Kilpailuetu ja liiketoiminnan kehittäminen – cash&carry-ketju muuttuvassa ympäristössä

Suomalaiset yritykset ovat lähteneet hakemaan kasvua omille liiketoiminnoilleen, ja Baltian markkina-alue on ollut monille yrityksille ensimmäinen askel kansainvälisille liiketoiminnoille. Erityisesti tukkukauppatoimiala on ollut kasvussa Baltian alueella. Tässä työssä on käsitelty yhtä tukkukaupan muotoa, noutotukkukauppaa, Virossa toimivan pääosaltaan suomalaisomisteisen cash&carry-ketjun näkökulmasta. Ensimmäinen ketjun toimipiste perustettiin jo 1990-luvun alussa lähes heti Viron itsenäistymisen jälkeen. Toukokuussa 2005 perustetaan ketjun kahdeksas toimipiste. Jotta yritykset pärjäisivät kilpailussa, on niiden investoitava eri tavoin toimintaansa, että liiketoiminta jatkuisi ja asema kilpailutilanteessa säilyisi. Tehokkaat markkinointi- ja jakelukanavaratkaisut ovat yritysten intresseissä, koska niillä yritykset pystyvät lisäämään usein kontrollia markkinoista. Jokainen yritys pyrkii kehittämään liiketoimintaansa, ja sillä pyritään saavuttamaan kilpailuetuja tai säilyttämään nykyinen kilpailuetu. Toiminnan kehittäminen vaatii jatkuvaa liiketoimintaympäristön seurantaa, jotta aukenevat mahdollisuudet pystyttäisiin hyödyntämään ja tekemään liiketoiminnalle kannattavia ratkaisuja.

Ship Leases under IAS 17, case Fortum Shipping

International accounting standards will be applied from the1st of January 2005 in accounting of member states of the EU with a view of harmonizing the accounting practices in Europe, and on the long term even more widely. The purpose of adopting IAS accounting standards is to make the financial statements and financial information received from companies more comparable and more transparent for investors and other interest groups. IAS 17 introduces the treatment of a lease agreement in the light of the new accounting standards. Finnish companies have used finance leases widely as an alternative, off-balance sheet form of financing capital investments consistently with Finnish GAAP. Along with the appliance of IAS 17 the off-balance-sheet financing possibility of leases classified as finance leases will no longer exist. IAS 17 states that finance leases are going to be recognized in the balance sheet as both assets, in form of fixed assets, and loans in liabilities classified as long and short term loans. IAS 17 will make two major changes to the income statement. Firstly, the lease payments formerly treated as variable costs are moved below the operating profit level to finance costs. Secondly, the depreciations from the leased assets are also introduced. The effects to the case company's, Fortum Shipping's, income statement and balance sheet are remarkable. Along with the appliance of IAS Fortum Shipping's net assets are somewhat going to be doubled, the amount of liabilities increases significantly and the earnings before interests and taxes increases moderately. The preceding factors have a big effect on the case company's financial key figures. So, the IAS originated effects on balance sheet and income statement have essential impacts on a company's key financial indicators. Most significant changes can be found in key ratios measuring profitability, capital structure, and efficiency. This means that when comparing the IAS calculated profits of companies with the profits calculated prior with Finnish GAAP, the analysis should be made with prudence because the figures are not comparable on straight-forward basis.

El paciente con insuficiencia renal en la práctica odontológica

Los riñones son los responsables de funciones muy importantes dentro del organismo como la regulación del volumen -líquido- y del equilibrio acidobásico del plasma, la excreción de compuestos nitrogenados y la síntesis de eritropoyetina, hidroxicolecalciferol y renina. Las manifestaciones generales de la insuficiencia Renal aparecen en los sistemas cardiovascular, gastrointestinal, neuromuscular, esquelético, hematológico y dermatológico. Por este motivo, es muy importante conocer sus principales características para prevenir y tratar correctamente los problemas que puedan surgir durante el tratamiento dental. Este artículo describe la fisiopatología, complicaciones y manifestaciones bucales asociadas a esta condición así como las consideraciones y el tratamiento odontológico del paciente con una Insuficiencia Renal.

