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Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening disorders characterized by widespread epidermal necrosis of the skin and mucosa. The severity-of-illness scoring system for TEN (SCORTEN) was widely used since 2000 as a standard prognostic tool consisting of seven clinical values. Methods: To evaluate the prognosis using current treatments and risk factors for mortality, we retrospectively analyzed 59 cases of TEN, including SJS/TEN overlap treated in two university hospitals from January 2000 to March 2020. Results: The mortality rate of TEN was 13.6% (8/59). All patients treated with high-dose steroid administration in combination with plasma exchange and/or immunoglobulin therapy recovered. Logistic regression analysis showed nine clinical composite scores, namely: heart rate (≧120 bpm), malignancy present, percentage of body surface area with epidermal detachment (>10%), blood urea nitrogen (>28 mg/dL), serum bicarbonate level (252 mg/dL), age (≧71 years), the interval between disease onset and treatment initiation at the specialty hospital (≧8 days), and respiratory disorder within 48 h after admission. The receiver operating characteristic curves confirmed a high potential for predicting the prognosis of TEN. Conclusions: Recent developments in treatment strategies have contributed to the improved prognosis of TEN patients. A modified severity scoring model composed of nine scores may be helpful in the prediction of TEN prognosis in recent patients. Further large-scale studies are needed to confirm mortality findings to improve prognostication in patients with TEN.

Background: The adjustable shunt valves of ventriculoperitoneal shunts (VPS) produce magnetic artifacts, which could disturb magnetic resonance imaging (MRI), and should therefore be placed on the chest wall. However, some significant complications, including ventricular catheter migration, disconnection, and rupture, should be considered. This study proposed a novel method for VPS placement with the valve placed on the chest wall using a fixation technique that uses titanium screws for securing the reservoir to the cranium. Methods: After a right-angled ventricular catheter with reservoir was inserted into the lateral ventricle, a 4-mm self-tapping titanium screw was inserted directly through the collars of the reservoir to fix it to the cranium. Adjustable shunt valves were implanted in the infraclavicular fossa of the chest wall. The connection site between the valve and tube was fastened using 3–0 nonabsorbable braided nylon surgical sutures. Results: In this study, following VPS placement in 83 patients with normal-pressure hydrocephalus, the review of all postprocedural images showed that of the 83 patients, four patients (4.8%) had catheter placement complications: two patients (2.4%) had incorrect placement of the ventricular catheter and two patients (2.4%) had subcutaneous migration of the abdominal catheter. None of the patients complained of ventricular catheter migration, disconnection, or rupture. Conclusion: In adult patients, placing the VPS valve in the chest and fixing the proximal catheter to the cranium using surgical screws can be an effective way to avoid MRI artifacts and to counteract mechanical failure due to the dislodgment of the proximal catheter.