Influence of imaginative teaching of diet on compliance and metabolic control in insulin dependent diabetes.

Dietary non-compliance is an important cause of poor metabolic control in insulin dependent diabetes. Patients are often blamed, but teaching methods may be at fault, so a prospective study was set up to compare the effect of three different teaching methods. After a three month run in, 40 adults with longstanding poorly controlled insulin dependent diabetes (mean haemoglobin A1 13.0%) were allocated at random to three teaching methods: conventional diet sheet instruction (group 1); practical lunchtime demonstrations (group 2); videotape education (group 3). Knowledge was assessed by questionnaires, compliance by seven day food records, and glycaemic control by serial glycosylated haemoglobin measurements. During six months of follow up there was no improvement in knowledge, compliance, or HbA1 in group 1, but in groups 2 and 3 both knowledge and compliance improved. In group 2 HbA1 fell to 10.6 (SD 2.1)% and in group 3 to 9.6 (2.3)%. The change in HbA1 showed an appreciable correlation with dietary compliance as judged by day to day consistency in carbohydrate intake. These findings show that new and interesting educational methods can have a major influence on knowledge, compliance, and metabolic control in insulin dependent diabetes.     

Survey of the clinical use of pressurized aerosol inhalers.

Questions as to the use of pressurized aerosol inhalers were asked of 130 persons presenting for routine pulmonary function studies who had used such a device in the previous year. After spirometry was conducted the subjects used the inhaler; they were unaware that their technique of use was being observed. Only 10.8% performed correctly all 11 maneuvers suggested for the proper use of the inhalers, and 24.7% failed to perform more than 5 satisfactorily. There were significant differences in performance according to referral diagnosis (chronic obstructive lung disease v. asthma) and regularity of use of inhalers.     

Comparison of effects of a self management booklet and audiocassette for patients with asthma.

The effects on self management of asthma of a specially prepared book and audiocassette tape with similar contents were observed in a controlled study of 177 patients with asthma in general practice. After a run in period of six months patients were randomly given the book, the tape, both the book and tape, or neither. Patients'' knowledge of the use of drugs, perceptions of their disability, skill in using an inhaler, consumption of drugs, consultations with their general practitioners, morbidity (from patients'' entries on diary cards), and use of the educational material were measured. Knowledge about the use of drugs was significantly increased in the groups who received the material after three months and persisted after 12 months. Patients who had been given the tape or the book and tape increased their scores of knowledge of drugs more than patients given the book alone. Patients in all groups given the material considered that their disability was reduced. There were no other significant changes. Patients given both the book and the tape preferred the book. Patients with asthma can obtain useful information from such material. The paradoxical result whereby patients learnt more from the tape but preferred the book suggests that a distinction can be made between information that patients need, which may be acquired better from an audiocassette, and information that they want, which may be acquired better from a book.     

A prospective study of two self-help CD based desensitization and counter-conditioning programmes with the use of Dog Appeasing Pheromone for the treatment of firework fears in dogs (Canis familiaris)

The aims of this study were to evaluate the efficacy of two self-help CD based desensitization and counter-conditioning programmes with the use of Dog Appeasing Pheromone (DAP) for the treatment of firework fears in dogs and to evaluate the training progress and owner compliance. Fifty-four individuals were recruited for an 8-week period of training between August and October 2004. The dogs were separated into two treatment groups, each using a different CD based programme. After implementing the CD programme for the 8-week period without any personalized instruction, two telephone follow-up interviews were completed after periods during which fireworks are commonly used (November and January). Forty-two individuals completed the first 4 weeks of training and 38 completed the 8-week training period. Thirty-six individuals completed the first follow-up interview with 29 completing the second follow-up interview. Assessment of efficacy was measured using both owner reports of its natural response (i.e. the dog's behaviour in the home) and video footage of behaviour in response to a novel recording of the problem sound (i.e. the dog's behaviour in the behaviour clinic) pre- and post-treatment.The majority of change with respect to the dogs’ response to the CD occurred during the first month of training with no significant change during the second month of training. With respect to real exposures, there was a significant reported improvement at both follow-up interviews in both the total severity scores and the global fear scores. There was significant improvement in the mean severity score of all individual behaviours at the first follow-up with the exception of “vigilance” behaviour. Inappropriate elimination was the only behaviour to be completely resolved by the second follow-up. No difference was found in the video recordings of fear behaviours occurring in response to a novel CD recording pre-treatment versus post-treatment.Although the CD programmes varied significantly from one another with respect to their format and the details given in their accompanying instruction booklet, there were no differences between total severity scores or global scores at follow-up two between the treatment groups.Eighty-three percent of owners claimed to have read over 90% of the accompanying instruction booklet for their respective CD but only 48% said that the majority of the instructions were clear. Approximately 90% reported they would consider using a CD based desensitization and counter-conditioning programme again if they were to acquire another dog that was scared of fireworks.These results suggest that the use of self-help CD based sound desensitization programmes in combination with DAP can produce a satisfactory result for some owners of dogs with fear of fireworks, but compliance may be a problem for a notable proportion of owners.     

