The treatment of TEN poses a great challenge because

The treatment of TEN poses a great challenge because of the rapid onset and progression of naltrexone hcl exfoliation with sepsis. Unfortunately, even with the advances in modern medicine, including improvements in intensive care, development of new dressing material and systemic therapies such as glucocorticoid and intravenous Ig, the mortality rate for TEN is still high and definitive treatments for TEN remain controversial. No optimal treatment protocol exists for TEN. In our BICU, no differences exist between the protocols for initial resuscitation for patients with drug- and infection-induced TEN. Continuous monitoring ensures adequate treatment of fluid and electrolyte imbalance as well as local and systemic infection. Interdisciplinary cooperation between dermatologists, ophthalmologists, intensive care physicians, and burn surgeons is also critical. Early confirmation of the causative agent of TEN is a crucial step for superior prognosis of infection-induced TEN because it enables the early prescription of antiviral drugs to stop severe cutaneous reactions. According to a recent study, pathogens are increasingly being identified as causative agents for severe mucocutaneous blistering reactions mimicking life-threatening severe cutaneous adverse reactions. Any diagnosis or treatment delay causes a severe cutaneous adverse reaction to eventually progress to SJS or TEN. One major drawback of this study is that the sample size of patients with infection-induced TEN (n = 5) was too small for the results to be considered statistically significant. Despite the small sample size, comparative analysis was performed between patients with drug-induced TEN and those with infection-induced TEN. In this regard, the results are obvious and the first of their kind in Taiwan. In conclusion, identifying the etiology of TEN requires the inclusion not only of a detailed drug history, but also the infection sources, including M. pneumoniae and herpes simplex virus. Our findings corroborate previous reports on the clinical and etiologic associations of TEN. M. pneumoniae and herpes simplex induced TEN manifested less severely than its drug-induced counterpart.
Introduction Providing an alternative conduit to bypass a segmental occlusion is a fundamental surgical principle in the revascularization of ischemic tissue. This principle has been widely applied in cardiac and vascular surgery. One of the most commonly used materials for bypass is the autologous vein. Long-term patency rates in lower extremity and cardiac surgery range from 40% to 60% at 10 years. Despite its frequent use, the long-term patency rate for upper extremity reconstruction is unknown. In addition, the effect of late occlusion has not been studied in depth.
Case reports
Results
Discussion The use of a vein graft is common in traumatic, atherosclerotic, or ablative procedures to restore blood flow to distal parts of the upper extremity. Patency rates of upper extremity venous grafts, however, have not been studied as extensively as those of coronary and lower extremity procedures. A systematic review showed a short-term patency rate of 87% at 3 years for autologous grafts. The richer collaterals and less dependent position of the upper extremity are thought to contribute to fewer recurrent ischemic symptoms after successful bypasses. Studies on late symptomatic ischemia > 5 years after successful vein graft surgery in the upper extremity are scant. In our literature review, we identified only three such case reports with a total of four patients. These reports presented patients who developed acute ischemic symptoms 9 years, 10 years, 16 years, and 17 years after their initial venous grafting procedures for traumatic replants of the upper extremity. Their presentations were similar to our patients with regard to cold intolerance, paresthesia, atrophic skin changes, and intermittent pain of the involved digits. Their diagnoses were all confirmed with preoperative angiograms. All were successfully treated with resection of the occluded vessels and new vein grafts. Histological examination of our vein graft specimens showed neointimal proliferation and arterialization of the vessel wall, which was similar to these reports of late occlusion (Fig. 2). Organized thrombi completely obstructed the lumen, which was similar to the morphological changes in an occluded atherosclerotic vessel. These histological findings and the extremely delayed occurrence suggest a progressive pathologic process, as in coronary artery and peripheral vascular diseases.