A reappraisal of the anatomy of the levator ani muscle in man

A study of the attachments of the musculotendinous fibres of the levator ani muscle shows that it is made of two portions: a thick anterior portion which is mostly fleshy and a thin posterior portion which is mostly aponeurotic. The anterior portion consists of two layers: a superficial perineal layer and a deep pelvic layer. Both layers have a common origin from the back of the body of the pubic bone and the anterior part of the tendinous arch. In addition both layers make a U-shaped loop around the recto-anal junction. The posterior fibres of the deep pelvic layer received nerve supply only from the third and fourth sacral nerves. The rest of the muscle was supplied from the sacral nerves as well as the perineal branches of the pudendal nerve. The role of the anterior fibres in reinforcing the sphincters of the anal canal and fixation of the pelvic viscera is stressed. The close anatomical relation between the posterior portion of the muscle and the obturator internus suggests that the latter may play a role in supporting the weak posterior portion of the levator ani, especially during straining positions associated with lateral rotation at both hips.     

Fos Protein Expression in Sacral Spinal Cord in Relation to Early Phase of Cauda Equina Syndrome in Dogs

1. The aim of the present study is to map the incipient phase of Fos expression in the sacral spinal cord neuronal pools of multiple cauda equina constrictions canine model.2. Fos-positive neurons were found bilaterally in the lateral portion of superficial dorsal horn layers (Laminae I–III) and along the lateral edge of the dorsal horn accompanied by the lateral collateral pathway, fibers of Lissauer's tract, terminating at the sacral parasympathetic nucleus. Similarly, high Fos expression was detected in the ventral portion of the dorsal sacral commissure and in the dorsomedial portion of the anterior horns at S₁–S₃ segment level. Finally, a clearly expressed Fos-positivity was disclosed bilaterally in the neuropil of the nucleus Y in the anterior horn.3. Data from the present study show that continuous stimulation of the central fibers of sacral dorsal root ganglia neurons, i.e., fibers of sacral primary afferents, unlike those using various stimulations of the peripheral fibres offers an unusual pattern of Fos-like immunoreactivity.     

四川自贡大山铺蜀龙动物群简报 Ⅰ.剑龙

<正> 蜀龙动物群(Shunosaurus fauna)是新发现的一个恐龙动物群。它主要产于四川盆地的下沙溪庙组和西藏昌都地区的察雅群。目前最具有代表性的一个化石产地是自贡市的大山铺。大山铺恐龙化石的发掘和报道已引起国内外古生物工作者极大兴趣。1981年4月,日本朝日新闻社派记者采访了该化石产地的发掘现场。同年应朝日新闻社之要求,经中国科学院批准将在该化石点采集到的一具完整的剑龙头骨,作为特别展品参加     

Evolution of the lumbosacral angle

The lumbosacral angle (LSA) was studied in 131 children ranging in age from birth to 5 years. This angle increases from an average of 20 degrees at birth to an average of 70 degrees at the age of 5 years; it remains at that level thereafter. This study demonstrates that the formation of the LSA is not related to increasing age, height, or weight. Nor do obstetrical requirements seems to play any major role in the formation of the lumbosacral angle. Rather, it appears that the development of the LSA is related to the progressive acquisition of erect posture and the ontogeny of bipedal locomotion. This angle is almost nil in the nonprimate mammals (who only infrequently stand erect). It is minimal in monkeys who occasionally assume bipedal postures and increases somewhat in living apes who engage in facultative bipedal positional behavior. In the early australopithecines, the LSA is increased over that in apes, and it reaches its maximum in Homo sapiens. Deviations from normal and healthy erect posture in Homo sapiens result in corresponding changes in the lumbosacral angle. Lumbar and sacral angles (both forming the lumbosacral angle) are almost equal in all mammalian species. Since the sacral angle of Australopithecus afarensis is approximately 15 degrees, it can be implied that its lumbosacral angle was small, thus attesting to its "imperfect" erect posture and "primitive" form of bipedal locomotion.     

