著者

中野 真祐 鬼澤 浩司郎 生井 友農 山縣 憲司 白土 貴之 吉田 廣

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.51, no.5, pp.335-339, 2002-09-10 (Released:2011-09-07)

参考文献数

7

---

Long-term corticosteroid administration induces secondary adrenal insufficiency and an increased susceptibility to infection. Surgical intervention in patients receiving steroid medication should be performed with consideration to preventing adrenal crisis, delayed wound healing, and infection. To securely manage tooth extraction in patients receiving steroid medication, 50 patients taking predonisolone (PSL) were retrospectively investigated. The mean dosage of PSL in the patients was 14.2mg/day, and the mean duration of the treatment was 7 years and 3 months. Forty-nine of the 50 patients were treated under local anesthesia, and the number of teeth concurrently removed was from 1 to 4. Preoperative supplemental steroid administration was applied to only two patients: one treated under general anesthesia, and the other during a period of reducing steroid dosage. Penicillin was commonly selected as the antibiotic to prevent infection, and it was administered preoperatively and postoperatively, for a mean duration of 4.1 days. As complications, infection occurred in 2 cases, and dry socket and discomfort in 1 case for each, in whom PSL had been taken for more than 12 years. These results suggested that removal of teeth in patients taking steroid medication can be securely performed without supplemental steroid by using effective administration of antibiotics.

著者

田中 宏明 小原 真美 高田 健治 山田 啓子 生井 友農 山縣 邦弘

出版者

The Japanese Society for Dialysis Therapy

雑誌

日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy (ISSN:13403451)

巻号頁・発行日

vol.41, no.6, pp.395-400, 2008-06-28

被引用文献数

3 1

---

72歳,男性.糖尿病性腎症による慢性腎不全にて維持血液透析を施行されていた.2006年1月歯周炎にて近医で抜歯されたが,その後左頸部の強い疼痛が出現し2月1日当院受診.頸部CT検査でガス産生蜂窩織炎と診断し,同日緊急で切開排膿術を施行した.膿の培養で<I>Streptococcus anginosus/milleri</I>と<I>Prevotella intermedia</I>を検出し,非クロストリジウム性蜂窩織炎と診断した.γ-グロブリン製剤投与に加えて,ABPC/SBT 3g/日,CLDM 1,200mg/日連日投与,および1日3回の創洗浄を行い,2月13日,壊死組織の除去,創閉鎖術および,抜歯・腐骨除去術を施行した.術後も創洗浄の継続にて排膿量は減少し,培養検査も陰性化したため,3月9日ドレーンを抜去した.左側頭部痛,頸部・顎下部の腫張は速やかに改善,経口摂取も可能となり3月10日退院した.退院1か月後のCTでは,abscessは消失していた.歯周炎から蜂窩織炎を発症した血液透析症例で,糖尿病合併などcompromised hostであったために重篤と思われたが,早期の切開排膿と適切な術後管理により救命しえた.