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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代表的なin vitro制癌剤感受性試験である3- (4, 5-dimethylthiazol-2-yl) -2, 5-diphenyl tetrazolium bromide (MTT) assay (Original) およびその変法であるLiquid top agarose layer MTT assay (Liquid) , MTT Hybrid assay (Hybrid) における線維芽細胞とリンパ球の影響についてシスプラチンを用いて検討した.リンパ球はいずれのMTT assayでもほとんど影響はみられなかった.腫瘍細胞 (HOSM-1) と線維芽細胞 (HF) の混合細胞に対しては50%以上の線維芽細胞混入で有意に制癌剤感受性を低下させ, またin vivo腫瘍に抗ヌードマウス血清を作用させマウス由来細胞を除去したものでは有意に制癌剤感受性の上昇がみられた.これらのことは新鮮材料を対象とする感受性試験では線維芽細胞等の細胞活性を抑制することが必要であることを示唆している.線維芽細胞の増殖はOriginalで2.9倍の増殖がみられたのに対しLiquidではOriginalの66%, さらにHybridのtop layer 0.25%では55%に増殖を抑制した.このことにより新鮮材料に対してはtop layerが0.25%agarのMTT hybrid assayが適すると考えられた.

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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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感染性心内膜炎 (IE) は, 弁膜症の様な患者の抜歯後菌血症により引き起こされるといわれている.感染性心内膜炎を予防するためAmerican Heart Association (AHA) により, 抗菌薬の予防投与が勧告されている.今回我々は, 抜歯後菌血症により分離されたレンサ球菌32株に対する, AHAの勧告に従った抗菌薬, アンピシリン (ABPC) , アモキシシリン (AMPC) , クリンダマイシン (CLDM) , バンコマイシン (VCM) , エリスロマイシン (EM) , セファクロール (CCL) について, その感受性の検討を行った.ABPC, AMPC, VCM, に対して高度の耐性を示す株は認められなかった.2株を除いてCLDMは, レンサ球菌に対して感受性があった.今回の検討の結果, AHAの励告と同様ABPCとAMPCはそのMICの結果から感染性心内膜炎を予防するうえで, 最も有用と考えられた.しかしながら, AHAの勧告する抗菌薬の投与量は日本人には多すぎるため, 我々は代わりにバカンピシリン (BAPC) の様なABPCのプロドラッグを推奨する.BAPCはABPCやAMPCと同じ投与量で高い血中濃度が得られ, 口腔レンサ球菌に対する感受性は同等であるからである.

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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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抗菌薬の予防投与を行わず, 抜歯などの歯科観血処置を行った場合, 処置直後の静脈血では69.2%で血液培養が陽性になる事をMorishima & Sasakiが報告した.最近抗菌薬の予防投与を行い抜歯などの歯科観血処置直後の菌血症の発現率の検討を行っている.血液培養の培地としては, Beckton DickinsonのBactec16AとBactec17Aを用いてきた.近年は菌血症の検索のためにOrganon TeknikaのFANとbio Merieux VitekのVITAL ANAも用いられるようになってきた.Bactecと他社のものを比較してみる必要があり, イミペネム (IPM) の予防投与下に3種類の培地を用いて比較検討した.
その結果, BactecとFANでは12症例中2例で菌を検出することができた.これは, 両培地中の抗菌薬中和剤 (吸着剤) が働いたためと判断される.

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