Nausea and vomiting induced by anticancer agents are common problems. In particular, cisplatin, the most popular anticancer agent against oral cancer, has severe nausea and vomiting. High-dose metoclopramide was used because its effect against cisplatin induced vomiting. However, it is not yet entirely effective. On the other hand, a novel antiemetic, 5-HT₃ receptor antagonist is undergoing clinical evaluation.
In this study, the efficacy and safety of granisetron were compared with those of high dose metoclopramide plus dexamethasone in patients undergoing treatment with cisplatin. The results were as follows:
1. Granisetron and high-dose metoclopramide are effective in preventing cisplatin-induced nausea and vomiting.
2. In the patients treated by granisetron compared with high-dose metoclopramide, the frequency of vomiting decreased, the appearance of nausea and vomiting were delayed, and the duration of nausea was shortened.
3. The effective rate of granisetron was 100% and that of high-dose metoclopramide 86.4% within 24 hours.
4. The side effects caused by granisetron were minimal.
The above results revealed that granisetron showed an excellent antiemetic effect against acute chemotherapy-induced emesis within 24 hours compared with high-dose metoclopramide.

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Once a day administration of 300mg roxithromycin (RXM) for treatment of acute dental infections was objectively evaluated in a controlled study using cefaclor (CCL) as the control drug. Patients received RXM at a daily dose of 300mg (once a day) or CCL at a daily dose of 1, 500mg (3times a day) . 36 cases in the RXM group and 30 cases in the CCL group were evaluated for efficacy.
1) The clinical efficacy rating according to the criteria for Antibiotic Efficacy Evaluation of the Japanese Association for Oral Surgery was 83.3% in the RXM group and 93.3% in the CCL group. Although the efficacy rating was 10.0% higher in the CCL group, no significant difference was observed between the two groups.
2) The clinical efficacy rating judged by the attending doctors was 83.4% in the RXM group and 83.3% in the CCL group ; no significant difference was observed between the two groups.
3) Side effects occurred in 1 out of 30 cases in the CCL group only, and there was no significant difference between the two groups.
4) The usefulness rating, based on clinical efficacy and side effects, was 91.6% in the RXM group and 83.3% in the CCL group, with no significant difference between the two groups.
These results showed that 300mg RXM once a day administration was as effective as 500mg CCL three times a day in the treatment of acute dental infections.

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The clinical and microbial effects of ultrasonic scaling in combination with povidone-iodine solution were examined in patients using the following three ultrasonic scaling systems in combination with povidone-iodine solution and root planing. Four different sites, one in each quadrant, were randomly selected in each of 10 periodontal patients participating in this study. Each patient received the following treatments : ultrasonic scaling in combination with povidone-iodine solution performed one time at one site (Group A), two times at one-week intervals at another site (Group B), two times at two-week intervals at the third site (Group C), and root planing alone at the fourth site (Group D) .
The results were as follows :
1. Clinical findings, except for plaque index, showed improvement in groups B and C as compared with group A throughout the observation periods.
2. By phase-contrast microscopic observation, both total bacterial count and spirochetal and motile rod incidence decreased in groups B and C as compared with group A throughout the observation periods.

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A retrospective review was performed on 257 patients with oral infections in our department from December 1977 through November 1992, and the patients with and without diabetes mellitus were compared.
Diabetes mellitus was found in 29 (24.1%) of 257 infected patients. Among the patients with basal disease (62 cases), the patients with diabetes mellitus (29 cases) were most frequent (46.8%) .
The mean period of hospitalization was longer in patients with diabetes mellitus than in non diabetes mellitus patients.
There were no significant differrences in the incidence of orofacial infectious disease between patients with and those without diabetes mellitus.
After incision and drainage, the time until the normalization of WBC and the decrease of the level of CRP was longer in patients with than in those without diabetes mellitus.
The mean period of hospitalization was longer in diabetes mellitus patients with a low level of blood sugar than in those with a high level of blood sugar.

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Prophylactic effectiveness of antimicrobial regimens on postoperative infection in oral surgery were evaluated in 65 patients. One out of five antimicrobial agents (ABPC, CEZ, CTM, CMZ and FMOX) was selected and administered just before surgery. Duration of administration of the antimicrobial agent was classified as one of three patterns (1 day, 4 days or 7 days) according to operative cleanliness, operative damage and protective ability against infection. Each antimicrobial agent was administered by intravenous 1 hr drip infusion every 4-6 hours on operation day, and the administration was continued postoperatively at a dose of lg (except for 2g in ABPC) every 8 hours or twice a day on the following days. No oral antimicrobial agents were administered during this period.
The results were as follows :
1) On our criteria for regimen, a four-day administration schedule was chosen for most of the cases (57/65) .
2) The rate of postoperative infection was 3.1% (2/65, mild) .
3) As side effects, elevation of s-GOT and s-GPT in 5 cases was observed and mild diarrhea in some cases was observed. However, it could not be judged whether they were regarded as side effects because they all had received nutrition.
Based on the present results, our regimen seems to be safe and quite useful for preventing postoperative infection in oral surgery.

