Moyamoya disease is a rare neurovascular disorder that involves constriction of certain arteries in the brain. In patients with moyamoya disease, it is very important to prevent cerebral ischemic attacks and intracerebral bleeding caused by fluctuating blood pressure and increased respiration. A 40-year-old woman with moyamoya disease was scheduled for extraction of her right upper and lower impacted wisdom teeth. Her lower impacted wisdom tooth was situated close to the inferior alveolar nerve. We decided to continue her oral antiplatelet therapy and planned intravenous sedation with analgesic agents administered approximately five minutes prior to extraction of the root of the mandibular wisdom tooth. Oral analgesic medications were regularly administered postoperatively to alleviate pain and anxiety. During the perioperative period, no cerebrovascular event occurred, and the wisdom teeth were successfully extracted as per the planned procedure. It is thought that the perioperative risks of wisdom tooth extraction in patients with moyamoya disease can be minimized with the use of our protocols.
Adult ; Analgesics ; Anesthesia, Local ; Anxiety ; Arteries ; Blood Pressure ; Brain ; Constriction ; Deep Sedation ; Female ; Hemorrhage ; Humans ; Mandibular Nerve ; Molar, Third* ; Moyamoya Disease* ; Perioperative Period ; Respiration ; Safety Management

From 1998 to 2001, using questionnaires, we surveyed the use of travel vaccines among Japanese expatriates in developing countries. The percentage of those using more than one type of travel vaccine before departure increased significantly (45.6% in 1998 to 53.4% in 2001 (p<0.001)). In regions such as tropical Africa and South Asia, vaccination rates were high. But the increase was most noticeable in East Asia, the Middle East, and Latin America. Vaccinations against hepatitis A, hepatitis B, and tetanus were high throughout the developing countries. Vaccinations against yellow fever and Japanese encephalitis were high in endemic regions. Vaccination rates were slightly higher for typhoid fever in South Asia and tropical Africa than that in other areas. Vaccination rates for cholera, however, showed yearly declines. These trends seem to reflect a growing awareness among expatriates of the benefits of travel vaccines. Even so, nearly half of those living the countries have not received sufficient vaccination, indicating a need for further education.

QT prolongation is an electrocardiographic change that can lead to lethal arrhythmia. Acquired QT prolongation is known to be caused by drugs and electrolyte abnormalities. We report three cases in which the prolonged QT interval was improved at the time of operation by briefly discontinuing the drugs suspected to have caused the QT prolongation observed on preoperative electrocardiography. The QTc of cases 1, 2, and 3 improved from 518 to 429 ms, 463 to 441 ms, and 473 to 443 ms on discontinuing the use of a gastrointestinal prokinetic agent, a proton pump inhibitor, and a molecular targeted drug, respectively. These cases were considered to have drug-induced QT prolongation. We reaffirmed that even drugs administered for conditions unrelated to cardiac diseases can have adverse side effect of QT prolongation. In conclusion, our cases indicate that dental surgeons should be aware of the dangerous and even potentially lethal side effects of QT prolongation. For safe oral and maxillofacial surgery, cooperation with medical departments in various fields is important.
Arrhythmias, Cardiac ; Electrocardiography ; Heart Diseases ; Proton Pumps ; Surgeons ; Surgery, Oral

BACKGROUND: It is important to evaluate preoperative anxiety and prepare sedation when performing dental surgery under local anesthesia. Spielberger's State-Trait Anxiety Inventory (STAI) is useful for predicting preoperative anxiety. State anxiety is defined as a subjective feeling of nervousness. Reduction in the number of the state anxiety items (questions) will be clinically important in allowing us to predict anxiety more easily. METHODS: We analyzed the STAI responses from 1,252 patients who visited our institution to undergo dental surgery under local anesthesia. Multiple linear regression analysis was conducted for 9 groups comprising anxiety level determinations using the STAI; we then developed a coefficient of determination and a regression formula. We searched for a group satisfying the largest number of requirements for regression expression while setting any necessary conditions for accurately predicting anxiety before dental surgery under local anesthesia. RESULTS: The regression expression from the group determined as normal for preoperative state anxiety was deemed the most suitable for predicting preoperative anxiety. CONCLUSIONS: It was possible to reduce the number of items in the STAI by focusing on “Preoperative anxiety before dental surgery.”
Anesthesia, Local* ; Anxiety* ; Dental Anxiety ; Humans ; Linear Models ; Test Anxiety Scale