No abstract

The purpose of this work is to share methods used and lessons learned during a comprehensive inter-institutional pandemic disaster response in Heidelberg, Germany, conveying experiences of the regional SARS-CoV-2 vaccination rollout campaign for up to 1,000,000 vaccines in the year 2020. In this volatile, uncertain, complex, and ambiguous (VUCA) environment, the following five strategic elements were pertinent for institutional arrangements so that specific contributions of the various project partners would be available fast without the necessity of extensive negotiations or information exchange: (1) robust mandate, (2) use of established networks, (3) fast onboarding and securing of commitment of project partners, (4) informed planning of supply capacity, and (5) securing the availability of critical items. Planning tools included analyses through a VUCA lens, analyses of stakeholders and their management, possible failures, and management of main risks including mitigation strategies. The method of the present analysis (VUCA factors combined with analyses of possible failures, and management of stakeholders and risks) can theoretically be adjusted to any public health care emergency anywhere across the globe. Lessons learned include ten tactical leadership priorities and ten major pitfalls.

1. We have studied, in vivo, the degree of spontaneous activity, responsiveness to mechanical and chemical stimuli, and the conduction velocities in C- and A-fibers ending in the neuromas formed 8-66 days after ligation and transection of a cutaneous sensory nerve in the rat. 2. Some of these C- and A-fibers developed ongoing activity. The percentage varied considerably between neuromas in different animals, from 0 to 23% (mean, 4.2%), with no major variation in the incidence as a function of neuroma age. 3. The endings of the fibers in the neuroma could be excited by both mechanical and chemical stimuli. From 0 to 26% (mean, 13%) of these fibers had mechanosensitive endings, some of which were located in the muscle/facia tissue outside the neuroma itself. Some fibers were excited by direct application of chemicals to their endings in the neuroma; 3.0% of A- and C-fibers responded to bradykinin, 2.0% to histamine, and 2.8% to adrenaline. There was no systemic variation in the percentages of mechano- or chemosensitive fibers with neuroma age. 4. The C-fiber action potentials showed a continuing decrease in conduction velocities over the 9 wk after nerve transection. More than 4 wk after transection, the conduction velocity of neuroma fibers was 88% that of C-fibers of normal saphenous nerve. 5. We conclude that fibers in a cutaneous nerve neuroma have some sensory capabilities similar to those in normal nerves terminating in the skin. This could be because they are retained after the nerve is transected or because they are initially lost but then regenerate. However, the numbers are restricted, probably because the fibers remain isolated from factors produced by their target skin tissue that are necessary for development and maintenance of sensory functions.

Excitability of afferent C-fibres in a skin nerve was studied in 28 rats treated with capsaicin on day two of their lives (80 mg/kg, s.c.). At the age of 4-5 months they were subjected to experiments in which recordings were made from single C-fibre units of saphenous nerve. The effectivity of neonatal capsaicin treatment in blocking reactions to the irritating action of the toxin was evaluated with the wiping test. Five untreated rats served as controls. In capsaicin treated animals afferent cutaneous C-fibres were diminished by more than 50%. No significant change was found, however, in the spectrum of kinds of cutaneous receptors. In particular, the ratio between nociceptors responding to heat and mechanical stimuli (polymodal nociceptors, MH-units) and other C-fibre receptors, such as sensitive cold units was not changed significantly. Furthermore, in the animals neonatally treated with capsaicin conduction velocities of afferent C-fibres and thresholds to mechanical and thermal stimuli were not significantly altered. In both capsaicin treated and control samples, the spike conduction in most of the mechano- and heat sensitive C-nociceptors was blocked by acute topical application of this toxin to the nerve stem. It is concluded that part of the afferent C-fibres survived neonatal capsaicin treatment, even in those rats that showed complete intensitivity to the toxin in behavioural tests.

No abstract

A total of 113 patients with acute and chronic instability of the ulnar collateral ligament metacarpal phalangeal (MP) joint of the thumb were treated surgically between 1980 and 1985; 82 patients were followed up after a mean period of 10 years. Of 59 patients with acute injuries, 52 were painfree with full stability of the MP joint; 23 patients with chronic instability and tendon grafting also showed restoration of stability. Nevertheless, the range of motion was reduced severely and opposition of the thumb was impaired. The results of follow-up reveal that acute reattachment of the injured ulnar collateral ligament is more effective.

No abstract

A 50-year-old woman complained of upper abdominal pain for several weeks, getting worse and radiating towards the left shoulder in the 24 hours preceding her hospital admission. Plain X-ray film of the abdomen revealed plaque-like calcifications projecting onto the tail of the pancreas. Ultrasound imaging demonstrated splenic rupture with free intra-abdominal fluid. During an emergency laparotomy the spleen was removed. At first the postoperative course was uneventful. But epigastric pain recurred a few days after discharge. Serum amylase and lipase concentrations were elevated (280 U/l and 553 U/l, respectively). Endoscopic retrograde cholangiopancreatography revealed chronic pancreatitis with a 3 cm pseudocyst in the tail of the pancreas. A papillotomy was performed, after which the symptoms rapidly regressed and the pancreatic enzyme concentrations fell. This was thus a case of spontaneous splenic rupture associated with previously undiagnosed chronic pancreatitis with inflammatory papillary stenosis and pseudocyst in the pancreatic tail.