Benign to Malignant Hepatic Lesion Transformation in Abernethy Malformation.

Abernethy malformation or congenital extrahepatic portosystemic shunt is an extremely rare condition whereby the portomesenteric blood drains into a systemic vein and bypasses the liver through a complete or partial shunt. Severe complications include hyperammonemia and encephalopathy, benign and malignant liver tumors, and hepatopulmonary syndrome. We describe a case where a female adult diagnosed with congenital extrahepatic portosystemic shunt subsequently developed focal nodular hyperplasia and then hepatocellular carcinoma.

Utility of Magnetic Resonance Imaging for Localizing Prostate Cancer Near the Urethra in Men Who Are Candidates for Focal Gland Ablation.

PURPOSE: Given that treatment near the urethra is often limited to reduce side effects, in this study we aim to determine whether prostate MRI can accurately identify the distance of prostate cancer to the urethra in a cohort of men who were potential candidates for focal gland ablation. MATERIALS AND METHODS: A single-institution analysis was performed of men who underwent MRI, targeted biopsy, and radical prostatectomy from July 2012 to April 2021. Men who were candidates for focal gland ablation were identified. The ability of MRI to identify prostate cancer within 5 mm of the prostatic urethra as confirmed on whole-mount pathology was assessed. Multivariate regression was utilized to determine characteristics associated with prostate cancer within 5 mm of the urethra on whole-mount pathology. RESULTS: In 48 out of 67 men (72%), the tumor was within 5 mm of the urethra on whole-mount pathology. MRI was concordant with whole-mount pathology in 49 out of 67 men (73%). The sensitivity of MRI for identifying cancer within 5 mm of the urethra was 77% (65%-89%) and the specificity was 63% (42%-89%). The positive predictive value was 84% (range 73%-95%) and negative predictive value was 52% (32%-73%). In adjusted analysis, PSA density and Prostate Imaging-Reporting and Data System were not significantly associated with having prostate cancer within close proximity of the urethra. CONCLUSIONS: A significant number of men who are potential candidates for focal gland ablation have cancer within close proximity to the urethra that could serve as a significant source of in-field recurrence. The sensitivity of MRI for identifying these lesions is 77% and can be used to further improve patient selection for focal gland ablation.

Ameloblastic carcinoma with hepatic metastases: A case report and review of ameloblastomic carcinoma.

Ameloblastic carcinoma is a locally aggressive odontogenic tumor that most commonly affects young and middle-aged adults. Metastatic disease may develop insidiously and manifest months or years after the initial diagnosis. Herein, we describe the clinical, imaging, and pathologic findings of a 31-year-old male who presented to the emergency department with headache and vision loss of 3 months duration and was subsequently found to have ameloblastic carcinoma with hepatic metastases. Initial computed tomography (CT) and magnetic resonance imaging revealed a multilocular cystic mass with avidly-enhancing nodular soft-tissue components associated with the right temporal fossa. Histologic examination of a tissue sample showed findings consistent with ameloblastic carcinoma. An initial staging CT scan showed several small hepatic cystic lesions. Follow-up surveillance imaging showed interval growth. A subsequent biopsy of a hepatic lesion showed findings compatible with metastatic ameloblastic carcinoma. The patient was started on systemic chemotherapy with evidence of disease progression at 1-year follow-up.

Successful Management of Diffuse Unilateral Subacute Neuroretinitis with Anthelmintics, and Intravitreal Triamcinolone followed by Laser Photocoagulation.

PURPOSE: Diffuse unilateral subacute neuroretinitis (DUSN), a form of posterior uveitis, is secondary to the presence of a highly motile nematode in the intraretinal or subretinal space. Herein, we report a case of DUSN that was successfully managed by an intravitreal injection of triamcinolone and laser therapy. CASE REPORT: A middle-aged man with complaint of decreased vision and marked unilateral vitritis and neuroretinitis. Fluorescein angiography revealed disc leakage, vessel wall staining, and diffuse track-like transmission defects of the RPE. Optical coherence tomography confirmed the subretinal location of the worm. The patient received oral thiabendazole and an intravitreal injection of triamcinolone acetonide. After 10 days, media haziness decreased, and a live motile subretinal worm was identified. Direct laser photocoagulation was performed to destroy the worm. After two months, a localized chorioretinal scar developed and no further active inflammation and subretinal worms were detected. CONCLUSION: Intravitreal steroids can be used safely in cases with DUSN and may help detect the causative worm for applying laser photocoagulation.