Sacral anterior root stimulation and cryotechnique: A new option for selective urethral sphincter block and reversible deafferentation in the future?

A possible application of cryotechnique might be a selective block of nerve fiber activity during sacral anterior root stimulation to achieve selective block of urethral sphincter and reversible deafferentation. In 13 foxhounds, electrical stimulation of sacral anterior roots S2 was performed while the accompanying spinal nerves were simultaneously cooled down from +25 degrees C in a stepwise fashion until a block of urethral sphincter activity was observed. The effects of cold block on the urethral sphincter and bladder were monitored by urodynamic investigation. In 2 additional dogs sacral posterior roots S2 were cooled down to +3 degrees C while accompanying anterior and posterior roots were stimulated distal to the cryothermode. Compound action potentials (APs) were registered proximal to the cryothermode before, during and after cooling and recovery time of cold blocked nerves was evaluated. Complete cold block of the urethral sphincter during spinal nerve cooling was achieved in all cases. Block temperature averaged +12 degrees C. Detrusor pressure was a mean 5,2 cm water. Recovery time was on average 5 min. The cold block was always reversible. In both dogs of the second series the compound action potentials disappeared nearly completely at +3 degrees C. Three min after the end of the cooling period the appearance of the compound action potentials was back to normal. In this study, cryotechnique proved to be effective for selective and reversible block of nerve fibers during sacral anterior root stimulation. In functional electrical stimulation this technique may lead to an improvement of quality of life in para- or tetraplegic patients resulting in optimization of voiding, standing, walking and grasping and does so without the necessity of surgical dorsal root rhizotomy.     

Comparative and functional morphology of musculus canalis ani in tetrapod mammals and primates]

Comparative anatomy of structure and function of the M. canalis ani in tetrapode mammals and primates is described for the first time. The muscle itself lies on the sphincter ani internus in the area between the anorectal ("pectinate") and anocutaneal ("white") lines and its circumference is intact around the entire anal canal. The canalis ani muscle orginates from the superior part of the sphincter ani internus and concomitantly receives additional fibers from the longitudinal muscle. Caudally the muscle dips back into the sphincter ani internus and, at the same time, a small portion of the fibers go to the longitudinal muscle and, likewise, a portion also sets itself on the perinaal skin. On the basis of its morphological relationship to the convoluted vessels of the rectal venous plexus, the canalis ani muscle appears to be able to complete the closing of the anus in the continence phase to such an extent that a complete closing of the anal lumen is guaranted.     

Reconstruction of large sacral defects following total sacrectomy

Total sacrectomies for cancer ablation often result in extensive defects that are challenging to reconstruct. In an effort to elucidate the criteria to select the most effective reconstructive options, we reviewed our experience with the management of large sacral wound defects. All patients who had a sacral defect reconstruction after a total sacrectomy at our institution between January of 1993 and August of 1998 were reviewed. The size of the defect, the type of reconstruction, postoperative complications, and functional outcome in each patient were assessed. A total of 27 flaps were performed in 25 patients for sacral defect reconstruction after a total sacrectomy. Diagnoses consisted of chordoma (n = 13), giant cell carcinoma (n = 2), sarcoma (n = 5), rectal adenocarcinoma (n = 4), and radiation induced necrosis (n = 1). The size of sacral defects ranged from 18 to 450 cm2 (mean, 189.8 cm2). Ten patients, including five who had preoperative radiation therapy, underwent transpelvic vertical rectus abdominis myocutaneous (VRAM) flap reconstruction for sacral defects with a mean size of 203.3 cm2. Of these, five patients (50 percent) had complications (four minor wound dehiscences and one seroma). Eight patients, including one who had preoperative radiation therapy, underwent bilateral gluteal advancement flap reconstruction for sacral defects with a mean size of 198.0 cm2. They had no complications. Two patients, both of whom had preoperative radiation therapy, underwent gluteal rotation flap reconstruction for sacral defects of 120 cm2 and 144 cm2. Both patients had complications (one partial flap loss and one nonhealing wound requiring a free flap). Three patients, including one who had preoperative radiation therapy, underwent reconstruction with combined gluteal and posterior thigh flaps for sacral defects with a mean size of 246 cm2; two of these patients had partial necrosis of the posterior thigh flaps. Three patients, all of whom had preoperative radiation therapy, underwent free flap reconstruction for sacral defects with a mean size of 144.3 cm2. They had no complications. Our experience suggests that there are three reliable options for the reconstruction of large sacral wound defects: bilateral gluteal advancement flaps, transpelvic rectus myocutaneous flaps, and free flaps. In patients with no preoperative radiation therapy and intact gluteal vessels, the use of bilateral gluteal advancement flaps should be considered. In patients with a history of radiation to the sacral area and in patients whose gluteal vessels have been damaged, the use of the transpelvic VRAM flap should be considered. If the transpelvic VRAM flap cannot be used because of previous abdominal surgery, a free flap should be considered as a last option.     

