Hashimoto's Disease (Hypothyroidism) is one of the autoimmune disease that tend to all ages and females. Generally, this has bradycardia, the fail of cardiac output, hypotension, the deterioration of mental activity, and so on. If we manage with propofol for the patient who have findings like this, we must be careful for wakefulness from general anesthesia, circulatory collapse and cardiac failure.
In this case, we managed the patient who is 53 years old female with Hashimoto's Disease (Hypothyroidism) and depression with propofol in perioperative management. The operation is the removal of implant within maxillary sinus. When we tried tracheal intubation, the patient's pulse rate was decreased momentary. We assumed that the thyloid swelling may caused the vagus nerve to close to the larynx and the pharynx thereby adding the laryngoscopy stimulation. We checked hemodynamics for the parameter of the depth of anesthesia. In spite of our failure to know depth of anesthesia during the operation, the operation was stable without any particular facts to point out.
We concluded that general anesthetic management with propofol is useful for Hashimoto's Disease patient.

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96 year-old female with Diabetes, Diabetic Nephropathy, Hypertension and Old Myocardial Infarction was scheduled for the extraction and post-operative curettage.
Although the point of the management seemed to be only high aged, we found serious anemia (Hb 7.6) and renal disfunction (BUN 117.7 Creatinine 2.40 Uric Acid 10.6) from her preoperative blood examination. We needed to change her habitual medical drugs and to transfuse and to feed central venous nutrition at general hospital.
We managed this patient with inhalation sedation (N2O 30% O2 70%) and monitoring (Blood pressure, Pulse rate, Respiration rate, Oxygen Saturation) during dental treatment. These parameters were no changes except continuous high blood pressure.
We considered that the cause of renal disjunction and gastric bleeding were uncontrolled diabetes caused eating disorder after dental treatment. When we need to manage for high-aged patient with dental invasive treatment, we have to be more care for general condition such as many basal diseases, low organ function and the observation of post dental treatment.

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The purpose of this study was to prepare the guidelines for dental management in patients who were undergoing bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT). Sixty three patients with leukemia or malignant lymphoma were examined from March 1994 to March 2000 at the department of special patient of oral care unit, Kyushu University Dental Hospital. The period from first dental examination until BMT/PBSCT, laboratory data, dental problems, and dental management and treatment were examined. There were 34 men and 29 women, the mean age of the patients was 39.0 years old ranging from 13 to 73 years old.
Twenty seven out of 63 patients were examining more than 31 days before the transplantation. Laboratory data showed that 41 out of 63 patients had less than 5000/μl of WBC, which indicated the immunity is depressed condition and 13 patients had less than 50000/μl of PLT, which indicated the condition of the stanching difficulty.
Some dental problems were found in 55 patients out of 63. There were 89 cases of C2 graded teeth in 26 patients of which 43 teeth received restorative treatment, 2 third molars were extracted and the rest of 44 teeth were observed. Thirteen teeth in 7 patients were diagnosed as pulpitis, of which 12 teeth were received pulpectomy under the local anesthesia, one third molar was extracted. Out of 47 teeth with apical periodontitis in 21 patients, root canal treatment was done for 13 teeth, 21 teeth was extracted and 13 teeth were not treated and observed. There were 24 teeth with marginal periodontitis in 12 patients, 8 cases of extraction, periodontal treatment such as scaling, tooth cleaning, and irrigation, and observation were included respectively. Twenty three C4 graded or root fractured teeth were found in 13 patients. Twenty one teeth were extracted and 2 teeth were observed. The pericoronitis of third molars were found, 20 teeth in 12 patients, in which 19 teeth were extracted. We did not have any comments from physician that the dental treatment or observation influenced the outcome of any BMT/PBSCT recipients.
Since the age of patients relatively young, early dental visit and intensive oral care are necessary to preserve the teeth by restorative or periodontal treatment including preventive approaches. We have to make the management system with the medicine more intensify for the maintenance the oral condition better before, during and after transplantation.

