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Were drawn from a population of women who underwent pelvic MRI at JHMI beginning July 15, 2003 in reverse chronological order. Nulliparous adult 18 years old ; females with a normal gynecologic examination were included. Patients with pelvic organ prolapse, prior prolapse surgery, prior hysterectomy, or abnormal anatomy distorting the apex of the vagina examples include certain mullerian anomalies, large leiomyoma, enlarged uterus, rectal pathology compressing the posterior vagina, cervical mass, large adnexal mass, or significant ascites ; were excluded. Sample size was selected to achieve 95% confidence intervals within 1cm of the mean for each measurement. This confidence interval was felt to represent a clinically acceptable margin of error during surgery. The posterior fornix and the anterior aspect of the middle of the S2 vertebra were identified on sagittal images. The ischial spines and cervical-vaginal junctions were defined on axial images. Using coordinates from these points, we calculated the vector distances for each dimension right left, anterior posterior, and superior inferior ; as well as the direct vector distance. We then calculated means, standard deviations, and 95% confidence intervals for each measurement. Intraclass correlation coefficients ICC ; were used to test interobserver reliability. RESULTS: Eleven patients with an average age of 30.4 years were included. The most common indication for the MRI was pelvic pain 54% ; . The right cervical-vaginal junction was 4.6 0.5 cm left, 1.2 0.7 cm anterior, and 1.6 0.7cm superior to the ipsilateral ischial spine. The direct vector distance between the right cervical-vaginal junction and ischial spine was 5.3 0.3 cm. The left cervical-vaginal junction was 4.7 0.6 cm right, 1.1 0.6 cm anterior, and 1.6 0.7 cm superior to the ipsilateral ischial spine. The direct vector distance for the left side was 5.3 0.6 cm. The posterior fornix was 1.0 1.0cm anterior and 5.3 0.8 cm inferior to the middle of the S2 vertebra. The direct vector distance between the posterior fornix and S2 was 5.6 0.9 cm. There was excellent interobserver reliability ICC 0.827 to 0.995, p 0.005 for individual measurements and ICC 0.997, p 0.001 overall. ; CONCLUSIONS: This study identifies the normal anatomic relationship between the vaginal apex and the bony landmarks that are commonly used in prolapse surgery. This information could be important for the restoration of normal anatomy during reconstructive pelvic surgery. The large proportion of patients with pelvic pain may limit the generalizability of this study. Disclosure Grant Research Support: V.L. Handa, CR Bard, Watson, Wyeth Pharmaceuticals; G.W. Cundiff, Cook Ob Gyn; Consultant: G.W. Cundiff, Lilly Pharmaceuticals Oral Poster 3 Suture Erosion and Wound Dehiscence with Permanent versus Absorbable Suture in Posterior Vaginal Surgery A.M. Luck, S.L. Galvin, & J.P. Theofrastous; Mountain Area Health Education Center, Asheville, NC OBJECTIVE: To determined the incidence of suture erosion and wound dehiscence following posterior colporrhapy using permanent versus absorbable suture. METHODS: A retrospective cohort study of all women undergoing posterior colporrhaphy over 49 months was conducted. Permanent suture #2-0 polyester Ethibond ; was initially used, & after observing what seemed to be a high rate of suture erosion, absorbable suture #0 polyglactan Vicryl ; was used thereafter. Differences in the incidences of suture erosion, wound dehiscence, & demographic & surgical characteristics were compared using Chi square, Student's t-test, or Mann Whitney tests as appropriate. The Kaplan-Meier method was used to analyze time to wound dehiscence and the twosided log-rank test was used to compare the groups. Significance level was defined as p 0.05. RESULTS: Ninety-nine women had repair with permanent sutures PS ; and 111 using absorbable sutures AS ; . There were no differences in demographics or comorbidities between patient groups. Significant differences were observed in the incidence of suture erosion dehiscence: 31.3% of the PS. Associations referring to withdrawn drugs are excluded. Listed Y Y + ; the July 2000 online versions of Martindale and the Physicians' Desk Reference[6] and not listed N ; in the 30th edition of Martindale.[5] Not listed N ; in the July 2000 online versions of Martindale or the Physicians' Desk Reference; [6] or listed Y Y + ; the 30th edition of Martindale.[5], for example, lotrimin ointment.