Pellettien laatu ja ominaisuudet eri raaka-aineilla ja niiden seoksilla

Diplomityö tehtiin osana Vapon toteuttamaa monivuotista pelletin kehitysohjelmaa. Kehitysohjelma koostuu useista pienemmistä osaprojekteista, jotka täydentävät toinen toisiaan. Pellettien raaka-ainepohjan laajentaminen on eräs näistä osaprojekteista. Tutkimustyön tavoitteena oli selvittää erilaisten potentiaalisten bioraaka-aineiden soveltuvuutta pelletointiin joko sellaisenaan tai erilaisina seoksina. Raaka-aineiden pelletoitavuutta tutkittiin kenttäolosuhteissa mobiilipelletointilaitoksella. Laitoksen pääkomponentit muodostivat Kahl C 38–780 tasomatriisipuristin, jäähdytin ja täryseula. Pelletointikokeissa tutkittuja raaka-aineita olivat mäntysahanpuru, männynkuori, harvennusranka, haapa, koivu, jyrsinturve ja ruokohelpi. Raaka-aineiden irtotiheys käyttökosteudessa vaihteli välillä 73–244 kg/m3 ja keskimääräinen kosteuspitoisuus 6,5–15 %. Useissa tapauksissa säkitettyjä raaka-aineita säkkikostutettiin haluttuun kosteuspitoisuuteen ennen pelletointia. Säkkikostutettujen raaka-aineiden kosteuspitoisuudet vaihtelivat tällöin välillä 12–14 m- %. Valtaosa tutkituista raaka-aineista ja niiden seoksista pystyttiin pelletoimaan puristimen matriisilla 8/40 mm, jossa puristuskanavan halkaisija oli 8 mm ja kanavan suoran osan pituus 40 mm. Vaikeuksia tuotti ainoastaan pelkän koivupurun ja ruokohelven pelletointi. Käytetty matriisi oli kanavapituudeltaan liian pitkä koivupurun pelletointiin nostaen puristusvastuksen suureksi. Ruokohelven pelletoinnin vaikeudet johtuivat pääasiassa pelletointiin liian karkeasta raaka-aineesta. Myös matriisia 8/55 mm kokeiltiin, mutta se osoittautui liian ”tiukaksi” valtaosalle puuraaka-aineista. Ainoastaan jyrsinturpeen pelletointi onnistui tällä matriisilla. Männynkuoren pelletointia ei matriisilla 8/55 mm yritetty. Kenttäkokeissa valmistetuista pelleteistä määritettiin erilaisia ominaisuuksia, kuten keskipituus, kosteuspitoisuus, irtotiheys, hienoaineksen määrä ja käsittelykestävyys. Lujuus mitattiin sekä Ligno-testillä että CEN-rummutuslujuuden määrityksellä. Lisäksi pelleteille määritettiin alkuaineanalyysi, tuhkapitoisuus ja lämpöarvo ENAS Oy:n laboratoriossa Jyväskylässä. Ligno-testauksessa parhaimman luokan pelletin tulee yltää arvoon 97,5 %. Pelletoitaessa raaka-aineita ja niiden seoksia tasomatriisikoneella sopivalla matriisilla yllettiin usein näihin tai parempiin tuloksiin. Puumateriaaleilla raaka-aineen optimaalinen lähtökosteus oli välillä 12–14 m- % ja turpeella sekä ruokohelvellä 14–16 m- %. Pelletointi onnistui tällöin vaivattomasti, kunhan sopivat puristimen ajoparametrit oli löydetty. Pellettiä alkoi muodostua matriisin puristuskanavien lämpötilan kohotessa noin 70 ºC. Pellettien lämpötila stabiilitilanteessa heti pelletoinnin jälkeen oli useissa tapauksissa 80–90 ºC. Pelletoinnin aikainen tehontarve vaihteli välillä 90–150 kWh/t, ollen suurimmillaan irtotiheydeltään keveillä materiaaleilla. Raaka-aineen suuri partikkelikoko kasvatti puristimen tehontarvetta. Tämä havaittiin selvästi lisättäessä karkeaa ruokohelpisilppua eri raaka-aineiden joukkoon. Kestävyydeltään erinomaisia pellettejä saatiin, kun raaka-aineena oli jyrsinturve, harvennusranka tai mäntypuru. Varsinkin jyrsinturpeen ja harvennusrangan seoksesta valmistetut pelletit osoittautuivat erittäin kestäviksi. Myös jyrsinturpeen ja ruokohelven sekä mäntypurun ja ruokohelven seoksien pelleteille määritettiin hyviä kestävyysarvoja. Männynkuoresta valmistetut pelletit jäivät Ligno-testauksessa kestävyydeltään alle 97,5 % rajan. Pääsyynä tähän oli kuoren pelletointiin käytetyn matriisin 8/40 mm liian lyhyet puristuskanavat.

