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Mucormycosis is a rare fungal infection mainly developing in compromised hosts, and the associated mortality rate is high. We encountered a patient with rhinocerebral mucormycosis that had extended into the skull. Amphotericin B (AMPH-B) was markedly effective and saved the patient’s life. The patient was a 51-year-old male with a past medical history of type-1 diabetes and he was being treated with dialysis for chronic renal failure. He visited his family doctor for left cheek pain, and received treatment for a diagnosis of left sinusitis and odontogenic maxillary sinusitis, but the swelling of the left cheek aggravated, and dysesthesia and left palatine mucosal necrosis developed. Thus, the patient was transferred to our department. On the first examination, Horner syndrome and cavernous sinus syndrome were observed, and multiple abscess in the left bucca, mucosal hypertrophy of the paranasal sinus, and lesions in the orbit and skull were noted on CT. Treatment for severe ondontogenic infection was performed, but mucormycosis was diagnosed on the second histopathological examination of the necrotized palatal region. The intravenous administration of AMPH-B (2.5 mg/kg/day) was initiated, and size reduction of the lesions was confirmed on CT after administration for 6 weeks. The lesions completely disappeared thereafter, but the patient died of another disease after 8 years. AMPH-B was markedly effective and saved the patient’s life. When buccal cellulitis and sinusitis develop in a compromised host, it is necessary to take rhinocerebral mucormycosis into consideration.

The literature investigating the relationship between objective and subjective sleep in depressed patients is limited and the results are inconsistent. Furthermore, many factors that influence the aforementioned relationship have not been investigated. The present study was carried out to clarify the characteristics of self-estimation of sleep in depressed patients. Sleep was estimated concurrently using a sleep log and polysomnography for 5 consecutive days to investigate the relationship between subjective sleep estimation and objective sleep estimation in 23 patients with major depression (Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised; DSM-III-R). Factors related to a discrepancy between both types of estimation were identified. The subjective total sleep time showed a significant, but moderate, positive correlation (correlation coefficient: 0.63) with the objective total sleep time. The degree of discrepancy was significantly correlated with various objective sleep variables and severity of depression. In the underestimation group in which the subjective total sleep time was shorter than the objective total sleep time, the objective total sleep time and slow-wave sleep time were shorter, age was greater and the extroversion score (Maudsley Personality Inventory) was lower than in the overestimation group in which the subjective total sleep time was longer than the objective total sleep time. The data suggest that subjective sleep estimation in depressed patients is influenced by their objective sleep, severity of depression, age and personality.

Incidence of serotonin syndrome was determined by two different diagnostic criteria during clomipramine monotherapy. Incidence, determined by Sternbach's criteria, was 12.1% (8/66 patients), and that determined by the criteria of Dursun et al. was 3.0% (2/66 patients). The two patients who met the latter criteria also met the former criteria. The lower incidence with the latter was attributable to the fact that it does not include certain symptoms, such as tremors and diaphoresis, which are included in the former, and were seen in a relatively large number of patients; as well as the fact that the latter more strictly define certain symptoms. Both criteria have pros and cons. Sternbach's diagnostic criteria make it possible to diagnose serotonin syndrome in a wider range of patients, but they sometimes make it difficult to make it differential diagnosis in the presence of certain limited symptoms. In contrast, the criteria of Dursun et al. may make a more accurate diagnosis possible, though only in severe cases.