Several problems are discussed about “informed consent”, “second opinion”, and other recent issues in the field of neurosurgical operation. The surgeon should present as “evidence” for informed consent the history of his own experience and detailed results of his own surgery when recommending a surgery to a patient. The merits and demerits of “less invasive” treatment modalities such as radiosurgery and intravascular treatment are discussed with special reference to small acoustic neurinomas and carotid artery aneurysms in and around the cavernous sinus. The usefulness of surgical supporting systems such as computer navigation and intraoperative MRI are also described and discussed. In spite of the introduction of these recently advanced modalities, the significance of continuous refinement of microsurgical techniques should still be emphasized in the practice of surgical treatment of neurosurgical patients. The authors' several methods are described related to instructing and training trainees in the neurosurgery operating room. Some problems are also discussed about the medical related postgraduate education system.

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The year 2002 was an epoch-making year for the pathogenesis and treatment of polycystic kidney disease (PKD). The last genetic puzzle concerning major PKD gene, the gene PKHD1 causing autosomal recessive PKD had remained elusive for many years. However, cloning of the gene PKHD1 was achieved at the beginning of the year. In the end of the year, it was elucidated that most of the different kinds of PKD gene products concentrated in the cilia of the renal tubular epithelial cells. In the field of therapy, an angiotensin II receptor blocker, candesartan, was reported to better preserve renal function of autosomal dominant PKD patients with hypertension than calcium antagonist did. On the other hand, the candidate medicine for PKD, pioglitazone, which was already being used as a drug for diabetes mellitus was proposed as an effective drug. For the mass effect of PKD and polycystic liver disease transcatheter renal and hepatic arterial embolization treatment was established.
In this review, the author explains clinical development against PKD in the past 10 years in Japan as well as major topics of PKD in 2002.

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To prevent medical errors, it is important to establish a safe medical system in line with the remarkable progress of modern medicine. We analyzed 1595 incident reports from our hospital covering a year and focused on 671 medication errors which made up the largest part of the reports. Nurses found medication errors in 83%, because they have contact with the patients most frequently. Nine percent of the errors were unexpectedly found by patients and/or their family. Medication errors caused by physicians were classified into six categories;incorrect writing-35%, oral indication-23%, description against the rule-16%, error of a patient card-14%, lack of knowledge-5%, and others including incorrect information-7%. The major factor contributing to incidents was insufficient confirmation, which accounted for 73% of the errors by physicians, 78% by pharmacists, and 49% by nurses.
Factors related to the working environment contributed to the errors at the almost same rate in each occupation;18% for physicians, 20% for pharmacists and 17% for nurses. Other factors causally related to the errors were poor cooperation among physicians, -9% and lack of reconfirmation by nurses, -33%.

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According to a notification by the Ministry of Health, Welfare and Labor, medical insurance reimbursement would be reduced if pressure ulcer prevention was not started by October 2002. As a direct result, I was appointed as chief dermatologist, to conduct these preventive measures at Saishunso National Hospital from July 2002. As I had also been called to treat pressure ulcer patients at this hospital prior to July, I was able to compare the pre and post periods of my mission (pre:from February to June, 2002;and post:from July to October, 2002) to demonstrate the effectiveness of the preventive measures implemented in our program.
In the pre-stage, dermatological attention was limited to deep pressure ulcer patients, only after a long period had intervened from the onset. Since one aspect of the post-period was to check every patient, the number of occurrences increased, but most of them were found in stage I or II and healed in a relatively short period. The obvious reduction of both the length for treatment and the number of deep pressure ulcer occurrences was considered to be the result of improvement of nursing skills:specifically, prevention planning according to individual risk factors, and wound treatment technique including proper usage of occlusive dressing materials.

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Discoid skin rashes and hepatosplenomegaly were seen from one month after birth in a baby born to a mother with autoimmune hepatitis. One year before giving birth, the mother was found to have antinuclear antibody and hypergammaglobulinemia, and she was treated for systemic lupus erythematosus. Her liver function had been normal during her pregnancy, but from the 10^th postpartum day, for 12 days, she had a fever reaching 39°C. At the same time, she showed a GOT of 183IU/L and a GPT of 113IU/L, and autoantibodies appeared:antinuclear antibody of 1:1, 280 and anti-DNA antibody of 1:80. Lupoid hepatitis was diagnosed. The child was born at 40 weeks' gestation, and had a birth weight of 3, 310g. At the age of one month, stomatitis and diarrhea developed, and discoid skin rashes appeared on the face, chest and upper extremities. On admission to hospital, the infant showed the following values:GOT, 282IU/L;GPT, 311IU/L;anti-SS-A antibody, 1:16;anti-SS-B antibody, 1:2;and antinuclear antibody, 1:80;and it was considered that SLE-related antibody had been transferred from the mother, causing the hepatic dysfunction in the baby. Both anti-SS-A and anti-SS-B antibodies decreased to low levels at 4 months;and together with the fall in antibody levels, GOT and GPT were normalized at 5 months.

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The patient is a 51-year-old man who from the age of 44 became unsteady on his feet since his legs would become entangled. He was diagnosed as having olivopontocerebellar atrophy. It gradually became more difficult for him to walk. He was admitted to our hospital complaining of dysphagia and dyspnea in June, 2002. He developed intractable hiccup at the end of August, and nasogastric tube, tracheotomy and percutaneous endoscopic gastrostomy were applied in turn. In October linear erosion with redness was found on the lower esophagus during a check. We assumed that he had an intractable hiccup associated with a brainstem lesion and so the esophageal erosion appeared due to mucosal graze from the nasogastric tube or backward flow by gastric juices. In these circumstances, it is necessary to inhibit hiccup or create gastrostomy at an early stage.

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Sharing of patient information has become important as the need for enabling cooperation in consultation and the referencing of clinical data among multiple hospitals. Questionnaires on the sharing of clinical information were sent to 55 national hospitals. As for the result, the majority of the facilities surveyed (91.7%, 39 hospitals) want to be able to share the clinical data of each national hospital within the network. There were also some concerns and comments about potential security problems, the protection of personal information, and ethics considerations. In this research, in addition to reporting the results of this questionnaire investigation, we studied the environment of the hospital information system and the data infrastructure in national hospitals in order to realize clinical data sharing. For future study, the indicators for handling data and the guidelines for the secondary use of patient information are required. Furthermore, we think that a unification code among hospitals is indispensable for database standardization.

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