Surgical mesh for ventral incisional hernia repairs: Understanding mesh design.

Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years.

Le treillis chirurgical est devenu indispensable pour réparer les hernies, car il améliore les résultats et réduit les coûts. Cependant, les treillis sont en constant développement afin de vaincre les complications postopératoires. Parmi les complications courantes, soulignons l'infection, la douleur, les adhérences, l'extrusion du treillis et la récurrence des hernies. Il est essentiel de réduire les complications liées à l'implantation des treillis, car des centaines de milliers de patients souffrent de hernies chaque année aux États-Unis. Dans la présente analyse, les auteurs présentent les divers types de treillis pour hernie, en exposent les principales propriétés et démontrent l'effet de chaque élément de conception sur le rendement et les complications. Le présent article aidera les chirurgiens à choisir le treillis pour leurs patients et exposera les aspects technologiques importants qui continueront d'évoluer au cours des prochaines années.

The management of catatonia in bipolar disorder with stimulants.

Catatonia, while not a rare occurrence in bipolar disorder, has not been widely discussed in the literature. We present a case of a married Caucasian male with a history of bipolar disorder, exhibiting catatonia and experiencing difficulty in day-to-day functioning. He demonstrated impairment in cognition and an inability to organize simple activities of daily life. After exhausting a number of options for medical management, including benzodiazepines, atypical antipsychotics, and amantadine, he only displayed significant clinical improvement with the addition of a stimulant, methylphenidate. In time, the patient saw a complete return to normal functioning. The use of stimulants for catatonia in bipolar disorder may be an interesting and effective option for treatment. While this is not the first time this treatment has been suggested, there is very little data in support of it; our case confirms the discoveries of previous case reports.

Mitigation of hypertrophic scar contraction via an elastomeric biodegradable scaffold.

Hypertrophic scar (HSc) occurs in 40-70% of patients treated for third degree burn injuries. Current burn therapies rely upon the use of bioengineered skin equivalents (BSEs), which assist in wound healing but do not prevent HSc contraction. HSc contraction leads to formation of a fixed, inelastic skin deformity. We propose that BSEs should maintain their architecture in the wound bed throughout the remodeling phase of repair to prevent HSc contraction. In this work we study a degradable, elastomeric, randomly oriented, electrospun micro-fibrous scaffold fabricated from the copolymer poly(l-lactide-co-ε-caprolactone) (PLCL). PLCL scaffolds displayed appropriate elastomeric and tensile characteristics for implantation beneath a human skin graft. In vitro analysis using human dermal fibroblasts demonstrated that PLCL scaffolds decreased myofibroblast formation as compared to an in vitro HSc contraction model. Using a validated immune-competent murine HSc contraction model, we found that HSc contraction was significantly greater in animals treated with standard of care, Integra, as compared to those treated with collagen coated-PLCL (ccPLCL) scaffolds. Finally, wounds treated with ccPLCL were significantly less stiff than control wounds at d30 in vivo. Together, these data suggest that scaffolds which persist throughout the remodeling phase of repair may represent a clinically translatable method to prevent HSc contraction.

Intraretinal foreign bodies: surgical techniques and outcomes.

PURPOSE: To report the clinical features of eyes with intraretinal foreign bodies (IRFBs) and to evaluate the results of surgical management in these eyes. METHODS: Hospital records of 34 eyes of 33 patients with IRFBs were reviewed. All eyes underwent pars plana vitrectomy to remove the foreign bodies using intraocular forceps or by magnetic extraction. RESULTS: All patients were male with mean age of 28±12.3 years and were followed for a mean period of 24.5±2.3 months. The IRFBs were ferromagnetic in 29 (85.3%) cases and were removed using an external magnet in 13 eyes (38.4%) or intraocular forceps in 21 eyes (61.6%). Laser photocoagulation was performed around the IRFB prior to surgery in 7 (20.6%) eyes. Macular pucker and scars developed in 8 (23.5%) eyes and retinal breaks posterior to the sclerotomy were formed in 12 eyes (35.3%) postoperatively. Final visual acuity was 20/40 or better in 12 (35.3%) eyes and 20/200 or better in 23 (67.7%) eyes. Final visual acuity of 20/200 or better had no significant relationship with the site, size, or type of the IRFB or with the interval from trauma to surgery. CONCLUSION: Despite the complexity of surgical management of IRFBs, anatomic and visual outcomes of vitreoretinal surgery in these cases are generally good. The appropriate route of removal may be determined by the type, size, and site of the IRFB. Removal of magnetic IRFBs using external magnets versus intraocular forceps seems to entail comparable results.

