Cholesterol Lowering Guidelines: From Whence We Came and Where We Are Now

Treatment guidelines have proliferated in cardiology, although most guideline recommendations are not supported by clinical trial evidence. What is considered to be a normal cholesterol level has progressively declined over the past 50 years, with the increasing realization that “normal” is far from optimal and that lower is better. The first important United States and Canadian cholesterol guidelines were published in 1988, and recommended diet for 6 months to be followed by consideration of bile acid sequestrants or nicotinic acid. Over the ensuing 25 years guidelines have changed rapidly and dramatically in response to a large number of definitive clinical trials, usually with statins. Low-density lipoprotein cholesterol targets have moved progressively lower, and in some guidelines, have been abandoned entirely. The concept of selecting patients for treatment according to the absolute risk reduction expected from treatment on the basis of clinical trial data seems to be a rational approach. For secondary prevention, some patients are still untreated or undertreated, presenting an opportunity for improving outcomes.     

Neodymium: YAG transconjunctival laser revision of late-failing filtering blebs.

OBJECTIVE: To study the effectiveness of neodymium:YAG (Nd:YAG) laser transconjunctival revision of late-failing filtering blebs. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Thirty consecutive patients from a glaucoma referral practice at the Ohio State University Department of Ophthalmology. INTERVENTION: Transconjunctival Nd:YAG laser revision of blebs diagnosed as failing secondary to episcleral fibrosis. MAIN OUTCOME MEASURE: Reduction in intraocular pressure (IOP) and survival of bleb. RESULTS: Reduction in IOP was attained in 24 (80%) of 30 patients with a mean prelaser IOP of 21.21 mmHg and a mean 1-week postlaser IOP of 13.97 mmHg (P < 0.0001). These results were maintained at the 1-, 3-, and 12-month follow-up visits with mean IOPs of 16.31 mmHg (P = 0.0008), 14.81 mmHg (P < 0.0001), and 15.25 mmHg (P = 0.0003), respectively. Two-year data were available on a small number of patients (4) with a mean of 15.25 mmHg (P = 0.0085). Mean time interval between trabeculectomy and laser revision was 31 months. CONCLUSION: Late-failing filtering blebs are often amenable to Nd:YAG transconjunctival revision.     

An implant impression technique involving abutment transition from interim prostheses to definitive restorations in the esthetic zone

This article presents an impression technique involving transfer of the position of implants and the emergence profile of splinted interim prostheses fabricated on nonindexed interim abutments to definitive single crowns fabricated on indexed abutments.