Effects of Salbutamol and Isoprenaline Phenylephrine in Reversible Airways Obstruction

Ventolin (salbutamol) and Medihaler-Duo (isoprenaline/phenylephrine combination) standard pressurized inhalers were used to administer doses of two or six “puffs” to 16 patients with known reversible airways obstruction. The doses were administered in random order over two days. Both the Ventolin and Medihaler-Duo inhalers substantially increased FEV₁, but in the doses used salbutamol was more effective than isoprenaline/phenylephrine (P < 0·01). There was no significant difference between two and six puffs of salbutamol, though there seemed to be an advantage of six puffs of isoprenaline/phenylephrine over two puffs (P < 0·05). Adrenaline (1/1,000) 0·5 ml and atropine 0·6 mg produced similar increases in FEV₁ to those produced by salbutamol.The Pao₂ fell more than 5 mm Hg in three patients after salbutamol and in three after isoprenaline/phenylephrine. There was no significant fall in mean Pao₂ in any of the treatment groups. It is concluded that the Ventolin inhalant, administered in the conventional dose of two puffs, is as effective a bronchodilator as subcutaneous adrenaline and atropine, is more effective than the Medihaler-Duo, and is without detectable side effects.     

Prenatal screening for hemoglobinopathies. II. Evaluation of counseling.

Learning during genetic counseling is often below expectations, especially in the context of genetic screening. In this report we describe learning as a result of genetic counseling of 298 pregnant women identified as hemoglobinopathy carriers, 234 with sickle cell trait and 64 with beta-thalassemia trait. Counseling was designed to provide the information needed in a simple, clear, and nondirective manner. A special videotape produced for this purpose provided dramatization and a role model illustrating an appropriate response. After viewing the videotape the counselee had an opportunity to question the counselor and to have any misconceptions corrected. Questionnaires revealed significantly increased knowledge as a result of counseling in each of the three hemoglobinopathy subject areas tested-namely, clinical manifestations, genetics, and prenatal diagnosis. Five factors correlated with higher knowledge scores after counseling-namely, a younger patient age, more years of education, knowledge of having trait before this identification, knowledge of the baby's father having trait before counseling, and having no prior children.     

A rapid technique for the histological examination of large ovarian follicles

A rapid technique for counting and classifying large ovarian follicles of domestic animals is described. Using a cryostat, 250-micrograms thick sections were cut from the frozen ovary; an image of the surface of each ovarian section was recorded on videotape. By replaying the videotape, the largest profile of each follicle larger than 1 mm in diameter was readily identified and measured. The presence or absence of atresia was determined by applying standard histological methods to fragments of individual follicles taken from the frozen sections. The results obtained are similar to those found using previous methods and demand only one-quarter of the time.     

Norethisterone oenanthate as an injectable contraceptive: use of a modified dose schedule.

Norethisterone oenanthate (NET-OEN) was given as an injectable contraceptive to 295 healthy women over 1606 woman-months. A modified injection schedule was used. There were no pregnancies, and the 12-month, life-table, use-related discontinuation rate was 39.1/100 users. Menstrual disturbance (10.8/100 women), minor side effects (13.5/100 women), and personal reasons (12.0/100 women) were the main causes of use-related discontinuation. There was no difference in use-related discontinuation rates between women receiving their first injection during a normal menstrual period and those receiving it immediately after a pregnancy. There were no serious side effects. The use of NET-OEN in certain groups of women is recommended, particularly in those in need of highly effective contraception, who cannot or do not wish to take oral contraceptives, who are lactating, or who are awaiting hospital admission for sterilisation.     