A qualitative evaluation of men living with HIV: views on condom use.

BACKGROUND: Unprotected sexual activity is an important reason for the currently growing incidence of HIV infection in Iran. Recognizing barriers to safe sexual practice and affordance of behavioral changes can improve planning for condom promotion. The main objective of our study is to evaluate the opinions of HIV-positive men on condom use. METHODS: Our study was performed at three behavioral disease consultation clinics (HIV care clinics) in Tehran, Iran. Participants were initially selected among HIV-positive male patients by convenience sampling and narrowed-down by maximum diversity sampling in order to obtain the number of patients that would express various viewpoints regarding barriers and benefits to condom use. Data were collected using in-depth semi-structured individual interviews. All interviews were recorded and transcribed, and the codes were extracted after reviewing them several times. RESULTS: In this study, 22 HIV-positive men with a mean age of 37.5 ± 7.3 years were interviewed. Participants mentioned the prevention of HIV and sexually transmitted diseases as a benefit of condom use. However, most named decreased sexual satisfaction as the most important reason for not using condom. Because of decreased sexual satisfaction and unpleasantness, 9% of participants had not used condom during sexual intercourse. CONCLUSION: The most important reason for not using condom was decreased sexual satisfaction. This study has indicated a need for consultations with HIV-positive and at risk populations to change their attitudes towards condom use and demonstrate the advantages of condom. To achieve this, government programs and media should be utilized.

A computer-based anaglyphic system for the treatment of amblyopia.

PURPOSE: Virtual reality (VR)-based treatment has been introduced as a potential option for amblyopia management, presumably without involving the problems of occlusion and penalization, including variable and unsatisfactory outcomes, long duration of treatment, poor compliance, psychological impact, and complications. However, VR-based treatment is costly and not accessible for most children. This paper introduces a method that encompasses the advantages of VR-based treatment at a lower cost. METHODS: The presented system consists of a pair of glasses with two color filters and software for use on a personal computer. The software is designed such that some active graphic components can only be seen by the amblyopic eye and are filtered out for the other eye. Some components would be seen by both to encourage fusion. The result is that the patient must use both eyes, and specifically the amblyopic eye, to play the games. RESULTS: A prototype of the system, the ABG InSight, was found capable of successfully filtering out elements of a certain color and therefore, could prove to be a viable alternative to VR-based treatment for amblyopia. CONCLUSION: The anaglyphic system maintains most of the advantages of VR-based systems, but is less costly and highly accessible. It fulfills the means that VR-based systems are designed to achieve, and warrants further investigation.

Comparison of the ocular response analyzer and the Goldmann applanation tonometer for measuring intraocular pressure after deep anterior lamellar keratoplasty.

PURPOSE: To compare intraocular pressure (IOP) measured using the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, NY) with that measured using the Goldmann applanation tonometer (GAT) in keratoconic eyes after deep anterior lamellar keratoplasty (DALK) and evaluate the influence of central graft thickness (CGT), corneal astigmatism, corneal hysteresis (CH), and corneal resistance factor (CRF) on the IOP measurements. METHODS: IOP using the GAT (IOP(GAT)), CH, CRF, Goldmann-correlated IOP (IOP(g)), cornea-compensated IOP (IOP(cc)) using the ORA, and CGT were measured in 23 keratoconic eyes undergoing DALK. Bland-Altman plots were used to evaluate agreement between the tonometers. The correlation between refraction, CH, CRF, and CGT with IOP readings was investigated using multivariate regression analysis. RESULTS: Mean patient age was 27.2 ± 6.5 years. Mean CGT, CH, and CRF were 547.0 ± 42.6 µm, 9.6 ± 2.1 mm Hg, and 9.4 ± 2.1 mm Hg, respectively. Mean IOP(GAT), IOP(g), and IOP(cc) were 11.3 ± 2.9, 14.1 ± 2.4, and 15.6 ± 2.6 mm Hg, respectively (P < 0.001). The 95% limit of agreement for IOP(g) and IOP(GAT) was between -2.61 and 8.19 mm Hg and for IOP(cc) and IOP(GAT) it was between -0.69 and 9.21 mm Hg. CH and CRF were significantly associated with IOP(GAT). No significant association was found between CGT and IOP readings obtained using either the ORA or GAT. CONCLUSIONS: IOP readings by the ORA were significantly greater than those by the GAT, and CH and CRF play a more important role in post-DALK IOP readings by both GAT and ORA than other graft characteristics including curvature and central thickness.