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The study was conducted to examine the clinical efficacy of Tizanidine to reduce the masticatory myofascial pain and dysfunction in patients with temporomandibular dysfunction. Twenty-three patients were involved in this study. Inclusion criteria for diagnosis was masticatory myofascial pain and dysfunctions. The diagnostic group with internal derangement of the temporomandibular joint and degenerative joint disease were excluded from this study. There were 6 male and 17 female patients, and the age ranged from 15 to 79 years old. One tablet of Ternelin (1 mg of Tizanidine per tablet) were orally administrated after each meal by three times a day for 2-4 weeks. In order to assess the efficacy of Tizanidine, the visual analogue scale and jaw pain dysfunction score were recorded by questionnaire in pre- and post-examination patients. The interincisal opening degree and the masticatory muscle tenderness were also recorded.
The effective rate was 60.9% based upon subjective impression by patients, and the usefulness was also judged as 60.9% by the examiner.
It was suspected that side effect had occurred in two patients as mild stomachache and stomatitis but recovered uneventfully. The study concluded that Tizanidine was an effective and safe oral drug relieving masticatory myofascial pain and temporomandibular dysfunction.

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A case of temporal abscess due to advanced phlegmon of cheek complicated with severe diabetes mellitus was diagnosed at our department. Diabetes was diagnosed in a 38-year old male at the age of 23 ; this patient had received therapy but later discontinued it.
He was slightly flushed and showed diffuse swelling from the area below the left mandible to the cheek caused by the 3rd molar of the left mandible. Mild rubefaction, heat sensation, pain and difficulty in opening his mouth were noted. Diffuse swelling, floridity and pain were focused on the molar region of the left mandible.
According to clinical examination performed during the initial consultation, the following results were obtained ; leukocyte count : 127×10²/μl, blood sedimentation : 89mm/1h, CRP : 2+, blood sugar : 483mg/dl, urine sugar : > 1000mg/dl (4+), ketone body : 100mg/dl (3+), HbA_1c : 11.9%, and HbA₁ : 13.7%.
The patient was hospitalized and received ASPC intravenous drip infusion and he was placed on insulin therapy and a diabetic diet.
On the day after his admission, under local anesthesia, an intraoral incision was made for drainage. The drug sensitivity test performed on the 14th day after his admission showed a negative reaction to ASPC.There fore ASPC was replaced with FMOX. A left temporal abscess gradually formed and a drainage incision was made on the 18th day.
These therapeutic techniques failed to stabilize the blood sugar level and accelerated the local inflammatory symptoms. In order to improve these symptoms, a higher dose of insulin was administered. The causative tooth was extracted on the 21st day and anaerobic bacteria were detected on the 23rd day. PAPM/BP and FMOX were administered to extend the antimicrobial spectrum.
On the 26th day, formation of a temporal abscess was observed, so incisional drainage and removal of the necrotic tissues by incision were performed.
On the basis of a roentgenolography and a bone scintigraphy, a diagnosis of osteomyelitis of the left mandible was made. On the 61st day, under general anesthesia, the left mandible was scraped out after extraoral skin incision. From the 69th day on, the inflammatory symptoms improved and LAPC was orally administered.
After this surgery, insulin therapy was terminated because his blood sugar level dropped to under 200mg/dl.
He has been in satisfactory condition for seven months postoperatively.

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The mouse osteoblastic MC3T3-E1 cells were cultured for 7-10 days until subconfluence and then placed in serum-free medium for 24 hours and the cells were subsequently treated with 12-O-tetradecanoylphorbol-13-acetate (TPA ; 100 ng/ml) which enhances protein kinase C activity for 0, 5, 10, 15, 30, and 60 minutes. The c-fos mRNA is rapidly and transiently induced by TPA in mouse osteoblastic MC3T3-E1 cells cultured in both normal medium (control group) and low calcium medium (low Ca group) . The c-fos mRNA expression was seen in both groups, and in both groups, the expression of c-fos mRNA dramatically increased to reach its maximum at 30 minutes after treatment with TPA and was then abolished rapidly (similar to FCS-treated cells¹⁾) . The degree of expression was significantly higher in the low Ca group than in the control group in each treatment period (p<0.01) . This suggests that the MC3T3-E1 cells placed in a low calcium environment react to restore normal cell function at the gene level, mediating activation of protein kinase C (PKC) which plays a role in the induction of c-fos mRNA.

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