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A case of severe allergy induced by cefaclor is presented in this article. A 61-year-old man with the perimaxillary inflammation was referred to our department by his family dentist on August 13, 2001. The pathogenic tooth was extracted on August 23, because the inflammation had disappeared with administering the antibiotics in about one week. The patient was given one 250mg capsule of cefaclor for evading the postoperative infection. General weakness and urticaria appeared within about two hours. When he revisited the our hospital three hours after taking the drug, the state of the middle degree shock to be accompanied by the blood pressure decrease and bradycardia was admitted. Epinephrine, hydrocortisone and lactate Ringer's solution were admin-istered immediately, and the state of general condition has been improved successfully. He was discharged 6 days later. Drug-induced lymphocyte stimulation test (DLST) showed the positive for cefaclor.

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A 78-year-old man with a tumor measuring 6mm in diameter in the left mandibular gingiva was referred to our department. He had a history of renal cell carcinoma and had undergone a right radical nephrectomy. He also had metastatic lesions to the lungs and multiple bones. The tumor was resected under local anesthesia. The surgical specimen showed a renal cell carcinoma that had metastasized from the kidney. Renal cell carcinoma metastasizing to the oral cavity is rare and metastasized tumors of a renal cell carcinoma have a very poor prognosis. He died two months after the operation.
Because metastasized tumors generally have a poor prognosis, it is very important to consider the patient's quality of life when choosing the treatment for them.

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We experienced the radical and reconstructive operation for oral cancer after minimally invasive direct coronary artery bypass (MIDCAB) for a myocardial infarction. The patient was a 76 year-old male with carcinoma of the oral floor. He had old myocardial infarction, and digoxin and nitroglycerin were administered. Because general condition of the patient recovered after 2 weeks of MIDCAB, we were able to perform the radical and reconstructive operation for the carcinoma with no complications. The good postoperative course was obtained.

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We reported a case of obsolete dislocation of the temporomandibular joint (TMJ) in a patient with Parkinson's disease and cerebral infarction. This dislocation was treated with open reduction under general anesthesia and the occlusion was restored with denture.
The patient was a 67-year-old male. He sometimes had dislocation of TMJ since he was 59 years old. Every time he had dislocation of TMJ, the reduction was not done by himself but performed relatively easily at a clinic. In the middle of December 1999, he had dislocation of TMJ again. But he didn't go to the clinic for 2 weeks, because it was not painful. When he visited the clinic, the reduction became to be impossible. More than 6 months later, he came to our clinic. He suffered from difficulty of masticating and closing mouth. As an intra-oral finding, some molar teeth were missing. Panorama X-ray showed the dislocation of TMJ. Reduction of TMJ under general anesthesia was planned because reduction of TMJ with consciousness was impossible. Reduction of TMJ with only hands was impossible even under genral anesthesia. So open reduction was performed and succeeded. Concerning general anesthesia, propofol, fentanyl, and vecuronium were used. After the surgery, 2-weeks intermaxillary fixation and 2-weeks more restricton of opening mouth were done. Then denture was set for occlusal reconstruction.
There has been no recurrence of dislocation of TMJ. Also his Parkinson's disease has been controlled and cerebovascular attck has not happen.

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The salty of tooth extractions (TE) in Acute Myelocytic Leukemia (AML) patients has not been well established. In this study, we examined 14 AML patients whom TE were performed (Fig. 1, 2) and also compared blood cell count with before TE and after TE.
We noted following observations:
1. With proper supportive care, TE can be safely performed in AML patients at any status.
2. In patients with AML undergoing induction chemotherapy, because of myelosuppression, WBC and granulocyte count were markedly decreased after TE (Fig. 4, 5). Even at this stage, TE can be performed without significant complications (Fig. 3).
3. RBC, hemoglobin, hematocrit and platelet count had been remained stationary after TE was performed (Fig. 6-9).

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