Changes in the lumbosacral angle, sacral inclination and the curvature of the lumbar spine during aging.

Measurements of the curvature of the lumbar spine are useful in the investigations of low back pain. It is unclear whether the degree of lumbar lordosis, sacral inclination and lumbosacral angulation are the same for all normal adults. Radiographic studies were carried out on the lumbar spines of subjects aged 9-61 years. Mean and 95% tolerance ranges of the values of lumbar lordosis, lumbosacral angle and sacral inclination for adult age groups up to the sixth decade are given. The results showed that all three parameters varied steadily with age. The pattern of changes differed in males and females. Females had greater angles than males. Sacral inclination appeared to be a more important determinant of the degree of lumbar lordosis. All three parameters showed a tendency to decrease after the sixth decade. The significance of the findings is discussed.     

On the Sacral Plexus and Sacral Vertebra of Lizards.

The authors mention that of late it has been recognized that, in any attempt to answer the question as to which vertebra of any lower animal answers to the first sacral vertebra of Man, the nervous no less than the osteological relations of the parts should be carefully investigated. And it has been considered that the nervous rather than the osteological relations should be deemed the more important: in fact it has been sometimes asserted that the nerves must be taken as the fixed points, and that the bones must rather have their homology decided by the nerves, than vice versa. Should it be possible to show that in any group of reptiles, both the nervous and osteological relatious of any vertebra constautly agree with the nervous and osteological relation of Man's first sacral vertebra, the homology between such two parts may well be taken as thereby established; but if either of these sets of relations exhibit discrepancy, then of course such homology cannot be considered satisfactorily determined. Nor can we justly set aside osteological in favour of nervous resemblances if it should turn out that the nerves themselves exhibit notable variations of conditions as we pass from one allied form to another–a fortiori if there should be variations in this respect even within the limits of a species. It might surely be anticipated that more or less variation would be found to exist inner‐vous as well as in skeletal structures; and in the event of such anticipations being justified, the determination of sacral homology must depend upon a comparison of the values of the conflicting claims of different degrees of resemblance in both the osseous and nervous systems–unless we prefer to consider the osteological sacrum and the nervous sacrum as two distinct structures, which may or may not completely coincide, and may or may not widely diverge. The authors afterwards discuss the opinions held by Professor Gegenbaur with regard to the pelvic relations in birds and some reptiles, also those of Professor Hoffmann concerning the lumbar and sacral plexuses of Batrachians and Reptiles. Then follows an account of dissections of the Chameleon (Cha‐mceleo vulgaris), the Green Lizard (Laeerta viridis), the common Teguexin (Teius teguexin), the Bearded Lizard (Grammatophora barbata), the Agama colonorum, the Tuberculated Lizard (Iguana tuberculata), and of the Monitor (M. arenaria). On these dissections are based some remarks on the general condition of the nervous and osseous structures of the sacral region in Lizards, according to their views and as compared with those held by G‐egenbaur and Hoffmann. To this succeed other chapters devoted to a consideration of the sacral region of Batraehians, to the sacral region of Mammals, and to the sacral region of Birds, each discussed in a similar spirit. Their generalizations to the foregoing may be thus summarized:– It appears, then, that in Lizards generally, the lumbar plexus may be formed by from two to three roots, aud that the most pre‐axial of these is here in advance of the fourth presacral nerve, while the most postaxial root is never more postaxial than the first presacral nerve. But Monitor