Background: A depressive state for residents during residency training is a serious problem. Enhancement of senior doctor's support is considered to be one preventive measure, but it is uncertain whether onset of a new depressive state during training is related to senior doctors' support.
Methods: A dual questionnaire survey was conducted in 2003 on 608 first-year residents at 40 teaching hospitals in Japan. Residents who had not been in a depressive state at the time of the first survey-using the Center for Epidemiologic Studies-Depression (CES-D) Scale, but were in a depressive state at the time of the second survey were defined as “residents in a new-onset depressive state.” The degree of senior doctors' support was assessed with Senior Doctor's Support Scale (SDSS), then adjusted OR and 95% CI of the residents in a new-onset depressive state were computed with a multivariate logistic regression model.
Results: 82 residents (24.4%) were determined to be “residents in the new-onset depressive state.” The mean CES-D Score of Low SDSS Score Group (n=24), Middle SDSS Score Group (n=100), and High SDSS Score Group (n=152) were 20.0 (SD=9.9), 13.8 (SD=8.7), and 11.0 (SD=8.0), respectively (p<0.001). With logistic regression, residents who could fall into a depressive state during residency training were considered to be those who achieve middle SDSS Score (OR: 3.04, 95% CI: 1.45-4.80) and low SDSS score (OR: 17.89, 95% CI: 4.83-66.30).
Conclusion: Because onset of residents' depressive state is related to senior doctors' support, we should enhance support during residency training.

Recently in Japan, "transition of care" cases, in which patients are transferred from a medical institution that had once provided medical care to a new one and the medical care provider is therefore changed, are increasing. However, the concept of "transition of care" and "undesirable outcomes in patients accompanied by care transition" have been studied very little in Japan. The concept of "transition of care" consists of factors such as patient background (age, underlying disease, and family's caregiving ability), transfer of clinical information, and tools to transfer clinical information. In Europe and the USA, undesirable outcomes accompanied by care transition, such as "medicamentous adverse events", "clinical examination data taken during hospitalization are not confirmed", and "medical care planned for a patient is not implemented", are reported to have occurred for 19% to 50% of patients who had been discharged from hospitals and transferred to clinics. It is also necessary to understand the state of care transition in Japan and investigate countermeasures compatible with the Japanese medical care system.

An observation of the therapeutic effects of the parallel use of acupuncture/moxibustion and medicine (mainly herbs) on 8 patients with chronic liver disorders at our clinic was done for a period of one year. The basic therapeutic points were: Right Chimen (LV), Right Puyung (ST), Chungwan (CV), Tsu sanli (LU), Sanyinchiao (SP), Taichong (LV), Chihyang (GV), Keshu (BL) and Pishu (BL); and other points were determined according to the subjective symptoms of each patient. Treatments were done 2 times a week as a basic rule. Significant improvements were observed in serum GOT, GPT and γ-GTP, and an increase was observed in serum protein. Also, a significant improvement was observed in the subjective symptoms of patients.
Judging from these results, it is suggested that the parallel use of acupuncture/moxibustion and medicine proves to be effective in the treatment of chronic liver disorders.

Although recent progress in surgery for acute traumatic rupture of the thoracic aorta is encouraging, hospital mortality remains high due to associated fatal lesions. Delayed repair of acute aortic rupture, after management of critical lesions, has been reported in the literature with increasing frequency. We present here a successful operative case of a 54-year-old-woman with acute traumatic aortic rupture. She was admitted to the intensive care unit with loss of consciousness, rib fracture and lung contusion in order to investigate additional critical lesions under strict control of systolic blood pressure under 120mmHg. After completion of all diagnostic procedures, aortic repair was performed 2 days after the accident. The intima of the aorta was found to be disrupted for two thirds of the circumference and pseudoaneurysm was diagnosed. A gelatin-coated vascular prosthesis with one branch was interposed under cardiopulmonary bypass during which general heparinization, systemic hypothermia (20°C) and retrograde brain perfusion method were used. She recovered uneventfully and was discharged 2 weeks after the operation.

We report a rare case with infection of a stent-graft. A 82-year-old man, who had undergone endovascular stent grafting to repair the descending aortic aneurysm 2 years previously, was admitted with high-grade fever. The blood culture detected methicillin-resistant Staphylococcus aureus (MRSA). Endoleak due to stent-graft infection was diagnosed and operation for synthetic graft replacement was performed. The synthetic graft was infiltrated in Rifampicin prior to the graft replacement to prevent re-infection. Additionally, the graft was covered with the greater omentum. He was discharged on the 45th day after surgery without any problems. One year follow-up showed no sign of re-infection of the graft.

In Europe and America, it is reported that residents develops burnout syndrome or depression by their stress, and these are connected with dropouts from their training program and undesirable outcomes of the patients such as unethical practice. Recently, though resident's poor working conditions and death from overwork, etc. become problems also in Japan.But, Japanese resident's stressor is uncertain.
1) Focus group interview was executed for 25 junior residents in 10 facilities, and their stressor were explored.
2) As a result, three cateogories ; physiological stressor as one human being, stressor as a new member of society, and stressor as a trainee doctor and beginner novice doctor was extracted.
3) Three stressors were named the life gap, the society gap, and the profession gap respectively. The stressor of junior resident was described as the product what was born by the gap of medical student and becoming a doctor.
4) Japanese residents have various stressors. Stressor as a trainee doctor was a stressor peculiar to Japanese junior residents.
5) Stress management should be done considering such a stressor in the light of safety and effective clinical training.

In Europe and the United States, residents develop“burnout syndrome”or depression because of stress, and these conditions are associated with withdrawal from training programs and undesirable clinical outcomes, such as unethical practices.How stress affects Japanese medical residents and their practice is uncertain, as are factors that relieve stress.Furthermore, a theoretical model of stress in Japanese medical resident is uncertain.
1) Focus group interviews were performed for 25 junior residents at 10 institutions to explore their stress reactions and stress-relieving factors.A theoretical model of stress was then constructed.
2) Adverse effects in patient care and in training, in addition to events in daily life, were found to occur as stress reactions.
3) Improvements in the support system and positive feedback from patients were found to be stress-relieving factors.
4) A theoretical model of stress for trainee physicians was constructed and was similar to a general occupational stress model.
5) Stressors should be reduced and stress-relieving factors should be improved to improve the working conditions of residents and the quality of medical care.

The diagnosis of ruptured dissecting limited abdominal aortic aneurysm was made in four cases. The sex ratio (M/F) was 1/3, and mean age was 63.5 years (from 53 to 78yr). Only one of these cases die due to intraoperative bleeding. Other three cases were discharged from our hospital. Intraluminal proximal anastomosis after fixed dissected aortic wall due to mattress suture and end to end anastomosis with reinforcement by Teflon felt were good results. The one case who was anastomosed simple intraluminal method has pseudoaneurysm in the proximal portion. It is important to diagnose preoperatively dissection and to make end to end anastomosis with Teflon felt.