After our previous report, the concomitant use and the administration to aged patients of new quinolon agents (NQs) at 9 hospitals of 11 national university dental hospitals in Japan were surveyed.
Among the prescriptions received in 9 hospital pharmacies (36, 000 sheets/2 months), those containing NQs were only 666 (1.85%) .
As for these 666 prescriptions, the cases in which careful administration of NQs with other medicines is recommended was 54%.
Undesirable concomitant use of NQs with nonsteroidal anti-inflamatory drugs were frequently observed, but combined use of NQs with antacid such as aluminium salt or magnesium salt were few.
The rate of prescriptions for aged patients in whom careful administration of NQs is demanded was 19.5%. The mean age of the oldest patient in each hospital was 75.7 and the oldest was 83. In addition, the rate of prescriptions containing one, two, and three doubtful points were 25.2, 9, and 1.1%, respectively.

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Fleroxacin (FLRX), a new synthetic quinolone antimicrobial, was developed by chemically modifying norfloxacin (NFLX) . It is easily absorbed, passed and long-acting. However, the absorption of new quinolones is reportedly suppressed by metal cations contained in antacids. The degree of suppression varies with the drug : it is generally greater with NFLX, and less with FLRX.
When antimicrobials are prescribed by dentists for patients with weak stomach, antacids are frequently used in combination. The effect on the migration of FLRX and NFLX of a dispensing stomachic Sankyo Magen Mittel (S·M powder^®), containing about 30% aluminum magnesium silicate, was studied.
FLRX (200mg) and S·M powder^® (1.3g), were simultaneously administered to seven normal adults and blood was collected at specified intervals. FLRX, (20mg/kg), and S·M powder^®, (26mg/kg), were administered to male New Zealand white rabbits to collect blood and oral tissues. Concentration was measured by the thin layer disc method using Escherichia coli NIHJ JC2, and results obtained were analyzed pharmacokinetically. The passage of NFLX into rabbit sera was also evaluated.
1) S·M powder^® reduced the transfer of FLRX (200mg) into human sera with prolonged Tmax of 0.44hr., and decreased Cmax by about 19%.
2) S·M powder^® reduced the passage of FLRX (20mg/kg) into rabbit sera, with prolonged Tmax of 0.39hr., and reduced Cmax by about 8.4%. Tmax in the rabbit oral cavity tissues was similar to that in the bones, but was prolonged from 7.3% to 30.8% in every tissue.
3) As 20mg/kg of NFLX administered to rabbits revealed no detectable serum level, 50mg/kg was administered. As a result, Tmax was prolonged 0.21hr., and Cmax decreased about 42% in the group treated with S·M powder^®.
4) FLRX passed more satisfactorily than NFLX, although it was inhibited by S·M powder^® to a lesser degree.

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The effects of fibroblasts and lymphocytes on the 3- (4, 5-dimethylthiazol-2-yl) -2, 5-diphenyl tetrazolium bromide (MTT) assay (Original), a typical in vitro anti-cancer drug sensitivity test, and the liquid top agarose layer MTT (Liquid) and MTT hybrid assays (Hybrid), which are modified methods, using Cis-platin, were evaluated. Lymphocytes had little effect on the MTT assay. A mixture of 50% or more of the fibroblasts (HF) with the tumor cells (HOSM-1) significantly decreased anti-cancer drug sensitivity. On the other hand, anti-cancer drug sensitivity significantly increased in an in vivo tumor treated with anti-nude mouse serum to eliminate mouse-derived cells. These findings suggested that the inhibition of the activity of cells such as fibroblasts is important in sensitivity tests using fresh tumors. Regarding fibroblast proliferation, HF increased by 2.9 fold in the Original assay. Compared with the Original assay, HF proliferation was 66% in the Liquid assay and 55% in the Hybrid assay (top layer, 0.25%) . Thus, the MTT hybrid assay using 0.25% agar as the top layer may be most appropriate when fresh tumor specimens are used.