and Ohamwleo present a slight exception in certain respects. In all the Eeptilia examined and enumerated by the authors, the transverse processes which abut against the ilium are wholly or in part parapophysial, and are in serial relation (serial liomo‐logues) with the capitular processes (or the capitular parts of the transverse processes) of the more preaxial vertebrae. The junction of the sacral vertebrae with the ilium is much postacetabular in Saurians; but in Crocodilia and Tortoises (some at least) it is about opposite the acetabulum. In Batrachians the transverse processes abutting against the ilium are parapophysial, but diapophysial in nature like those of Eeptiles. In Mammals as compared with Lizards, it would seem, with respect to nerves, that the first and second sacral vertebra? (say, for instance, of the Cat), answer very well to the two vertebrae with enlarged transverse processes of Lizards, while osteologically they of course also answer very well to them. There can be little doubt, however, that the first two sacral vertebrae of the Cat are to be considered homologous with the anterior human sacral vertebra¹; and therefore it would seem that the two ilium‐joining vertebrse of Lizards should be considered homologous with the anterior human sacral vertebrae. In Man, the Cat, and also in other Mammals down to the Echidna, the transverse processes abutting against the ilium are parapophysial, like those of Eeptiles and Batrachians. In all the Mammals examined by the authors, however, the junction of the sacral transverse processes with the ilia is preacetabular, although that junction is much less preacetabular in position in Man than it is in most Mammals. Altogether, from the osseous and nervous conditions evinced together in the groups hitherto referred to, the authors propose the following definition of a “Sacral Vertebra” in Mammals, Eeptiles, and Batrachians:–“ vertebra'ivithparapophysial transverse processes winch abut against the ilium, preaxial or post‐axial or opposite to the acetabulum, and having a root of the sciatic plexus coming forth either immediately preaxiad or postaxiad of it.” This definition will exclude from the sacrum, as not abutting against the ilium, of Man, the more posterior vertebrse called “ sacral” in anthropotomy. But in the lower mammals (even already in Apes) the number of so‐called “ sacral ” vertebrre augments more or less with age by the ankylosis of the sacral vertebras, so as not to render the extent of the “ sacrum ” very variable. It would surely be well, then, to distinguish the human sacral vertebra, like the ribs, into true and false, those being the true sacral vertebrae which abut against the ilium. In Birds the determination of the homological relations of the different parts of the postdorsal part of the spinal column is a matter of much difficulty. On the whole, and seeing on the one hand the manifest homology between the sacral vertebrae of Man and Lizards by the help of Crocodiles and Tortoises, and on the other hand the manifest homology between the sacral vertebrae of Lizards and the posterior parapophysial vertebras of most Birds, the authors think it better to regard the latter vertebras in Birds as alone truly sacral, and to regard such forms as Bwceros, Pica, and certain Parrots as differing from the rule of the Class in the suppression of their parapophysial processes, sm&Fregatta as differing from the same rule by the development of parapophyses in all the vertebras of this region. The sacral vertebra? in Birds may be defined, then, as “vertebrce having one of the more postaxial roots of the sciatic plexus coming forth either immediately preaxiad or postaxiad, and having parapophysial transverse processes abutting against the ilium, such vertebra being placed immediately postaxiad to vertebra which are devoid of such parapophyses, or else being the homologues of a vertebra so conditioned in most birds. By the combination of these two definitions, as given above (the one for Mammals, Eeptiles, and Batrachians, and the other for Birds), it seems to the authors that the sacral vertebras may be defined in all Vertebrata above Pishes which have pelvic limbs.     