Evaluating the effectiveness of 2 educational interventions in family practice

BACKGROUND: Structured feedback of information can produce change in physician behaviour. The objective of this study was to assess the effectiveness of 2 educational interventions for improving the quality of care provided by family physicians in Ontario: the Practice Assessment Report (PAR) and the Continuing Medical Education Plan (CMEP) with a follow-up visit by a mentor. METHODS: The study was a randomized controlled trial. Physicians in the control group received only the PAR, whereas those in the experimental group received the PAR, CMEP and mentor interventions. The participants were 56 family physicians and general practitioners (27 in the PAR group and 29 in the CMEP group) in southern Ontario who agreed to participate in the interventions and provide data. A total of 2395 patients randomly sampled from the practices returned questionnaires and consented to have their medical records abstracted. The outcome measures were global scores in 4 areas--quality of care, charting, prevention and overall use of medications--and patient ratings of satisfaction with care and preventive practices. The measures were applied at the beginning (phase 1) and end (phase 2) of the study. RESULTS: The mean global scores at the end of the study for the PAR group were 70.1% for quality of care, 84.7% for prevention, 77.7% for charting and 82.2% for overall use of medications. The corresponding scores for the CMEP group were 68.3%, 82.1%, 76.4% and 83.2%. In the patient satisfaction component, the personal care scores at phase 2 were 93.6% for the PAR group and 94.6% for the CMEP group. Examples of the scores for prevention for the PAR group were 98.3% for children''s current immunization, 96.6% for blood pressure measured within the previous 5 years, 79.4% for referral of women of the appropriate age for mammography within the previous 2 years, and 58.4% for discussion about alcohol use. The corresponding scores for the CMEP group were 95.8%, 97.6%, 77.6% and 64.6%. The changes in mean scores between phase 1 and phase 2 ranged from -1.9 to 2.3 points. There were no significant differences between the 2 groups in phase 1 or phase 2 scores or in change in scores. A total of 64.3% of the physicians rated the PAR as useful, 26.5% found the CMEP to be useful, and 41.0% considered the mentor strategy to be a useful form of continuing medical education. Although changes in practice related to the PAR, CMEP or mentor were reported by some physicians, they were not related to chart audit or patient scores. INTERPRETATION: Educational interventions based on quality-of-care assessments and directed to global improvements in quality of care did not result in improvements in the outcome measures. Educational interventions may have to be targeted to specific areas of the practice, with physicians being monitored and receiving ongoing feedback on their performance.     

Comparison between videotape and personal teaching as methods of communicating clinical skills to medical students.

The efficacy of video recording in transmitting clinical knowledge and skills to medical students was tested by recording on videotape demonstrations of physical examinations given by five clinicians to a randomly selected group of 12 students (personal group) from the first clinical year and then showing these recordings, under identical conditions, to 13 students from the same year (video group). The efficacy of both the personal and video mediums in terms of whether content was retained was tested by a questionnaire completed by all students at the end of the sessions and by a structured clinical assessment in which students were asked to demonstrate some of the same clinical tasks three weeks after the demonstration. In answering the questionnaire the video group obtained a mean (SD) score of 20.8 (7.0) (maximum possible score 40), which was not significantly different from the score achieved by the personal group (17.4 (7.7)). The video group was able to reproduce 44 (10)% of the total clinical steps demonstrated and the personal group 45 (14)%. Videotaped demonstrations can be as effective as personal teaching of clinical methods, and video should be developed as a medium for first line clinical teaching.     

Self versus Family Ratings of the Frontal Systems Behaviour Scale and Measured Executive Functions: Adult Outcomes following Childhood Traumatic Brain Injury

