of urological conditions within their clinical context. Improvements in imaging techniques have meant greater diagnostic power and a dramatic rise in the number and quality of images obtained and viewed by practicing clinicians. None more so than in the field of urology, where static and dynamic images are fundamental to the diagnosis and treatment of almost all conditions. This book presents images of radiological and radionucleotide scans, macroscopic and microscopic histopathology specimens, urodynamic traces and photographs of dermatological conditions relating to urology. Each section has a series of questions, often relating to a clinical scenario, about the images. A comprehensive answer provides a description of each image and of the condition shown. Details of how to interpret the image and the use of contrast or staining methods to help differentiate normal anatomy from pathology are included. Images in Urology is an essential tool for urology, radiology and histopathology trainees and consultants, as well as being an excellent exam preparation guide."