Stafne bone cavity: a retrospective study of 11 cases

Objective: to describe the clinical and radiological characteristics of patients with Stafne bone cavity. Study design: a retrospective, observational study of 11 cases of Stafne bone cavity. After finding an imagine compatible with Stafne bone cavity in the Orthopantomograph® of 11 patients, a sialography of the mandibular gland was made in 3 cases, computerized tomography (CT) in 6 cases, and in 4 cases surgical intervention to confirm the diagnosis. Results: the average age was 51.5 years, predominantly males. The entity was diagnosed incidentally during a routine radiology in all cases. The sialography revealed glandular tissue within the defect, and the CT demonstrated the conservation of the lingual cortical and the peripheral origin of the lesion. Glandular tissue was found within the lesions of two of the patients who underwent surgery, and in the other two the cavity was empty. No progressive changes were found in any of the 11 cases. Conclusions: Stafne bone cavity was an incidental finding, presenting no evolutionary changes, and as such conservatory therapy based on periodic controls was indicated. Currently, complementary techniques such as CT are sufficient to establish a certain diagnosis.

Myofascial pain associated to trigger points: A literature review. Part 2: Differential diagnosis and treatment

During the last decades the advance in knowledge of myofascial pain has been constant in the medical and dental community. However, although several aspects have been clarified in relation to its epidemiology, clinical characteristics and etiopathogenesis, many uncertainties remain. Many clinical conditions are included in the differential diagnosis of myofascial pain associated to trigger points. A good anamnesis and clinical exploration is thus required in order to ensure correct diagnosis and treatment. Among the numerous treatments used in application to trigger points, the spray-and-stretch technique and direct injection targeted to such trigger points have been found to be the most effective options. In chronic cases, psychosocial intervention is required, due to the high incidence of mood disorders and/or anxiety observed in these patients, who in turn present a poorer prognosis. This underscores the importance of early diagnosis and treatment.

Classical line shapes based on analytical solutions of bimolecular trajectories in collision induced emission. II. Reactive collisions

The classical theory of collision induced emission (CIE) from pairs of dissimilar rare gas atoms was developed in Paper I [D. Reguera and G. Birnbaum, J. Chem. Phys. 125, 184304 (2006)] from a knowledge of the straight line collision trajectory and the assumption that the magnitude of the dipole could be represented by an exponential function of the inter-nuclear distance. This theory is extended here to deal with other functional forms of the induced dipole as revealed by ab initio calculations. Accurate analytical expression for the CIE can be obtained by least square fitting of the ab initio values of the dipole as a function of inter-atomic separation using a sum of exponentials and then proceeding as in Paper I. However, we also show how the multi-exponential fit can be replaced by a simpler fit using only two analytic functions. Our analysis is applied to the polar molecules HF and HBr. Unlike the rare gas atoms considered previously, these atomic pairs form stable bound diatomic molecules. We show that, interestingly, the spectra of these reactive molecules are characterized by the presence of multiple peaks. We also discuss the CIE arising from half collisions in excited electronic states, which in principle could be probed in photo-dissociation experiments.

Estudio clínico comparativo de la eficacia de azitromicina frente a amoxicilina/Ac. Clavulánico en el tratamiento de infecciones orales.

Fundamentos: el objetivo de este estudio fue comparar la eficacia. seguridad y tolerancia de la azitromicina frente a amoxicilina/ac. clavulánico en el tratamiento de pacientes con infecciones bucales agudas de origen odontogénico. Pacientes y Método: en este estudio abierto, comparativo y multicéntrico, se incluyeron 208 pacientes con infección bucal aguda de origen odontogénico, asignados aleatoriamente a dos grupos; 102 pacientes recibieron azitromicina, y 106 pacientes recibieron amoxicilina/ac. clavulánico. Se realizaron una historia clínica y una exploración física, y se tomaron muestras de sangre y orina. En cada una de las visitas, se recogieron los signos y síntomas característicos de la infección. Resultados: el nivel de respuesta fue similar en ambos grupos terapéuticos, obteniéndose un porcentaje de curación o mejoría superior al 90%. Azitromicina fue mejor tolerada y tuvo mejor cumplimiento que amoxicilina/ac. clavulánico. Los efectos adversos fueron en su mayoría gastrointestinales. Conclusión: Azitromicina y amoxicilina/clavulánico fueron igualmente efectivos en el tratamiento de infecciones agudas de origen odontogénico.