Traumatic brain injury (TBI) frequently occurs during childhood and adolescence with long-term neuropsychological and behavioral effects. Greater personal awareness of injury is associated with better outcomes. However, personal awareness is often assessed using ratings obtained from family members or significant others. Surprisingly, the accuracy of family-ratings compared with self-ratings has not been well studied in the TBI population. Thus, the purpose of this study was to examine self versus family-ratings of frontal dysfunction and secondly, the association between self/family reported frontal dysfunction and measured executive function outcomes. A total of 60 participants, approximately 10 years post-TBI, comprised 3 groups including; moderate/severe TBI (N=26; mean age 22.9, SD=3.0), mild TBI (N=20; mean age, 21.7, SD=2.7), and control (N=14: mean age, 21.6, SD=3.7). Neuropsychological testing was used to obtain domain scores for executive function and working memory/attention for each participant, and nominated family members and participants with TBI were asked to complete the Frontal Systems Behaviour Scale (FrSBe), consisting of three sub-scales; apathy, disinhibition, and executive dysfunction. Using the FrSBe there was no significant difference between the groups in executive function score, but the moderate/severe and mild groups had significantly lower working memory/attention scores compared with the control group (p<0.05). Repeated measures analysis of variance showed higher self-ratings on all sub-scales compared with family in each group (p<0.05). Scores on executive function and working memory/attention domains correlated with self, but not family reported executive dysfunction. Self-rated executive dysfunction explained 36% of the variance in executive function (p<0.001). While agreement between self-rated and family-rated total FrSBe scores was significant in all groups (p<0.001), our results showed that self-ratings were of higher predictive utility for executive functioning compared with family ratings. Further, at 10 years post-TBI, patients show greater awareness of deficits compared with family who rate consistently closer to the normal functioning range.     

Correcting the saddlebag deformity in the massive weight loss patient

Skin redundancy of the trunk and thigh is treated by a circumferential abdominoplasty and a lower body lift. Despite preservation and tight approximation of the subcutaneous facial system, the authors have failed to adequately correct severe saddlebag deformity and midthigh laxity in the massive weight loss patient. The technique used in the last nine of the senior author's 43 lower body lifts was modified by fully abducting each operated thigh on a side utility table, before closure in the prone position. This maneuver permits an increase in width of skin excision and causes the lateral thigh skin to be taut upon leg adduction. This is a retrospective review of the senior surgeon's experience over a 3-year period. Postoperative follow-up of the nine-patient cohort ranged from 8 to 12 months. A standardized set of six-view preoperative and postoperative photographs was available for each patient. A regional grading system was developed to assign points for deformity seen in preoperative and postoperative photographs. To compare the effect of the new technique on the correction of hip/lateral thigh deformities, the authors used this same grading system to analyze 10 other lower body lift patients treated by the same surgeon without full thigh abduction who had six sets of standardized photographs. A deformity severity score was determined for each anatomic region by four trained observers blinded to the surgical technique. The nonparametric Mann-Whitney U test using exact p values was used to compare preoperative and percentage change in deformity severity score from preoperative to postoperative scores relative to preoperative scores for each anatomical region among subjects in each treatment group. The nonparametric Wilcoxon signed rank test using exact p values was used to evaluate the change in deformity severity score from preoperative to postoperative values. The change in technique resulted in an observable symmetrical correction of the severe saddlebag deformity and better contour to the distal lateral thighs. All evaluated patients were satisfied with the lateral thigh skin contour. The grading system revealed that patients treated with or without intraoperative thigh abduction had similar preoperative deformity severity scores for each anatomic region (p > 0.05). Postoperatively, all subjects showed improvement in scores for all treated regions. However, patients closed during full thigh abduction had significantly lower deformity severity scores for the hip/thigh complex when compared with patients treated without full thigh abduction (p < 0.05). Complications in these 19 patients consisted of one 6-cm superficial skin layer dehiscence due to a broken polyester suture that healed spontaneously. There were three seromas that responded to a short series of aspirations or catheter drainage. There were no infections. Distal abdominal flap tip skin necrosis in four patients responded to outpatient débridement and healed secondarily. A new grading system for body contour deformities was successfully utilized to judge differences in the quality of trunk and thigh deformity and outcome in 19 patients with adequate photographic records. Tight suture closure in full thigh abduction in the prone position results in improved treatment of significant saddlebag deformity and midthigh skin laxity in the massive weight loss patient. The essential principles are meticulous planning, careful isolation, tight closure of the lateral trunk and thigh subcutaneous fascial system, and artistic contouring of remaining tissues. Dehiscence, undesirable scarring, and seromas were minor issues in the entire group of 43 patients.     