Barriers to a healthy lifestyle among obese adolescents: a qualitative study from Iran.

PURPOSE: Existing data show a rising prevalence of overweight and obesity among Iranian adolescents. The current study investigates adolescents' perceptions regarding overweight/obesity and explores barriers to a healthy life style among Iranian adolescents. METHODS: A grounded theory approach was used for analyzing the participants' experiences, and their perceptions. To collect data, semi-structured focus group discussions and in-depth interviews were conducted with 51 adolescents (27 girls and 24 boys), aged 15-17 years, who were either overweight or obese. Qualitative content analysis of the data was conducted manually and differences in coding were resolved via discussion by four independent reviewers. RESULTS: Two main barriers, personal and environmental emerged from data analysis. Positive perception of condition, priority of studying, lack of willingness, unsatisfactory results, low self-esteem, and perceived lack of control were the major personal barriers while lack of family and cultural support, inadequate education and scarcity of resources were the common environmental barriers to adolescents' healthy lifestyles. CONCLUSIONS: Findings demonstrated the main personal and environmental barriers for a healthy life style as perceived by adolescents. Understanding these barriers might contribute to existing literature by providing evidence from a different culture, and help to design effective preventive strategies, and implement appropriate interventions.

The knowledge and attitudes of a female at-risk population towards the prevention of AIDS and sexually transmitted infections in Tehran.

BACKGROUND: The female at-risk population represents a subgroup that is both a crucial determining factor in acquired immune deficiency syndrome (AIDS) transmission and a gap in the existing literature in Iran. The objective of this study was to evaluate the level of sex workers' knowledge towards to safe procedures of sexually transmitted infection and AIDS prevention as well as attitudes towards AIDS. METHODS: A sample of 256 female sex workers working in Tehran was obtained by a variety of methods. Appropriate questions for the assessment of knowledge and attitude were developed based on previous studies. RESULTS: The mean age of the subjects was 26.8 ± 6.1 years (ranging from 16 to 45). Methods of transmission were widely recognized, despite the exception that few realized oral (23.4%) and anal (44.9%) intercourse as methods of human immunodeficiency virus (HIV) transmission. Most subjects knew that AIDS currently has no cure (81.2%) and no vaccine (73.4%). Most also acknowledged that HIV is transmissible from people who do not know they are HIV positive (59.4%), proper condom use can reduce the possibility of infection (78.1%), and so can having a single sexual partner (68.8%). Of the participants, 43.4% knew that an HIV-positive person can seem perfectly healthy. CONCLUSIONS: Knowledge towards sexually transmitted infections (STIs) and condom use is still inadequate, especially regarding risky behaviors such as anal sex, and attitudes are mainly negative. Identifying at-risk populations, HIV-positive sex workers, education and campaigns to change the attitudes towards AIDS should be regarded a high priority in Iran.

A Cross-cultural Comparison of Objectivity in Childhood Games: Iran and the United States.

Games have been introduced as a means for studying cross-cultural differences and societies. This paper presents a case study in analogous games played by children in two different countries with two different cultures - Iran and the United States. Four examples are presented to demonstrate that games played by Iranian children are subject to less objectivity in their rules. Therefore, nonobjectivity may be a phenomenon that has roots in the society and the many differences between the two societies may very well be the results of this fundamental difference. If the presence of objectivity in childhood game rules could be, in actuality, indicative of objectivity in social and civil interactions in the everyday lives of the people, the direction of causality remains to be established. In other words, it remains unclear whether the games influence the culture or are influenced by the mandates of the society.

Effect of vitreous length and trephine size disparity on post-DALK refractive status.