Analysis of the antibiotic prophylaxis prescribed by Spanish oral surgeons

Aim: To identify prophylactic antibiotic prescription practices among Spanish dentists with preferential dedication to Oral Surgery in different types of tooth extraction surgeries. Method: Members of the Spanish Oral Surgery Society were surveyed on antibiotic prophylaxis use in 4 different tooth extraction modalities scaled according to their surgical invasiveness. Results: Sixty-nine of the 105 distributed questionnaires were returned completed. Thirteen percent of the surveyed surgeons would prescribe antibiotics to prevent postoperative wound infection when confronted with conventional tooth extraction lasting less than 5 minutes. In the case of surgery lasting more than 5 minutes, the percentage of participants that would prescribe antibiotics increased to 39%. When a mucoperiosteal flap was elevated or an ostectomy was performed, 87% and 100%, respectively, would prescribe antibiotic prophylaxis. Amoxicillin and its combination with clavulanic acid were the most commonly prescribed antibiotics. All participants would prescribe the antibiotic orally, starting after surgery and with a duration that ranged from 2-8 days. Conclusions: The results obtained suggest that antibiotic prophylaxis for preventing local odontogenic infection is not being correctly implemented in Spain. This can generate new bacterial resistances, facilitate adverse drug reactions and favor opportunistic infections. Better designed studies are needed in order to clarify the role of antibiotics in the prevention of postsurgical wound infection

Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine. Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.

Comparative study of two needle models in terms of deflection during inferior alveolar nerve block

Objectives: The purpose of this study is to determine the possible differences in deflection between two needles of same length and external gauge but with different internal gauges during truncal block of the inferior alveolar nerve. The initial working hypothesis was that greater deflection may be expected with larger internal gauge needles. Study design: Four clinicians subjected 346 patients to inferior alveolar nerve block and infiltrating anesthesia of the buccal nerve trajectory for the surgical or conventional extraction of the lower third molar. A nonautoaspirating syringe system with 2 types of needle was used: a standard 27-gauge x 35-mm needle with an internal gauge of 0.215 mm or an XL Monoprotect® 27-gauge x 35-mm needle with an internal gauge of 0.265 mm. The following information was systematically recorded for each patient: needle type, gender, anesthetic technique (direct or indirect truncal block) and the number of bone contacts during the procedure, the patient-extraction side, the practitioner performing the technique, and blood aspiration (either positive or negative). Results: 346 needles were used in total. 190 were standard needles (27-gauge x 35-mm needle with an internal gauge of 0.215 mm) and 156 were XL Monoprotect®. Incidence of deflection was observed in 49.1% of cases (170 needles) where 94 were standard needles and 76 XL Monoprotect®. Needle torsion ranged from 0º and 6º. Conclusions: No significant differences were recorded in terms of deflection and internal gauge, operator, patient-extraction side, the anesthetic technique involved and the number of bone contacts during the procedure

Complications of guided surgery and immediate loading in oral implantology: a report of 12 cases

Objectives: The growing interest in minimally invasive surgery, together with the possibility of fitting prostheses with immediate function, have led to the development of software capable of planning and manufacturing a surgical guide and prosthesis that can be placed upon conclusion of the implant surgery step. The present study evaluates the surgical and prosthetic complications of implant treatment with the guided surgery technique, together with patient comfort during and after treatment. Patients and methods: A retrospective observational study was made of 19 patients with partially or totally edentulous upper and/or lower maxillae, involving the placement of a total of 122 implants. All cases were planned and operated upon with the guided surgery technique. Results: A total of 122 implants were placed in 14 males and 5 females. The intraoperative surgical complications comprised a lack of primary stability, while the postoperative complications consisted of infections and a lack of implant osteointegration. Ten implants failed. The prosthetic complications in turn comprised loosening of the provisional prosthesis screws, prosthesis tooth fracture, and a lack of passive fit of the immediate prosthesis. The degree of patient satisfaction was evaluated using a verbal scale. Conclusions: Implant restoration with the guided surgery technique and immediate functional loading is a predictable procedure, provided patient selection and the surgical technique are adequate, affording lesser postoperative morbidity and increased patient satisfaction thanks to the immediate restoration of esthetics and function