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Aqua oxidized water (AOW) and Aqua alkalic water (AAW) are made by acidic electrolyzed water making equipment; OXILIZER (OXILIZER Co., Tokyo, Japan) . AOW is acidic water with a pH under 2.7 and is processed by electrolysis through a small NaCl mediated specific membrane. It was over 1, 100mV of oxidation-reduction potential and includes Cl₂, OH⋅, O₃, ClO. AAW is alkalic water with pH 11.
AOW has a strong bactericidal effect on bacteria and virus but the effect is reduced by the large number of organisms. It has a metallic corrosive function as well as an organic matter action. There are few reports about AAW sterilizing without a metallic corrosive action. The bactericidal effect of AAW to periodontopathic bacteria [Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn) ] and Staphylococcus aureus (Sa) and Escherichia coli (Ec) was investigated. The bactericidal effect of AOW and AAW were compared.
Bacterial strain Sa : 209-P, Ec : B, Aa : Y4 and ATCC 29522, Pg : 381 and ATCC 33277, Pi : 25611, Fn : 25586 were grown at 3TC in BHI (aerobic and anaerobic condition), GAM contained hemin, menadion and yeast (anaerobic condition), and GAM broth (anaerobic condition), respectively. After washing by centrifugation, each bacteria was suspended in PBS.
Serum and saliva were obtained from one healthy volunteer.
Bactericidal activity was measured by colony count seeding and grown on BHI or Anaero columbia blood agar or GAM medium after treatment with AAW or AOW.
The results were as follows:
1. Bactericidal effect and effective concentration of AAW
Aa, Pg, Pi were killed in one minute (Aa; 10⁸ to 10⁴ CFU/ml, Pg; 10⁸ to 10³ CFU/ml, Pi ; less than 10⁸ to 10³ CFU/ml) from original 100% AAW, while it took more than one minute to kill Fn, and Sa and Ec had survived after ten minutes. Further, sterilizing activity decreased with AAW' s dilution. AOW shows that a 25% concentration is most effective against periodontopathic bacteria.
2. The effect of saliva and serum on bactericidal activity of AAW
As for Aa, Pg and Pi, the addition of saliva or serum in a concentration of 1% of AAW had decreased bactericidal activity slightly. However, the bactericidal activity was completely negated by the addition of 10% serum of AAW. As for Fn, the bactericidal activity was negated in 1% of serumor salivery addition.

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Odontogenic keratocysts tend to recur after surgery. Voorsmit first used Carnoy's solution to prevent the recurrence of keratocysts.
A case of odontogenic keratocyst that was treated with Carnoy's solution is reported. The patient was a 28-year-old female who had a swelling at the left mandibular angle. Radiographic examination showed a multilocular cyst extending from the left mandibular angle to the ascending ramus. Carnoy's solution was applied for a minute to the wound cavity after extirpation of the keratocyst. There has been no signs of recurrence as of 12 months after the operation.

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Three cases with serum electrolyte disorders associated with anticancer chemotherapy including CDDP are reported.
Case 1 : A 66-year-old male with tongue cancer was treated with CDDP in induction chemotherapy and with antibiotics (β-lactams and vancomycin) for postoperative infection. Renal insufficiency was induced as a drug side effect. At first, hyperkalemia was caused by impairment of the renal function. Then hyperkalemia resulted from increased extraordinary potassium intake by tube feeding during renal regulation.
Case 2 : CDDP was given combined with radiotherapy in a 65-year-old male with tongue cancer. Hyperkalemia occurred as a result of mild renal insufficiency and metabolic acidosis. This metabolic acidosis (ketoacidosis) resulted from increased keto acids following starvation.
Case 3 : Hyponatremia occurred during cancer chemotherapy in a 65-year-old female with lower gingival carcinoma. The diagnosis was CDDP-induced SIADH.
Symptomatic treatment, mainly fluid therapy, improved the above disturbances in our three cases without severe sequelae.

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Two cases of head and neck abscess in elderly patients due to periodontitis of the mandibular molars were reported.
Case 1 : The patient was an 82-year-old male with severe anemia suffering from abscess with gas gangrene in the left temporal, frontal, and occipital regions.
Case 2 : The patient was an 85-year-old male suffering from abscess with necrotic tissue in the right submental, submandibular, and temporal regions, with subsquent extension to the left supraclavicular region.
It seemed that both cases had compound infection with anaerobic bacterium of extensive necrotic tissue as well as a putrid smell.
For elderly patients with severe infection, chemotherapy compensating for the suppressed immune system and surgical therapy was considered to improve their prognosis.

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Odontogenic chronic sinusitis was treated by long-term administration of roxithromycin, which is a 14-membered-ring macrolide antibiotic, pronase and carbocistein, and a good result was obtained. The subjects were 26 patients with odontogenic chronic sinusitis who visited our Department from January 1994 to October 1995. They were 16 males and 10 females, and their mean age was 42.6 years. The drugs were administered orally in a dose of 150 mg twice a day for roxithromycin, 18, 000 tyrosine units/day for pronase, and 500 mg three times a day for carbocistein. The mean administration period was 132.2 days. The efficacy of the regimen was assessed based on clinical symptoms and MRI findings. The efficacy rating was “improved” or better in 95.0% of the patients in terms of clinical symptoms, while the same rating was 53.3% in terms of MRI findings. In both assessments, there were no“worsened”cases, and no adverse reactions were noted. In conclusion, the results of this study suggested that the regimen is effective for treatment of odontogenic chronic sinusitis.

