著者

川越 弘就 吉位 尚 大塚 芳基 竹野々 巌 寺延 治 古森 孝英

出版者

JAPANESE SOCIETY OF ORAL THERAPEUTICS AND PHARMACOLOGY

雑誌

歯科薬物療法 (ISSN:02881012)

巻号頁・発行日

vol.18, no.3, pp.139-143, 1999-12-01 (Released:2010-06-08)

参考文献数

22

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Death due to gas gangrene following tooth extraction of mandibular third molar was reported. The patient was a 53-year-old female. Her mandibular left third molar was extracted 8 days before she was referred to our clinic. She did not receive any prophylactic antibiotics. After tooth extraction she developed swelling and pain of the left oral floor and the neck with severe sore throat and trismus. She had been treated with intravenous antibiotics and surgical drainage at a local hospital, however, the symptoms did not improve. The CT findings of the neck were abundant gas in the soft tissue of the neck. The diagnosis was cervical gas gangrene. The hematological tests revealed increase of white blood cells (13600/mm3), CRP (25.9mg/dl), blood sugar (332mg/dl), hypoalbuminemia (Alb ; 2.5g/dl), and liver dysfunction (GOT ; 42IU/l, GPT ; 63IU/l) .She seemed to be getting better due to drainage on Day 4 after admission, however, the neck skin became necrotic widely. On Day 8, rapid swelling and severe pain from the neck to chest were observed. The general conditions began to worsen, and she died of multi-organ failure on Day 12 (19 days after tooth extraction) . Enterococcus faecalis, Streptococcus milleri, Gemella haemolysan and Peptostreptococcus micros were isolated from the pus.It was considered that the necrotic tissues of the neck, which might cause residual infection, should have been removed completely, and the management for hyperglycemia and hypoalbuminemia was also very important to treat severe infectious gas gangrene.

著者

吉位 尚 濱本 嘉彦 村岡 重忠 糀谷 淳 古土井 春吾 麻柄 真也 大塚 芳基 中尾 薫 寺延 治 島田 桂吉 古森 孝英

出版者

特定非営利活動法人 日本口腔科学会

雑誌

日本口腔科学会雑誌 (ISSN:00290297)

巻号頁・発行日

vol.48, no.6, pp.479-488, 1999-11-10 (Released:2011-09-07)

参考文献数

47

被引用文献数

5

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The clinical efficacy of long-term roxithromycin (RXM) treatment was examined objectively in 8 patients with chronic diffuse sclerosing mandibular osteomyelitis. RXM was administered orally at a dose of 300mg per day for 68 days to 66 months.As a result, the results of 7 out of 8 cases (87.5%) were assessed effective, and the symptoms had disappeared in 1 to 12 months. One case assessed poor had several operations and various kinds of antibiotic therapy for more than 11 years before this therapy. In 7 cases assessed effective, the improvement of osteolytic changes on X-ray was observed. However, most of the X-ray findings remained osteosclerosis or the osteosclerosis became more predominant, when this therapy was terminated. It was considered that X-ray findings would take a long time to be normalized. Therefore, the optimum duration of administration which is the time to terminate this therapy should be decided according to the improvement of symptoms along with the disappearance of osteolytic findings on X-ray. Diarrhea and stomach discomfort in 1 case, and liver dysfunction in 1 case were found, however, these side effects were slight.The mechanisms of RXM are unclear however, these results indicate that long-term RXM treatment has therapeutic possibilities for diffuse sclerosing mandibular osteomyelitis and should be used as the first choice followed by surgical treatment if necessary.

著者

山崎 隆廣 吉位 尚 黒木 栄司 宮井 大介 林 徹 西村 栄高 吉川 朋宏 吉岡 歩 古土井 春吾 竹野々 巌 市来 浩司 大塚 芳基 中尾 薫 古森 孝英

出版者

一般社団法人 日本歯科薬物療法学会

雑誌

歯科薬物療法 (ISSN:02881012)

巻号頁・発行日

vol.18, no.2, pp.54-58, 1999-08-01 (Released:2010-06-08)

参考文献数

24

被引用文献数

2

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Cases with postoperative infections following teeth extraction are experienced occasionally, however, there have been few reports about the problems following teeth extraction. The purpose of this study was to investigate the influence of general and local background of cases with infections following teeth extraction. The results were as follows:1) The infections following teeth extraction occurred in 11 (2.1%) out of 517 cases.2) There was no relationship between age or underlying disease and the postoperative infection rate.3) The incidence of the infection was the highest after mandibular third molar surgery, however, the relationship between the surgical procedure such as incision or removal of the bone and the infection rate was not found.4) The infection rate of cases with acute inflammation before surgery was higher than that of the cases without any inflammatory signs.5) Prophylactic antibiotic administration was performed on 282 (54.5%) out of 517 cases. The incidence of the infections of the cases with prophylaxis was almost the same as the cases without prophylaxis.6) The postoperative pain in infection cases tends to last longer than the normal course. Therefore, it is important to observe carefully the course of pain to make a diagnosis of postoperative infection.