Chronic fatigue syndrome is a condition in which a seemingly healthy person suffers from sudden and severe general malaise and / or persistent low grade fever, severe malaise, exhaustion, headache, impaired cognitive function, and psychoneurotic disorder. This condition makes the patient to be unable to function properly in society. We herein report on the management for teeth extraction in a patient with chronic fatigue syndrome.
The patient was a 16-year-old female patient who presented with the major complaint of pain in the left mandibular molar region. Her oral hygiene was very poor, and she had many dental caries. Gingival swelling was identified in the left mandibular 2^nd molar region and she was diagnosed with an alveolar abscess originating from chronic apical periodontitis. After debriment and treatment of the abscess, a treatment plan was made for the infected alveolar root canal. However, the patient did not appear for her outpatient treatments owing to her general malaise. We therefore abandoned the conservative procedure with multiple treatments and extracted the tooth with the patient as an in-patient.
The general malaise associated with chronic fatigue syndrome makes it extremely difficult for these patients to visit the hospital and to keep their appointments, as a result the treatment period is limited. In establishing a treatment plan, it is advisable to minimize the number of appointments for these patients to return to the hospital for appointments. In cases when the stress on the patient is predicted to be large, it may be necessary to perform these treatments with the patient as an in-patient.

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Myelodysplastic syndrome (MDS) is a postnatal blood formation disorder with preleukaemia and obstinate anemia. Surgical procedures must take into account bleeding tendency in addition to the fact that the host is immunologically compromised (prone for infection). Two cases of myelodysplastic syndrome where the general physical condition was aggravated following oral surgery are herein reported.
Patients were hospitalized and treated by a hematologist. Post-surgical evaluation revealed that the surgical site was inflamed with decrease in platelet and neutrophil counts, increase in CRP, as well as having tolerance to antibiotics.
Patients were administered several kinds of antibiotics, platelets and granulocyte colony stimulating factors which resulted in improvement and alleviation of their symptoms.
In MDS patients, when the surgical sites are infected in spite of efforts toward prevention, it is possible symptoms may deteriorate rapidly. Therefore, it is of importance that the patients are to be treated by oral surgeons and hematologists.

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We evaluated and analyzed the oral management methods for tooth extraction of patients receiving anti-platelet drug therapy who sought medical and dental treatment at our hospital. Generally there is no established guideline, criteria or index to discontinue the administration of antiplatelet drugs for tooth extraction, even though there are values indicated by the TT-INR for Warfarin. On the other hand, there have been recent publications concerned with the risk of complications resulting from the discontinuation of anti-coagulant drugs. Therefore we have extracted tooth without discontinuing the administration of anti-platelet drugs at our institution for some years. From our experiences and retrospective evaluation and analyses of 28 patients (34 teeth) receiving anti-platelet drug therapy who underwent tooth / teeth extractions between April 2004 and October 2005, our findings suggested and revealed how to manage these patients without major post extraction complications. The method of management was as follows. First the bleedings time (Duke method) was determined / measured as the index of anti-coagulant efficacy / ability. Following tooth extraction, sutures were placed and a protector was utilized with a hemostatic drug for wound the wound to heal. With this management method, we had no experience of prolonged bleeding and no complications. From these results, it is suggestive that tooth extraction is possible to be performed for patients receiving anti-platelet drug therapy without discontinuing anti-platelet drug therapy with proper oral management.

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Myasthenia gravis (MG) is an autoimmune neuromuscular disorder, which is characterized by skeletal muscle weakness and fatigability. Medication, stress and infection is related to dental treatment that may result in exacerbation of their symptoms and the most serious clinical manifestation being myasthenic crisis.
We had experienced 4 cases of teeth extractions of patients with MG. The teeth extractions were performed under local anesthetics using 1% lidocaine with 1: 100, 000 epinephrine in an operating room equipped with respiratory support.
In one of the 4 cases, exacerbations of muscular weakness, ptosis and extremity weakness following teeth extractions developed. For the 29-year-old female patient whose clinical classification of MG was class III b, one mandibular third molar and two maxillary third molars were simultaneously extracted. This case suggested importance of clinical classifications of MG in dental treatment.

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The purpose of this study is to evaluate the efficacy of speech therapy for oral surgery patients with articulation disorders. We herein present and discuss our findings on the clinical evaluation of speech therapy for oral surgery patients. The patients enrolled in this study were treated in the 2^nd Division of Oral and Maxillofacial Surgery, Meikai University Hospital, between September 1, 2000 and August 31, 2005. In this study, a total of 156 patients were evaluated and/or managed with speech therapy. The results were as follows:
1. One hundred nine patients were diagnosed for congenital disorders. Eighty-nine of the patients had cleft palate accompanied with severe articulation disorders, and required more speech therapy than the remaining 20 patients without cleft palate.
2. Thirty-six patients had acquired disorders, resulting from surgical excision of oral carcinoma, benign tumor, etc. Severe articulation disorders were often recognized, in spite of reconstruction following extensive excision of oral carcinoma lesions, especially the lesions involving the floor of the oral cavity.
3. Only 9 patients had functional articulation disorders. Since their families expressed high motivation for the future of their child, speech therapy for the 9 young patients was conducted more frequentlythan the other patients.
4. There was only 1 case of dysarthria resulting from facial palsy.

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Multiple cancers are defined as different primary cancers which exist in different organs and are regarded as occurring simultaneously within a one-year period.
We herein report a case demonstrating triple cancers which arose synchronously in the tongue, the sigmoid colon and the lung. A 64-year-old man was initially referred to our department because of swelling in his tongue. The resection of the tongue tumor was performed on March 15, 2004. The tongue tumor was histologically diagnosed to be squamous cell carcinoma (stage II).
After discharge from the hospital, he consulted both a gastroenterological clinic and a respiratory disease clinic, because he noticed fresh blood in his stool and also coughed up bloody sputum, respectively. A tumor measuring 10mm in size was identified in his left lung by bronchoscopy on September 17^th. The pathological diagnosis of this tumor was squamous cell carcinoma (stage I). Thereafter, a wide basal polyp was also found in his sigmoid colon at the Department of Gastroenterology on September 29^th. The pathological diagnosis of the polyp obtained by biopsy was adenocarcinoma. An endoscopic resection of the mucous membrane was performed on November 12^th.
In addition, a left lower lobectomy of the lung was carried out on January 18, 2005. During a two-and-a-half-year follow-up after the last operation, no signs of recurrence or metastasis in the regional lymph nodes have been observed.
To succeed in cancer treatment, the checkup of whole body carefully is important for the early detection of multiple cancer.

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