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RINGWORM - What's New? Skin infection is a very important topic in sports medicine for wrestling. It can have a huge negative impact on individual wrestlers, who can be held out of competition, and also, can create a negative impression of our sport in the general public. The organisms causing skin infections are found every where, but the conditions under which we train and compete, make the prevalence of skin infections higher than in many other sports. There are three groups of microorganisms that cause the vast majority of skin infections in wrestling. These are viruses responsible for herpes ; , bacteria responsible for impetigo and boils ; , and fungi responsible for ringworm ; . This article will focus on ringworm and its treatment and prevention. Despite the name, ringworm is a plant. There are no worms! This type of fungi that grows in skin, are called dermatophytes. They digest a protein in the skin called keratin. Growth of these fungi begins when the spores, which are like the microscopic "seeds" that enter the skin and begin to grow. The growth pattern for ringworm infections are circular patches with scaly, raised borders. Healing in the center produces the typical ring effect. However, rings are not always present. Some people can carry the spores without any itch or rash appearing. In medical terms we use the word tinea to mean a fungal infection of the skin. There is tinea corporis body ; , tinea capitis head ; , tinea pedis athlete's foot ; , and tinea cruris jock itch ; . Ringworm in wrestlers is also referred to as tinea corporis galdiatorum. The conditions necessary for the growth of tinea include: a warm, moist, and dark environment; abrasions; and direct skin to skin contact. Sounds like a wrestling room! The results of a study of high school wrestling teams in Pennsylvania, showed 87% with at least one wrestler with ringworm. Historically, ringworm was often ignored or tolerated. Most cases do not have serious effects, but there has been, and rightfully so, a heightened awareness of the possible transmission of all diseases through competition. The guidelines set forth by the National Federation of High School Associations require that a wrestler with a skin lesion sore or rash ; have a doctor's authorization to compete. This form states that the condition "is not communicable." The NFHS recommends that standard for this non-communicable state is reached after one week of treatment two weeks if in the scalp ; . The NCAA has a standard of 72 hours post treatment. The NCAA also allows the covering of a single lesion, whereas this is not allowed in high schools. The facts are that we do not know at this time with certainty when this non-contagious stage is reached. It seems to be quite variable. Adding to this uncertainty is the fact that there are some people who carry the spores and do not show any outward symptoms, but can be the source of infection in others. Thankfully, there are a variety of effective drugs. There are over the counter topical creams. Some of these anti-fungals include Desenex, Aftate, Cruex, and Tinactin. More recently, Lotriin and Lamisil have been added to the arsenal. Lamisil is the medicine of choice given to me by number of well-respected dermatologists. Wrestlers and trainers would be smart to have a tube in their sport bags. According to Dr. Lawrence Johnson, a dermatologist from Geneva, IL who has worked with USA Wrestling, early lesions of the skin may be difficult to distinguish between herpes, dermatitis, early impetigo, or ringworm. Treatment by these medications are extremely safe, so even if the condition is. Unless otherwise specifically included, this Part shall not apply to recommendations involving: a ; Direct response solicitations where there is no recommendation based on information collected from the consumer pursuant to this Part. Contracts used to fund: 1 ; An employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act ERISA A plan described by sections 401 a ; , 401 k ; , 403 b ; , 408 k ; or 408 p ; of the Internal Revenue Code IRC ; 26 USCS 401 et seq. ; , as amended, if established or maintained by an employer; A government or church plan defined in section 414 of the IRC, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under section 457 of the IRC; A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor; Settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process; or Forma l prepaid funeral contracts.
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