Influenced by a favorable environment, volunteer activities are integrated into medical education in the United States. Volunteer activities by medical students in hospitals are also becoming more common in Japan. With this background in mind, we performed a survey examining the nature of medical students' volunteer activities at the University of Hawaii in the United States and Saga University in Japan. By analyzing the percentages of students participating in volunteer activities and the location and content of the activities, we found that volunteer activities of medical students in Japan and the United States are strongly influenced by differences in the respective premedical education systems. We found that a premedical education that includes volunteer activities plays an important role in the United States. We suggest that further debate on premedical education that includes volunteer work is necessary for Japan to develop its own methods of medical education.

BACKGROUND: An effective approach to lifestyle-related factors could be a main treatment for hypertensives. The components of blood pressure (BP) have been reported to have different clinical implications; however, the relationship between various lifestyle-related factors and BP components has not been thoroughly studied in hospital-based general medicine.
METHODS: This relationship was cross-sectionally investigated in a population of outpatients with hypertension but free of other diseases (136 subjects, aged 30 to 75, mean 54.2 years) . A self-administered questionnaire, which included items related to demographics, smoking, alcohol use, affinity for salt, habitual exercise, and sleep status, was used.
RESULTS: After controlling for lifestyle-related factors, multiple regression analysis revealed that body mass index (BMI) and smoking were significantly and positively correlated with systolic BP (SBP) and pulse pressure (PP) . For diastolic BP (DBP), age had a significantly negative, and lack of sleep had a significantly positive, correlation. BMI was also significantly and positively correlated with mean BP (MBP) .
CONCLUSIONS: Our results suggest that lifestyle-related factors are associated with differing BP components. Weight control should receive more attention in SBP, MBP and PP control, anti-smoking in SBP and PP control, and sleep management in DBP control.

　　A 48-year-old man with jaundice was referred to our hospital. Endoscopic retrograde cholangiography showed primary sclerosing cholangitis. Endoscopic biliary drainage was not successful because of highly viscous bile, so we performed percutaneous trans-gallbladder drainage (PTGBD), which was able to reduce the total serum bilirubin level from 8 to 10mg/ml. Subsequently, an indwelling drainage catheter was placed in the gallbladder for 13 months. However, liver atrophy worsened with the gradual progression of hepatic failure. Twelve months later, he complained of dyspnea. Computed abdominal tomography showed that the drainage catheter had perforated the diaphragm and become exposed to the chest cavity. In spite of intensive care, the patient died of liver failure while waiting for a liver transplant. Careful attention should be paid to the possibility of this serious complication in such patients.

Between 1988 and 1991, 231 patients underwent surgical repair for abdominal aortic aneurysm. Among them 132 patients underwent isolated Y graft replacement electively. They were divided into two groups, according to the operative procedure; transperitoneal approach (n=51) and retroperitoneal approach (n=81), and the surgical results were compared retrospectively. There was no significant difference in operative time, amount of operative bleeding, operative transfusion, total transfusion, autotransfusion, duration of intubation, total use of analgesia or length of postoperative stay in the two groups. The amount of fluid drained from the nasogastric tube was significantly greater in the transperitoneal group. The initiation of drinking and eating were both significantly prolonged in the transperitoneal group. The transperitoneal approach is indicated for cases with thoracic or thoracoabdominal aneurysm which may be operated on in the future, cases of bilateral common iliac aneurysms and cases with heart disease. Otherwise it is preferable to select the retroperitoneal approach as the first choice for elective surgical treatment of abdominal aortic aneurysm, because the retroperitoneal approach is superior in terms of the recovery of gastro-intestinal movement.

Objective: Several evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were based on clinical or basic studies with specific conditional settings and were not sufficiently based on real-world clinical practice. In particular, there was little information on the doses of mood stabilizers. Methods: The MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. The questionnaire included patient characteristics such as comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment. Results: Most patients received mood stabilizers such as lithium (n = 1,317), valproic acid (n = 808), carbamazepine (n = 136), and lamotrigine (n = 665). The dose of lithium was correlated with age, body weight, number of episodes, depression and GAF. The dose of valproic acid was correlated with body weight, number of episodes, presence of a rapid cycle and GAF. The dose of carbamazepine was correlated with age, mania, and the presence of a rapid cycle. The dose of lamotrigine was correlated with the number of episodes, depression, mania, psychotic features, and the presence of a rapid cycle. Doses of coadministered mood stabilizers were significantly correlated, except for the combination of valproic acid and lamotrigine. Conclusion The dose of mood stabilizers was selectively administered based on several factors, such as age, body composition, current mood status and functioning. Further prospective studies are required to confirm these findings.