Hôtel-Dieu de Montréal

Workarounds enable users to achieve goals despite system limitations but expose design flaws, reduce productivity, risk compromising data quality, and cause inconsistencies. This study investigates how users employ workarounds when the data they want to enter does not align with software form constraints. Through a descriptive user study, we analyzed how workarounds originate and impact system design and data integrity. Understanding workarounds is essential for software designers to identify unmet user needs.

To describe a novel, minimally invasive, ultrasound-guided Achilles tendon repair technique using a knotless barbed suture and to assess its feasibility in a cadaveric model. A midportion Achilles tendon rupture was simulated in a Thiel-embalmed cadaver. The tendon was repaired percutaneously under ultrasound guidance using a 0.6-mm USP 1 knotless barbed suture mounted on a 19-gauge, 3.5-inch curved needle. The needle was advanced intratendinously under continuous ultrasound guidance. Tendon reapproximation was assessed with ultrasound and confirmed by anatomical dissection. The resting plantar flexion angle was measured before and after the repair. The Achilles tendon repair technique resulted in successful reapproximation of the tendon ends with anatomic alignment. Post-repair ultrasound and dissection confirmed accurate intratendinous suture placement and full tendon continuity. The resting plantar flexion angle increased from 23° to 50° after the repair. This is the first report of an ultrasound-guided Achilles tendon repair using a knotless barbed suture. The technique appears feasible in a cadaveric model and may represent a promising minimally invasive option for patients requiring improved tendon approximation. Its office-based approach may reduce surgical risks associated with conventional repair and tendon elongation seen with conservative treatment. Further biomechanical and clinical studies are warranted to evaluate its safety, durability, and functional outcomes.

Hand spasticity with a flexor pattern is a common problem affecting stroke patients and can result in pain, contractures, esthetic concerns, skin maceration, and overall loss of function. Poststroke (≥6 months) hemiparetic adult patients having a Modified Ashworth Scale (MAS) score of ≥1 for metacarpophalangeal flexion and thumb adduction spasticity were selected to receive an ultrasound-guided 20% ethyl alcohol block performed perineurally at the level of the deep branch of the ulnar nerve. Their MAS scores were evaluated pretreatment at 1 month and the change in MAS scores was assessed using Wilcoxon’s test. The threshold for statistical significance was set at p < 0.05. The mean MAS score for the flexor muscles of the 5 MCP joints and for thumb adduction was reduced from 3.3 ± 0.5 at pretreatment to 0.9 ± 0.5 at 1 month after the injection for the 10 patients. One month after the injection, the MAS scores were significantly reduced compared with those at pretreatment (p < 0.001), without complications. These are encouraging results showing that ultrasound-guided alcohol blocks of the deep branch of the ulnar nerve are safe and can help chronic stroke patients with metacarpophalangeal flexion and thumb adduction spasticity at 1 month.

Primary cutaneous B-cell lymphomas (PCBCLs) are a heterogeneous group of extranodal lymphomas1 . Primary cutaneous marginal zone lymphoma (MZL) and follicle center lymphoma (FCL), the most prevalent PCBCLs, are typically indolent.

The extent of the genetic relatedness among Pseudomonas aeruginosa isolates and its impact on clinical outcomes in the cystic fibrosis (CF) population is poorly understood. The objectives of this study were to determine the prevalence of clonal P. aeruginosa infection in Canada and to associate P. aeruginosa genotypes with clinical outcomes. This was an observational study of adult and pediatric patients with CF across Canada. Isolates were typed using multilocus sequence typing. A clone was defined as sharing at least six of seven alleles. Genotyping results were associated with clinical outcomes, including forced expiratory volume in 1 second, body mass index, rate of pulmonary exacerbation, and death/transplant. A total of 1,537 P. aeruginosa isolates were genotyped to 403 unique sequence types (STs) in 402 individuals with CF. Although 39% of STs were shared, most were shared only among a small number of subjects, and the majority (79%) of the genetic diversity in P. aeruginosa isolates was observed between patients. There were no significant differences in clinical outcomes according to genotype. However, patients with a dynamic, changing ST infection pattern had both a steeper decline in forced expiratory volume in 1 second (-2.9% predicted change/yr, 95% confidence interval [CI] = -3.8 to -1.9 compared with 0.4, 95% CI = -0.3 to 1.0; P < 0.001) and body mass index (-1.0 percentile change/yr, 95% CI = -1.6 to -0.3 compared with -0.1, 95% CI = -0.7 to 0.5; P = 0.047) than those with a stable infection with the same ST. There was no widespread sharing of dominant clones in our CF population, and the majority of the genetic diversity in P. aeruginosa was observed between patients. Changing genotypes over time within an individual was associated with worse clinical outcomes.

Sodium polystyrene sulfonate, or Kayexalate, is an ion-exchange resin used to treat hyperkalemia. It is sometimes used with sorbitol, an osmotic laxative that prevents constipation. Small and large bowel necrosis and perforation due to Kayexalate were previously reported. However, no previous cases of gastric perforation were described. We present a case of gastric perforation in a 48-year-old patient, with chronic kidney disease (CKD), lung transplant under chronic corticosteroids, and two previous Nissen fundoplications. He presented with sudden epigastralgia, hematemesis and hemodynamic instability. Esophagogastroduodenoscopy was not able to localize the site of bleeding. Surgical exploration revealed perforation of the lesser curvature of the stomach. Antrectomy with a Billroth II reconstruction was performed. Pathological examination revealed no abnormalities except fibrinoleukocytic debris with Kayexalate crystals in the gastric wall. Kayexalate is believed to be a trigger for the gastric injury in a patient with tissues impaired by corticosteroids, CKD and immunosuppressors.