Scenario simulations of future salinity and ecological consequences in the Baltic Sea and adjacent North Sea areas-implications for environmental monitoring.

Substantial ecological changes occurred in the 1970s in the Northern Baltic during a temporary period of low salinity (S). This period was preceded by an episodic increase in the rainfall over the Baltic Sea watershed area. Several climate models, both global and regional, project an increase in the runoff of the Northern latitudes due to proceeding climate change. The aim of this study is to model, firstly, the effects on Baltic Sea salinity of increased runoff due to projected global change and, secondly, the effects of salinity change on the distribution of marine species. The results suggest a critical shift in the S range 5-7, which is a threshold for both freshwater and marine species distributions and diversity. We discuss several topics emphasizing future monitoring, modelling, and fisheries research. Environmental monitoring and modelling are investigated because the developing alternative ecosystems do not necessarily show the same relations to environment quality factors as the retiring ones. An important corollary is that the observed and modelled S changes considered together with species' ranges indicate what may appear under a future climate. Consequences could include a shift in distribution areas of marine benthic foundation species and some 40-50 other species, affiliated to these. This change would extend over hundreds of kilometres, in the Baltic Sea and the adjacent North Sea areas. Potential cascading effects, in coastal ecology, fish ecology and fisheries would be extensive, and point out the necessity to develop further the "ecosystem approach in the environmental monitoring".

Four-millimeter implants supporting fixed partial dental prostheses in the severely resorbed posterior mandible: two-year results.

BACKGROUND: Reduced alveolar bone volume complicates implant dentistry. PURPOSE: In this prospective multicenter study, a new, 4-mm long Straumann SLActive implant (Ø 4.1 mm) supporting a fixed dental prosthesis (FDP) in the severely resorbed posterior mandible was evaluated for two years. MATERIAL AND METHODS: Thirty-two patients (11 men, 21 women; mean age 64.1 years) participated. Ten to 12 weeks after single-stage surgery, a screw-retained FDP was attached to three or four 4-mm implants. RESULTS AND DISCUSSION: One hundred implants were inserted. Three failed at surgery and four were lost before loading. Twenty-eight patients received FDPs (93 implants). Two patients were discontinued because of secondary exclusion criteria; therefore, 26 patients were followed up from baseline (BL). After 1 year, one patient insisted on removal of all implants and one patient died because of nonstudy-related complications. Twenty-four patients (87 implants) were eligible for examination 2 years post-loading. All implants were found to be stable [survival rate 95.7% (confidence interval, CI 88.8-98.3) after 1 year and 92.3% (CI 84.5-96.2) after 2 years]. The mean change from BL to 12 months was - 0.43 mm (CI 0.31-0.59; p < .001) and from 12 to 24 months - 0.11 mm (CI -0.01-0.23; p = .056). The survival rate is only slightly lower than in similar studies on 6 to 8.5 mm implants. This may be related to high initial stability and effective use of the residual bone volume with high primary bone-to-implant contact in dense bone structures. The surgical handling of the tested implant was found to be similar to that of implants of common length. However, the preparation procedure must be done with great care to avoid overdrilling. Careful planning and design of the prosthetic construction is mandatory to prevent unfavorable occlusion and avoid harmful shear forces. CONCLUSION: This study showed that 4 mm implants can support an FDP in severely resorbed posterior mandibles for at least 2 years and with healthy peri-implant conditions.

Infiltration of morphine into an abnormal wound; effects on pain relief and endocrine/immune response.

We wanted to evaluate pain relief and endocrine/immune response after local administration of morphine into an abdominal wound. In a randomised double blind design 29 patients undergoing hysterectomy received two blinded injections of morphine and saline. Before surgery the patients in the control group (n = 15) got 10 mg of subcutaneous morphine into an arm and at skin incision 30 ml of saline was infiltrated directly into the wound. The patients in the wound group (n = 14) received 1 ml of saline into an arm before surgery and 10 mg of morphine in 30 ml of saline into the wound at skin incision. Patient controlled analgesia (PCA) with i.v. morphine was used after surgery. Repeated blood samples were obtained from the day before the surgery until 3 days later and analysed for cortisol and interleukin-6 (IL-6). There were no differences between the groups either in pain relief or in the consumption of PCA morphine. The wound group used 47 +/- 15 mg of i.v. morphine and the control group used 50 +/- 16 mg. Peak values for IL-6 and cortisol appeared at 4 h. The area under the curve (AUC) of cortisol at 0-6, 0-10 and 0-20 h was significantly lower in the control group than in the wound group (P < 0.05). High doses of i.v. morphine reduced cortisol and IL-6 levels in the early hours after surgery. The injection of morphine into the wound did not improve pain relief or reduce the consumption of i.v. morphine after surgery. The endocrine stress response to trauma was modified by preoperative administration of morphine.