Expected and unexpected imaging features after oesophageal cancer treatment.

Oesophageal cancer is a leading cause of cancer-related mortality worldwide. Various surgical procedures are performed for oesophageal malignancies. The advancement in surgical technique as well as post-surgical care has significantly reduced the complication rate. However, various complications may still occur either immediately (infection, aspiration, anastomotic leak, ischaemic necrosis, fistulae, chylothorax) or late after surgery (strictures, tumour recurrence, fistulae, delayed emptying). The palliative treatment options of radiotherapy and stent placement may also be accompanied by complications, such as radiation necrosis, stricture, and stent ingrowth by the tumour. This review presents the expected post-surgical appearance as well as various complications after surgical and non-surgical treatments of oesophageal cancer.

The conundrum of prolonged delirium.

Withdrawal delirium in alcohol dependence usually lasts 48 to 72 hours. However, certain factors can prolong delirium. We report a 39-year-old man with long-standing alcohol use who presented with delirium, which failed to resolve with treatment. On evaluation, he was found to have AIDS and limbic encephalitis due to herpes simplex virus.

Neutrophil-lymphocyte Ratio and C-reactive Protein Level in Patients with Major Depressive Disorder Before and After Pharmacotherapy.

BACKGROUND: Neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) level are useful biomarkers of inflammation. This study aimed to assess NLR and CRP level in patients with major depressive disorder before and after pharmacotherapy to determine whether NLR or CRP could be used as biomarkers of severity of major depression and whether there was any sex difference. METHODOLOGY: Patients with major depression who received no pharmacotherapy 1 month prior to the study were included. Their haemoglobin, total white blood cell count, neutrophil and lymphocyte counts, NLR, and CRP levels were evaluated at baseline and 12 weeks post pharmacotherapy, as were the Montgomery Asberg Rating Scale for Depression, the Scale for Impact of Suicidality Management and Assessment and Planning of Care (SIS-MAP), and the Clinical Global Impression Scale - Severity. RESULTS: 24 male and 26 female patients were included. At 12 weeks after pharmacotherapy, males had a higher haemoglobin level (p = 0.025), higher total white blood cell count (p = 0.018), and lower percentage of neutrophils (p = 0.019) than females. There was no sex difference in NLR or CRP. From baseline to 12 weeks, males had no significant change in any blood parameter, but females had a significantly greater increase in the percentage of neutrophils (p = 0.0001) and decrease in the percentage of lymphocytes (p = 0.012), resulting in a significantly increased NLR (p = 0.001). Both males and females had significant improvement on all 3 scales (p < 0.001). At 12 weeks, in males, the increase in NLR positively correlated with CRP as well as the Montgomery-Asberg Depression Rating Scale and the SIS-MAP, but not the Clinical Global Impression-Severity Scale. In females, the increase in NLR did not correlate with CRP or any of the scales. CONCLUSION: In female patients, the NLR increased in response to antidepressant therapy while CRP remained unchanged. This indicated that inflammation has a role in the pathogenesis of major depression.

Psychological aspects of prostate cancer: a clinical review.

Prostate cancer is the most common non-skin cancer in men. It is fraught with both physical and psychological symptomatology. Depression, anxiety, stress, fatigue, pain and psychosocial factors all affect the patient with prostate cancer. Impotence, erectile dysfunction, sexual issues and incontinence in these patients complicate matters further. Anxiety may exist both before testing and while awaiting test results. Confusion over choosing from various interventions often adds to anxiety and depression in these patients. Various demographic factors and the developmental stage of the couple affect these psychological symptoms. The caregiver may undergo significant psychological turmoil while caring for a patient diagnosed with prostate cancer, which is addressed. The role of nurses in the management of prostate cancer is discussed. The present review looks at psychological issues in patients with prostate cancer from a clinical perspective, with the aim of highlighting these issues for the clinical urologist dealing with these patients. It also explores the consultation-liaison relationship between psychiatrists, psychologists and urologists as a team for the multimodal management of prostate cancer.

Suicide and depression.

Suicide is considered to be a symptom or sequel of depression. Depressive patients (15-20%) die after committing suicide. Aetiology of suicide comprises social factors, psychological factors and biological factors. Suicide, ideational or operational must receive immediate therapeutic attention. Pharmacotherapy, electroconvulsive therapy constitute the management of suicide--Preventive strategies include primary, secondary or tertiary preventions.