Zeolin is a recombinant storage protein with different solubility and stability properties according to its localization in the endoplasmic reticulum or in the chloroplast

Several strategies have been exploited to maximize heterologous protein accumulation in the plant cell. Recently, it has been shown that a portion of a maize prolamin storage protein, gamma-zein, can be used for the high accumulation of a recombinant protein in novel endoplasmic reticulum (ER)-derived protein bodies of vegetative tissues. In this study, we investigate whether this protein can be expressed in the chloroplast. Our long-term purpose is to use zeolin to produce value-added proteins by fusing these polypeptides with its gamma-zein portion and targeting the recombinant proteins to the ER or to the chloroplast. We show here that zeolin accumulates in the chloroplast to lower levels than in the ER and its stability is compromised by chloroplast proteolytic activity. Co-localization of zeolin and the ER chaperone BiP in the chloroplast does not have a beneficial effect on zeolin accumulation. In this organelle, zeolin is not stored in protein bodies, nor do zeolin polypeptides seem to be linked by inter-chain disulfide bonds, which are usually formed by the six cysteine of the gamma-zein portion, indicating abnormal folding of the recombinant protein. Therefore, it is concluded that to accumulate zeolin in the chloroplast it is necessary to facilitate inter-chain disulfide bond formation.     

Spondylolysis of the sacrum in Alaskan and Canadian Inuit skeletons

Spondylolysis of the lower back, particularly that involving the isthmus between the superior and inferior articular processes (pars inter-articularis), is generally attributed to stress fracturing caused by movement of the affected vertebra relative to the vertebra below. The finding of isthmic spondylolysis in the first vertebra of a fused sacrum is thus unusual and requires explanation. Although unrepresented in the clinical literature, sacral spondylolysis has been reported for archaeological specimens and appears to be especially prevalent in North American Inuit. A study of 373 Inuit sacra from Alaska and Canada produced 16 examples of spondylolysis (eight from each area). All but one of the affected individuals were male, and nearly all were young adults, many between 18 and 20 years of age. All cases of sacral spondylolysis observed in this study were judged to have resulted from stress fracturing that occurred while S1 was still unfused, and most appear to have been in the process of healing, following fusion of S1 with S2, when death occurred. The high frequency observed in these people is attributed to unusual stresses becoming concentrated in the lower back of adolescent males due to such activities as weight lifting, wrestling, kayak paddling, and harpooning, combined with, and perhaps even contributing to, delayed maturation (S1-S2 fusion) of the sacrum. © 1996 Wiley-Liss, Inc.     

The autonomic innervation of Rana ridibunda intestine

1. The innervation of Rana ridibunda intestine has been studied by the following methods: (a) demonstration of cholinesterase activity; (b) FIF method for catecholamines; (c) immunohistochemistry for VIP, SP and SOM, and (d) conventional electron microscopy. 2. The intrinsic intestinal innervation is represented by cholinergic-, VIPergic-, SP- and SOM-like plexuses. The intestinal adrenergic component is of extrinsic origin. 3. The intestinal peptidergic innervation is the most developed, the large intestine being the portion where the studied peptidergic plexuses are more widely distributed. 4. Against a poorly developed cholinergic/adrenergic innervation, it seems that there is a predominant peptidergic innervation in the amphibians intestine wall. 5. Taking into account that amphibians sacral parasympathetic as well as sympathetic innervation development are limited, it could be considered that in vertebrates the intestinal peptidergic innervation is phylogenetically earlier and hence better developed.     

Deafferentation of the urinary bladder and implantation of a sacral anterior root stimulator (SARS) for treatment of the neurogenic bladder in paraplegic patients.

Since 25 years electrical stimulation has become an established and widely acknowledged therapy option. Today, FES is widely employed, e.g. for cardiostimulation, diaphragm stimulation, kinetotherapy, for treatment of tremor in Parkinson patients, and finally for bladder stimulation in patients with bladder voiding dysfunctions. Brindley was the first researcher who succeeded in stimulating the spinal nerves via implanted electrodes in an animal model. In the years 1978/79 Brindley implanted five paraplegic patients with so-called sacral anterior root stimulators; all of them were able to void under stimulation. This method of sacral anterior root stimulation (SARS) proved an alternative to frequent one-way catheterisation for patients with severe voiding dysfunctions, without achieving complete continence, however. The following study is to provide an overview over the latest insights in the context of implanting sacral anterior root stimulators; it discusses the preconditions required for such interventions and presents criteria to decide in which cases there is a contraindication for sacral deafferentation of the posterior roots. Moreover, it contrasts advantages and disadvantages of the intradural and extradural implantation methods and presents the currently available long-term follow-up results with SDAF and SARS for treatment of bladder voiding dysfunctions.     

