Our society is becoming an aging society and it is estimated that the rate of patients with systemic diseases will increase. In light of this situation, it is necessary to know the actual situation and specifics of in-patients with systemic diseases to provide prompt and appropriate treatment to them. We analyzed past history of in-patients who we treated in the Department of Dentistry and Oral Surgery, Ishikawa Prefectural Central Hospital, and the following is the outline of our study.
The number of inpatients treated in our department over the past two years (January 1999 to December 2000) was 478 and, out of this group, 304 had anamnesis (63.6%) with the average age of the patients being 52.5 years old. The average number of diseases per patient was 2.0. Regarding the diseases treated in departments other than ours at the hospital, the number of diseases affecting circulatory organs was the largest, with diseases affecting digestive organs and neoplasm following.
As for diseases treated in our department, diseases causing cysts were the largest, with inflammatory diseases and injuries following.

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We performed the surgical treatment of oral cavity to a 53-year-old male patient which have been recessive dystrophic epidermolysis bullosa hereditaria (RDEB), and reports for successful treatment on this paper. He complained of severe trismus and difficulty in mastication, which were caused by RDEB, before the surgical treatment. Under the local anesthesia, the vestibular extension was performed in consideration of strong hope of the patient. We worried that the scartissue was formed again, therefore the dentures were made at the early stage of wound healing. Ten months are passing from the wearing of the dentures now, and there are no blisters at the oral mucosa to touch the denture. The patient feels pleasure in remarkable increasing of the kind of food which can be taken.

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We performed a clinicostatistical study of the liver transplanted patients who visited Department of Dentistry & Oral Surgery, Shinshu University School of Medicine during the period from June 1990 to September 2000. The subjects consisted of 66 patients (23 men and 43 women) who underwent liver transplantation at 1st Department of Surgery. The patients under 10 years old were the most frequently seen although the range in age from 1 to 69. Sixty percent of pretransplant patients were referred within one month before transplantation. After the transplantation, 57% of the patients visited our department later than 6 months after the transplantation.
Before transplantation, 70% of the patients visited us with the purpose of oral and dental screening, while after transplantation they came to us with various reasons. Tooth extraction, restorative treatment and TBI were the main treatment for the pretransplant patients and posttransplant patients received many kinds of treatment including tooth extraction, restorative treatment, prosthodontic treatment, and so on.

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Although nonsteroid anti-inflammatory drugs (NSAID) are frequently administered, their prolonged use sometimes causes serious side effects. The mainside effects of NSAID include gastrointestinal disorders. In this paper we report a patient in whom the use of NSAID for a short period of time caused bleeding gastric ulcers. The patient was a 66-year-old man with a chief complaint of pain and difficulty in his opening mouth. He had a history of treatment for gastric ulcer 30 years ago. The clinical diagnosis at the first examination in our department was right buccal abscess due to periodontitis around the right lower third molar. After admission, the symptoms tended to improve after anti-inflammatory treatment by abscess drainage and NSAID administration. On the 7th hospital day, however, the patient had suddenly hemoptysis for which heunderwent endoscopic hemostasis and transfusion of 6 units of packed red cells. Endoscopic examination showed multiple well-demarcated ulcers, consistent with the features of NSAID ulcers. He was treated for gastric ulcers, and discharged on the 28th hospital day. The post-discharge course was uneventful.

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Bernard-Soulier syndrome is a rare disease characterized by bleeding tendency. Bleeding occurs due to the congenital defect of platelet glycoprotein (GP) necessary for platelet adhesion. We report experience of dental treatments for a patient of Bernard-Soulier syndrome.
A 22-year-old female was referred to us from the department of pediatrics with a complaint of pain in the left maxillary molar region. Her oral hygine was poor. She had many decayed teeth and a large quantity of dental calculus was found. She showed severe marginal gingivitis with bleeding from periodontal pockets.
After platelet transfusion, the patient received dental treatments including tooth brushing instruction, tooth extraction of _??_78 and root canal treatments of infected _??_6. It was difficult to control the postoperative bleeding after scaling and tooth extraction and additional platelet transfusion was necessary. Her oral condition has been improved remarkably, resulting in healthy gingiva without bleeding, although she is still under dental treatments for other decayed teeth as an out patient.
From our experience of dental management for a Bernard-Sourier syndrome patient, it is the most important for the patient to understand the importance of oral care and to maintain a good oral condition by herself.

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We report a case of a management of anticoagulation with heparin in patients with tongue carcinoma (T3N0M0). A 66-year-old female was referred to our hospital with a complaint of an ulcer of the left border of the tongue. She had received the mitral and tricuspid valve replacement surgery after a diagnosis of their valve closure and stenosis at the age of 49. Warfarin at 2.5mg/day and Panaldine at 100mg/day was admimistrated for her anticoagulation. She had complicated with atrial fibration and a high risk of a thrombus formation at the replaced valves in a short time of increased coagulation.
Seven days preoperatively, Warfarin administrated her was changed to heparin, there after it was stopped to 6 hours prior to the glossectomy. After two hours the heparin was restarted with 500 units/hr and replaced to Warfarin. We successfully managed her without bleeding and clotting when heparin sodium was administered in an ACT range of 130-150 seconds.
We experienced that the replacement of Warfarin to the heparin provided good perioperative management to ACT against the patient with anticoagulation.

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