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The prediction of difficult intubation in obese patients was investigated by co-estimating the degree of visibility of oropharyngeal structures in conjunction with the respective body mass index. Data were collected prospectively in a series of 1833 consecutive adult patients. Body mass index (BMI) in kg m-2 was used as a measure of obesity (morbid: > 40, moderate: 30-40, no obesity: < 30). The oropharyngeal class findings were assessed using the original methodology as well as by a modification requiring the tongue to be pulled forward by the examiner. Difficult intubation was defined as inadequate exposure of the glottis by direct laryngoscopy. Both oropharyngeal class methodologies were of equal sensitivity, whereas the modified technique presented a significantly higher positive predictive value (50.0% vs. 37.2%, P < 0.01). Statistical analysis revealed an increased risk of difficult laryngoscopy among obese patients compared with subjects with normal body mass index (20.2% vs. 7.6%, P < 0.001). When obesity is estimated with respect to oropharyngeal class the positive predictive value is greatly improved (66.7% vs. 20.2%, P < 0.001). We conclude that obesity which is associated with a disproportionately large base of the tongue, is a predisposing factor for difficult laryngoscopy.

given, turned off, and then turned back on to give the full dose of light energy to the patient. The authors note that it 'is well tolerated by patients and results in excellent cosmesis ... important implications for future guidelines on PDT.' I agree but again disagree with their description of fractionated PDT.In 2007, Ruiz-Rodriquez et al . published a manuscript entitled 'Enhanced efficacy of photodynamic therapy after fractional resurfacing: fractional photodynamic photorejuvenation'. 3 In this article, the authors describe the use of a non-ablative fractional resurfacing device utilized prior to the application of their photosensitizer to enhance the absorption of aminolevulinic acid into the skin. The fractional device used in this study was a separate laser system than what de Haas et al . are trying to describe. 1 Ruiz-Rodriquez et al . showed increased efficacy associated with the rejuvenation process when they utilized the fractionated device prior to routine PDT. 3 Recently, we have also prepared an article 4 where an ablative fractional laser system was utilized prior to pulsed dye laser-PDT therapy for a recalcitrant verrucous lesion on the sole of the foot. Once again, the fractionated part of the story was a separate laser to enhance the absorption of the photosensitizer, not in how the light energy was given.Fractionated laser resurfacing is a very common name in laser medicine and dermatology. PDT has come a long way over the past decade, and many want to see its continued growth as new investigations, such as the one described by de Haas et al ., 1 continue to expand the uses for PDT. However, we must be careful in selecting new terms and new names for procedures in medicine, so that they do not confuse those not in our field and have a desire to learn from those of us performing novel and important research.

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Environmental factors have a significant impact on the disease expression. This stresses the necessity of preventive measures against exposure to sun and high temperature.