PURPOSE: To evaluate the effect of vitreous length (distance between posterior lens surface and vitreoretinal interface) and donor-recipient disparity on the refraction and keratometric astigmatism after deep anterior lamellar keratoplasty (DALK). METHODS: In this retrospective comparative study, 85 eyes of 83 patients with keratoconus underwent DALK using the big-bubble technique. A 0.25-mm oversize donor was used for a vitreous length of ≥ 16.0 mm, and a 0.50-mm oversize donor for a vitreous length of <16.0 mm. At least 3 months after complete suture removal, spherical equivalent refractive error (SE), keratometric astigmatism, and mean keratometry were compared between the 2 groups. Multiple regression analysis was performed in group 1 to investigate the correlation between vitreous length and SE, between vitreous length and keratometric astigmatism, and between mean keratometry and SE. RESULTS: Mean patient age was 26.5 ± 7.7 years, and they were followed for 22 ± 10 months postoperatively. Seventy-five eyes received a 0.25-mm oversize donor (group 1), and 10 had a donor oversized by 0.50 mm (group 2). Compared with group 1, the patients of group 2 had a significantly steeper cornea (46.83 ± 2.0 vs. 48.29 ± 1.9 diopters, respectively; P = 0.01). SE and keratometric astigmatism in group 1 did not significantly differ from those in group 2. In group 1, there was a significant association between vitreous length and SE and between mean keratometry and SE but not between vitreous length and keratometric astigmatism. CONCLUSION: In DALK, a donor oversized by 0.25 mm is advisable for elongated keratoconic eyes, whereas a 0.50-mm oversize donor is advocated for small ones.

Visual acuity and refraction after deep anterior lamellar keratoplasty with and without successful big-bubble formation.

PURPOSE: To compare visual acuity and refractive outcomes after Anwar's deep anterior lamellar keratoplasty (DALK) between eyes with and without successful big-bubble formation. MATERIALS AND METHODS: In this retrospective comparative study, keratoconic eyes undergoing DALK with the big-bubble technique were divided into 2 groups: group 1 in which a bared Descemet membrane (DM) was achieved and group 2 in which layer-by-layer manual dissection was performed because of the lack of big-bubble formation after several intrastromal air injections. The 2 groups were compared with respect to best spectacle-corrected visual acuity, keratometric astigmatism, and refractive error at months 1, 3, 6, and 12, and at least 3 months after complete suture removal. RESULTS: A total of 123 keratoconic eyes were enrolled. A bared DM was successfully achieved in 100 eyes (81.3%) (group 1), whereas in 23 eyes (18.7%) (group 2), some posterior stroma was left in place. The mean follow-up period was 21 ± 9 months in group 1 and 23 ± 9 months in group 2 (P = 0.37). Postoperative best spectacle-corrected visual acuity was significantly better in group 1 than in group 2 at months 1, 3, 6, and 12. But, at the final examinations, there was no significant difference between the study groups (0.24 ± 0.21 logarithm of the minimum angle of resolution in group 1 and 0.32 ± 0.14 logarithm of the minimum angle of resolution in group 2; P = 0.18). The 2 groups were comparable regarding keratometric astigmatism and spherical equivalent refractive error throughout the follow-up period. CONCLUSIONS: Retention of posterior corneal stroma delayed visual recovery after DALK using Anwar's technique, but the participants in this group ultimately reached the same levels of visual acuity as observed in the bared-DM group.

An unexpectedly high incidence of acute childhood diarrhea in Koot-Abdollah, Ahwaz, Iran.

OBJECTIVES: Koot-Abdollah is a neighborhood in Ahwaz, in the southeast of Iran, susceptible to public health hazards due to a number of factors, including a low level of personal hygiene, inappropriate community sanitation, and a high level of environmental and water pollution. This study was designed to measure the incidence of acute childhood diarrhea in this neighborhood. METHODS: This was a descriptive population-based study. Via multistage sampling, data were collected by interviewing the mothers in their homes. Reported 95% confidence intervals included a finite population correction factor and accounted for the cluster sampling design. RESULTS: The study included 2016 children aged 6 to 60 months. Overall, 725 (36.0%) of the children studied had experienced an episode of acute diarrhea during the previous two weeks. In other words, the children demonstrated a rate of diarrhea per 100 person-years of 936 for the studied period, which was a time period expected to reveal the lowest possible incidence of diarrhea. CONCLUSIONS: The incidence of diarrhea per two weeks in Koot-Abdollah is exceptionally high. The limitation of available drinking water, warm weather, illiteracy, poverty, and low incomes, in addition to the low level of sanitation and personal hygiene and extreme environmental pollution contribute to this high incidence.

Relaxing incisions combined with adjustment sutures for post-deep anterior lamellar keratoplasty astigmatism in keratoconus.