Leiomioma bucal en el paladar duro: a propósito de un caso

El leiomioma es un tumor benigno del músculo liso muy poco frecuente a nivel de la cavidad bucal. Se acepta que la fuente de músculo liso originaria de este tumor es la túnica media de los vasos arteriales. Se trata de un tumor que puede aparecer a cualquier edad, sin presentar una clara predilección por el sexo y normalmente lo hace en forma de tumoración asintomática de crecimiento lento. Su diagnóstico está basado en el estudio anatomopatológico, utilizándose tinciones específicas como podrían ser las técnicas de inmunohistoquímica. Su tratamiento consiste en la extirpación completa de la lesión con márgenes de seguridad. En este artículo se expone el caso de un paciente hombre de 57 años que presentaba una lesión en el paladar duro, adyacente a los premolares superiores del lado izquierdo, de 4 meses de evolución. Tras la exéresis quirúrgica con márgenes de seguridad de dicha lesión, se realizó su estudio anatomopatológico. La tinción con hematoxilina y eosina junto con el estudio inmunohistoquímico de la muestra confirmaron el diagnóstico de leiomioma

Estudio del estado bucodental del paciente trasplantado hepático

Desde que se realizó en España el primer trasplante hepático en el año 1984 los avances en la técnica quirúrgica y en los fármacos inmunosupresores empleados han producido un aumento en el número de pacientes trasplantados. El objetivo del presente estudio fue valorar el estado bucodental de los pacientes trasplantados hepáticos. Se realizó un estudio descriptivo transversal de una muestra de pacientes que habían sido sometidos a un trasplante hepático en el Hospital Príncipes de España de la Ciudad Sanitaria y Universitaria de Bellvitge (L Hospitalet de Llobregat - Barcelona). Los datos recogidos fueron los de filiación, los de la historia médica general, los de la historia bucodental y los de la exploración intrabucal. En total fueron examinados 53 individuos, 28 hombres y 25 mujeres, con una edad media de 57,6 años. El tiempo medio del trasplante fue de 3 años y 9 meses. La causa más frecuente del trasplante hepático fue la cirrosis hepática por el virus de la hepatitis C (49,1%). Los inmunosupresores más utilizados fueron la ciclosporina y el tacrolimus. El índice CAOD de la muestra fue de 11,2. En cuanto a la patología periodontal, el 22% de los pacientes dentados presentaban agrandamiento gingival, la mitad de los dentados tenían recesiones gingivales y el 34% presentaban algún tipo de movilidad dentaria. A la exploración de la mucosa bucal, la patología más prevalente fue la lengua fisurada (39,6%), la lengua saburral (28,3%) y la xerostomía (18,9%). La patología bucodental de estos pacientes está relacionada con el uso de fármacos inmunosupresores y de otros factores tales como la falta de medidas preventivas. Los datos de este estudio demuestran que sería necesario instaurar tratamientos preventivos en este grupo de población

Thermal increment due to ErCr: YSGG and CO2 laser irradiation of different implant surfaces. A pilot study

Objective: An evaluation and comparison is made of the thermal increment at different implant surfaces during irradiation with CO2 and ErCr:YSGG lasers. Study design: Five threaded and impacted implants with four types of surfaces were inserted in an adult pig rib: two implants with a hydroxyapatite surface (HA)(impacted and threaded, respectively), a machined titanium surface implant (TI mach), a titanium plasma spray surface implant (TPS), and a sandblasted, acid-etched surface implant (SBAE). A 0.5-mm diameter bone defect was made in the implant apical zone, and a type-K thermocouple (Termopar)® was placed in contact with the implant. The implants were irradiated in the coronal zone of each implant with a CO2 (4 W continuous mode) and an ErCr:YSGG laser (1.5 W, pulsed mode) first without and then with refrigeration. The temperature variations at the implant apical surface were recorded. Results: An apical temperature increase was recorded in all cases during CO2 and ErCr:YSGG laser irradiation without refrigeration. However, when the ErCr:YSGG was used with a water spray, a decrease in temperature was observed in all implants. The acid-etched and sandblasted surfaces were those most affected by the thermal changes. Conclusions: The ErCr:YSGG laser with a water spray applied to the sealing cap or coronal zone of the implants does not generate thermal increments in the apical surface capable of adversely affecting osseointegration and the integrity of the peri-implant bone tissue