Assessment of bilateral cleft lip nose deformity: a comparison of results as judged by cleft surgeons and laypersons

Reconstruction of bilateral cleft lip nose deformity is difficult and the outcome is inconsistent. This study was conducted to evaluate the gross outcome and the difference in the assessment of nasal appearance as judged by two groups of raters, cleft surgeons and laypersons. Sixty-four patients with bilateral cleft lip were selected for review. The patients' ages ranged from 5 to 30 years. All patients had undergone primary cleft lip repair and secondary nasal reconstruction, and had been followed for at least 6 months. One image for each patient, which included a digitized frontal, lateral, and worm's-eye view, was projected for evaluation by the raters. The raters included five cleft surgeons and five laypersons. A rating scheme was used in which a score of 3 was given for a good, close to normal nasal appearance, 2 for an average result that needed minor revision, and 1 for a poor result that needed major reconstruction. The scores were averaged for each patient in each group and for each group as a whole. The final outcome was judged as good, fair, or poor on the basis of the mean score for each patient. Statistical analysis was performed. The mean score for all patients was 2.08 as assessed by the laypersons and 2.18 as assessed by the cleft surgeon group. There was no statistically significant difference between the two groups. Comparisons on rating scores among different raters revealed a fair agreement on the ratings within each of the two groups. The results were found to be good in 29.7 percent, fair in 64.1 percent, and poor in 6.3 percent of patients when evaluated by the surgeons. When rated by the laypersons, the nasal appearance was found to be good in 26.6 percent, fair in 60.9 percent, and poor in 12.5 percent of patients. This difference in distribution between the two groups was not statistically significant. When comparing the results given by the two groups of assessors, there was agreement on the nasal appearance in 65.6 percent of patients, and a difference in grading in the rest. For the patients who received different grading, the surgeons rated them one grade higher in 63.6 percent and one grade lower in 36.4 percent. There was no difference in grading between any of the evaluators that reflected a two-grade discrepancy in evaluation of results. This study shows that the surgical outcome of bilateral cleft lip nose deformity repair, at the authors' institution, is less than optimal. When assessing bilateral cleft lip nose appearance, the judgment of results by cleft surgeons was similar to that of the laypersons. However, different rating of results existed within each of the two groups, supporting the importance of clearly assessing patient/parent expectations and defining realistic surgical goals.     

Impact of new prostheses on the oral health related quality of life of edentulous patients

Objective: A study was conducted to evaluate the impact of the placement of complete dentures by using the Global Oral Health Assessment Index (GOHAI). Background: Oral health quality of life indicators can be used to evaluate the effects of dental treatments. Material and methods: The 26 participants were treated in a French University Clinic during 2002. They were randomly divided into two groups. Each group received new prostheses, but evaluation of the quality of life was made at different periods [baseline, denture placement (group 1), 6 and 12 weeks (group 2) after placement]. A questionnaire was used to collect information on patient's satisfaction with the previous and new prostheses. Nonparametric tests were used to test the relationships between patients’ satisfaction or baseline data and GOHAI variations with time as well as to compare mean values of GOHAI within each group. Results: At baseline, the impact of oral health problems was apparent; the mean GOHAI‐Add score was 45.8 (10.2). Six weeks after placement of the new denture, there was no difference in GOHAI scores compared with the initial assessment. An improvement in GOHAI score was observed 12 weeks after the participants received their new dentures (p < 0.05). Change in GOHAI‐Add scores was negatively correlated with the initial GOHAI‐Add score. Patients who preferred the new prosthesis enjoyed a positive change in GOHAI scores (p < 0.001). There was a relationship between participants’ satisfaction with the new dentures and change in GOHAI scores (p < 0.05). Conclusion: The GOHAI can be used to evaluate needs for and effect of the making of new complete dentures.     

Psychological disturbance in children with haemophilia.

OBJECTIVE--To assess the need for formal psychotherapeutic intervention in children attending a children''s haemophilia clinic after some of them had been diagnosed as positive for HIV. DESIGN--Comparison of haemophiliac children with matched control groups of diabetic and healthy children. SETTING--The West of Scotland Children''s Haemophilia Centre, Glasgow. PATIENTS--43 Children aged 3 to 16 years with mild, moderate, and severe clotting disorders were matched with control groups of 46 diabetic children and 42 physically healthy children. INTERVENTIONS--Parents of children aged 3-5 years were interviewed with the behaviour screening questionnaire. Children aged 6 to 16 were assessed by parental and teacher report using standardised questionnaires and self report using a computerised depression inventory. All were scored numerically according to the presence of symptoms of emotional and behavioural problems. MAIN OUTCOME MEASURES--The groups were compared for mean scores on each rating device and for number of children achieving scores within the pathological range. RESULTS--In the 6-16 age group five haemophiliac children, five diabetic children, and three healthy children scored in the pathological range on the parent questionnaire, as did two, three, and five respectively on the teacher questionnaire and four, four, and eight on the depression inventory. There was no significant difference across the three groups. Analysis of mean scores similarly showed no significant difference across groups. In contrast, the single measure used for younger children showed an increase in behavioural difficulties among the diabetic children. CONCLUSION--Haemophiliac children attending the West of Scotland Centre were no more disturbed than their diabetic or healthy peers despite the identification of HIV infection within the clinic and the widespread adverse publicity associated with AIDS and HIV infection.     