PURPOSE: To find an effective and reliable method to correct astigmatism after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. PATIENTS AND METHODS: This interventional case series included 14 eyes of 14 patients with keratoconus (12 males) undergoing graft refractive surgery (GRS) for intolerable post-DALK astigmatism. The technique of GRS for the 5 initial cases consisted of only relaxing incisions at the steep meridian in the graft-host interface down to Descemet membrane. For the rest, the relaxing incisions at the steep meridian were accompanied by simultaneous suturing and the effect of the relaxing incisions was controlled through selective suture removal starting a few days after the operation. The main outcomes were uncorrected and corrected visual acuity and change in refractive and keratometric astigmatism using subtraction and vector analysis methods. RESULTS: Mean patient age was 29.36 +/- 6.2 years. Mean time interval from complete suture removal to GRS and follow-up period were 4.5 +/- 2.0 months and 12.0 +/- 7.4 months, respectively. Mean preoperative best-corrected visual acuity was 0.29 +/- 0.1, increasing to 0.22 +/- 0.1 logarithm of minimum angle of resolution after the operation (P = 0.007). Average keratometric astigmatism was reduced by 3.8 and 5.5 diopters measured with subtraction and vector analysis methods, respectively. Four of 5 eyes that had only relaxing incisions initially required suturing of the incisions because of overcorrection, whereas preliminary results showed none of the 9 patients undergoing simultaneous relaxing incisions and suturing required further intervention. CONCLUSION: Relaxing incisions and suturing at the steep meridian followed by selective suture removal can effectively and predictably reduce post-DALK astigmatism in patients with keratoconus.

The impact of an urban sewerage system on childhood diarrhoea in Tehran, Iran: a concurrent control field trial.

The stepwise implementation of the Tehran Sewerage Project provided a convenient setting for which health impacts of an urban sewerage system could be examined with appropriate controls. In 2001, Tehran municipal districts 17 and 18 had no sewerage system connections, but areas within these districts had been planned to be connected by 2006. These areas were chosen as an intervention group. Neighbouring areas, with a similar socio-economic status, that had not been planned to connect to the sewerage system by 2006, were chosen as controls. Homes within designated areas were randomized and surveyed twice to determine diarrhoea incidences for children aged 6-60 months, once in 2001, before connection to the sewerage system, and once again in 2006, after the intervention. By 2006, 76% of the homes in the intervention zones were connected to the sewerage system. In the first stage of the study, diarrhoea incidences for intervention and control groups were 18.6 and 16.6%, respectively. In the second stage, incidences decreased to 10.1 and 10.5%, respectively. Data collected from 4179 children demonstrated that the diarrhoea incidence had decreased by 46% in the intervention group, whereas it had decreased by 37% in the controls.

Comparison of the upper lip bite test with measurement of thyromental distance for prediction of difficult intubations.

BACKGROUND: The upper lip bite test (ULBT) introduced in 2003 is a simple method for predicting difficult intubations. According to this test, the higher a patient can bite the upper lip with the lower incisors, the lower the risk of difficult intubation. Given the necessity for evaluation and re-evaluation of a newer predictive method, this study was conducted to compare the ULBT with another method for difficult airway prediction, the measurement of thyromental distance (TMD). METHODS: In this prospective, observational, single-blind study, 350 patients who required inhaled general anesthesia with endotracheal intubation for elective surgery were enrolled for evaluation of the accuracy in predicting difficult intubation by TMD measurement and ULBT. In the ULBT, the capacity of biting the upper lip is categorized into three classes: class I, a patient is able to raise the lower incisors above the vermilion line; class II, a patient is able to bite the upper lip below the vermilion line; and class III, a patient is unable to bite the upper lip. After induction of anesthesia with a standard protocol, the patient's grade of laryngeal view by the Cormack-Lehane classification was documented by an anesthesiologist with at least 3 years' experience who was unaware of prior evaluations. A TMD equal to or less than 4 cm and a class III ULBT were considered to be predictive of difficult intubation. A Cormack-Lehane class III or IV was considered a difficult intubation. RESULTS: Only 20 (5.7%) of the patients were considered to have difficult intubations. Sensitivity, specificity, positive and negative predictive values, and accuracy were 70%, 93.3%, 39%, 98.1%, and 92.6%, respectively, for the ULBT, and 55%, 88%, 22%, 97%, and 86.3%, respectively, for TMD. Specificity and positive predictive value were found to be significantly higher for the ULBT than for TMD (p < 0.05). The sensitivity, negative predictive value, and accuracy were not significantly different between the two methods. CONCLUSION: The findings suggest that the sensitivity of the ULBT and TMD for predicting difficult intubations may not be significantly different, but the specificity of the ULBT is significantly higher. The positive predictive value of the ULBT was significantly higher than that of TMD, signifying that a positive ULBT is more predictive of a difficult airway than is a positive TMD.