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Infective endocarditis (IE) has been believed to be induced by bacteremia after tooth extraction in susceptible patients such as damaged heart valves. To prevent IE, antibiotics prophylaxis has been recommended by American Heart Association (AHA) . In the present study, according to the AHA recommendation, antimicrobial susceptibilities of antibiotics, ampicillin (ABPC), amoxicillin (AMPC), clindamycin (CLDM), vancomycin (VCM), erythromycin (EM), and cefaclor (CCL), to 31 Streptococci isolated from tooth extraction bacteremia were examined. No highly resistant strain to ABPC, AMPC, VCM could be found. However two Streptococci were sensitive to CLDM. MIC₈₀ of EM and CCL were 50 and 100μg/ml, respectively. It was concluded that ABPC and AMPC were the most suitable antibiotics for prevention of IE by the present results of MICs, which was identical to the AHA recommendation. However, the dosage of the AHA recommendation was too large for Japanese individuals, so it was suggested to use an ABPC prodrug such as bacampicillin (BAPC) for substitution. BAPC could obtain higher antibiotic concentration level in the blood than ABPC and AMPC with the same dose, and its susceptibility to oral Streptococci was comparable.

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The purpose of the present study was to elucidate the acute toxicity in mice of a new dentin primer, the oxalates solution (a proprietary mixture of aqueous solutions of potassium and aluminum oxalate), which brings about more effective bonding of the new mechanism to composite resin and dentin, and was considered to cause little adverse reaction of treated teeth such as dentin fragility and pulp lesion.
Five mice were administered orally the test substance in a single dose of 10ml/kg, and submitted to general observation for 14 days. Purified and sterilized water was given to mice of the control group.
During the observation period, neither death nor toxic symtom occurred in mice of either group, their appearance was good and they showed quite normal behavior. The subjects had a normal growth curve, and there was no significant difference (p>0.05) between the groups as to weight gain and food and water intake. At the termination of 14-day observation, all the mice were sacrificed. After postmortem examination, hematological and histopathological examinations were performed and it was clarified that there were no anomalous findings in the test group in comparison with control group.
The results suggested that acute toxicity of the new primer is markedly slight even in man, and that it is practically non-toxic especially in such a small dose as used for dental treatment.

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Respiratory and metabolic changes as well as liver and kidney blood flow responses under acute hemodilution and controlled hypotension was studied in 9 mongrel dogs that were anesthetized with isoflurane and paralyzed with Pancuronium. Hemodilution was produced by removal of 20ml/kg whole blood and infusing 6% hydroxyethl starch saline (Salinhes^®) at 1.5 times the volume of blood removed. Subsequently, hypotension to pressure of 70mmHg was induced for 90 minutes by intravenous infusion of Sodium nitroprusside. The results were as follows:
1) The CI significantly increased during hypotension after hemodilution.
2) PVO₂ significantly increased after hemodilution, but showed no significant changes during hypotension. PaO₂ and PaCO₂ showed no significant changes during hypotension after hemodilution.
3) Hepatic and renal cortical blood flow significantly increased after hemodilution, but showed no significant changes during hypotension. Renal medullary blood flow significantly increased after hemodilution and tended to increase during hypotension, although the change was not significant.
4) pH and BE significantly decreased after hemodilution and during hypotension, but there was no significant change between these two periods. The lactate level significantly increased during hypotension, but cyan intoxication induced symptoms, such as an increase in PaO₂ or HR, were not observed.
From these findings, the present technique is considered to be useful for clinical application.

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Morishima and Sasaki reported that without the chemoprophylaxis of antimicrobial agents, 69.2% of blood culture was positive when the blood sample was collected from the vein immediately after tooth extraction. Recently, the incidence of transient bacteremia has been studied with the chemoprophylactic use of antimicrobial agents. In the present study, three kinds of medium (Bactec^®, FAN^®, VITAL ANA^®) were compared and the experiment was conducted with imipenem (IPM) for chemoprophylaxis. Intravenous drip infusion of IPM was started before the operation, which took about 30 minutes. Within 5 minutes after the completion of the drip infusion and while the surgical procedure was underway, the venous blood was collected.
The blood sample, after part of it was set aside for the measurement of the IPM concentration, was placed on Bactec^®, FAN^®, and VITAL ANA^®.
The culture positive rates of three media, Bactec^® containing neutralizer, FAN^® containing neutralizer, and VITAL ANA^® which doses not contain neutralizer, were compared. Bactec^® and FAN^® had 2 culture positive cases out of 12 cases, but the blood cultures of VITAL ANA^® were all negative. The MICs of IPM in the culture positive cases were high enouch to inhibit the growth of organisms. While investigating transient bacteremia immediately after dental surgery, if media did not contain neutralizer, administered agents were considered to work so as to make results false negative.

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