Validating techniques to sample behavior of confined,young pigs

Ten 1-h segments of videotaped behavior served as the population from which behavior was sampled. Half of the videotape segments were behaviors of recently re-grouped and aggressive pigs and the remaining segments were of the later socially-stable groups. Attack, feeding, drinking, lying, moving and standing were recorded. Time-sampling (recording less than the full periods) resulted in acceptable correlations and mean values when sampling periods were greater than 20 min per hour. Focal animal sampling was an accurate sampling technique for all behaviors except attack. Observing videotapes at 4 times faster than life provided an accurate sample of all behaviors, but viewing tapes 24 times faster than life was inaccurate for drinking and feeding behavior. These results highlight the need for validation of sampling techniques for studies measuring pig behavior.     

Teaching history-taking: where are we?

Knowledge in history-taking has increased rapidly over the last twenty years. Currently the principles to be taught include "conduct," "content," and "diagnostic reasoning." However, inattentiveness of medical schools, reluctance of busy faculty to be involved, and increasing enrollments have resulted in difficulties in teaching these skills. Studies have shown a beneficial short-term effect of teaching these materials on interview performance but it is unknown whether this effect is long-lasting. The methods for instruction include the bedside and videotape models utilizing the concept of the fifteen-minute interview technique, programmed instruction, patient instructors, and direct student feedback. Future research should focus on identifying strategies in diagnostic reasoning, developing graduated competency criteria for trainees at different levels of their education, refining methods to evaluate large numbers of students, measuring outcomes of effective training such as compliance, and comparing costs and effectiveness of various methods. In addition, there remains the need to establish an association of course directors.     

Improving achievement through problem-based learning

In this study, the effect of problem-based learning on students' academic achievement and performance skills in a unit on he human excretory system was investigated. Sixty-one 10th grade students, from two full classes instructed by the same iology teacher, were involved in the study. Classes were randomly assigned as either the experimental or the control group and were pre- and post-tested to determine their academic achievement and performance skills before and after the treatment. The experimental group was taught with problem-based learning while the control group received traditionally-designed biology instruction. Results showed that although there was no pre-existing difference between two groups, students instructed with problem-based learning earned significantly higher scores than those instructed with traditionally-designed biology instruction — in terms of academic achievement and performance skills. Students in the experimental group appeared to be more proficient in the use and organisation of relevant information, in constructing knowledge and moving toward better conclusions.     

Genetic counseling for beta-thalassemia trait following health screening in a health maintenance organization: comparison of programmed and conventional counseling.

Providing adequate counseling of patients identified in genetic screening programs is a major responsibility and expense. Adults in a health maintenance organization, unselected for interest, were screened for beta-thalassemia trait as part of preventive health care. Counseling was provided by either a trained physician (conventional counseling) or by a videotape containing the same information followed by an opportunity to question a trained physician (programmed counseling). Immediately before and after counseling, knowledge of thalassemia, knowledge of genetics, and mood change were assessed by questionnaire. Comparable mood changes and similar learning about thalassemia and genetics occurred with both counseling methods. Thus, as judged by immediate effects on knowledge and mood, videotaped instruction can greatly reduce professional time required for genetic counseling and facilitate the incorporation of genetic screening into primary health care.     

Periareolar mammaplasty with silicone supporting lamina.

A mammaplasty technique through a periareolar incision and inferior pedicle trilobar flap with inclusion of a silicone supporting sheet was used in 485 patients between July of 1985 and December of 1989. The indications for the surgical treatment were ptosis, moderate to severe hypertrophy, or the association of both. The results were satisfactory in 458 patients (94.4 percent). The mean follow-up period was 22 months (range 6 to 50 months) in 427 patients without recurrences or functional alterations. No pathologic processes were observed as a result of use of the prosthesis. The silicone sheet did not interfere with manual, mammographic, or xeromammographic periodic examinations of the gland performed during the follow-up period. This technique has made it possible to mold the breast properly and to preserve its anatomic and functional unity, and in addition, it minimizes the scar and avoids recurrences.