Univariate and multivariate methods for sexing the sacrum

Metric data on 200 sacra of known sex, age and race are analyzed to determine the usefulness of conventional observations for determining sex in this bone. Results of the univariate analysis show that significant sex differences in the sacrum involve primarily the top portion of the bone for both whites and blacks. However, measurements of curvature are important sex differences in the sample of blacks. A new index relating the S1 body to sacral breadth is proposed as more useful in classifying the bones by sex than indices involving other measurements. Discriminant analysis shows that the sample of whites can be analyzed significantly better by this method than by using an index. The choice of univariate or multivariate method must depend on the condition of the bone, and will be influenced to some extent by the race from which the sample is drawn.     

Vital dye labelling demonstrates a sacral neural crest contribution to the enteric nervous system of chick and mouse embryos

We have used the vital dye, DiI, to analyze the contribution of sacral neural crest cells to the enteric nervous system in chick and mouse embryos. In order to label premigratory sacral neural crest cells selectively, DiI was injected into the lumen of the neural tube at the level of the hindlimb. In chick embryos, DiI injections made prior to stage 19 resulted in labelled cells in the gut, which had emerged from the neural tube adjacent to somites 29-37. In mouse embryos, neural crest cells emigrated from the sacral neural tube between E9 and E9.5. In both chick and mouse embryos, DiI-labelled cells were observed in the rostral half of the somitic sclerotome, around the dorsal aorta, in the mesentery surrounding the gut, as well as within the epithelium of the gut. Mouse embryos, however, contained consistently fewer labelled cells than chick embryos. DiI-labelled cells first were observed in the rostral and dorsal portion of the gut. Paralleling the maturation of the embryo, there was a rostral-to-caudal sequence in which neural crest cells populated the gut at the sacral level. In addition, neural crest cells appeared within the gut in a dorsal-to-ventral sequence, suggesting that the cells entered the gut dorsally and moved progressively ventrally. The present results resolve a long-standing discrepancy in the literature by demonstrating that sacral neural crest cells in both the chick and mouse contribute to the enteric nervous system in the postumbilical gut.     

Effects of different regions of the developing gut on the migration of enteric neural crest-derived cells: a role for Sema3A, but not Sema3F

The enteric nervous system arises from vagal (caudal hindbrain) and sacral level neural crest-derived cells that migrate into and along the developing gut. Data from previous studies have suggested that (i) there may be gradients along the gut that induce the caudally directed migration of vagal enteric neural precursors (ENPs), (ii) exposure to the caecum might alter the migratory ability of vagal ENPs and (iii) Sema3A might regulate the entry into the hindgut of ENPs derived from sacral neural crest. Using co-cultures we show that there is no detectable gradient of chemoattractive molecules along the pre-caecal gut that specifically promotes the caudally directed migration of vagal ENPs, although vagal ENPs migrate faster caudally than rostrally along explants of hindgut. Exposure to the caecum did not alter the rate at which ENPs colonized explants of hindgut, but it did alter the ability of ENPs to colonize the midgut. The co-cultures also revealed that there is localized expression of a repulsive cue in the distal hindgut, which might delay the entry of sacral ENPs. We show that Sema3A is expressed by the hindgut mesenchyme and its receptor, neuropilin-1, is expressed by migrating ENPs. Furthermore, there is premature entry of sacral ENPs and extrinsic axons into the distal hindgut of fetal mice lacking Sema3A. These data show that Sema3A expressed by the distal hindgut regulates the entry of sacral ENPs and extrinsic axons into the hindgut. ENPs did not express neuropilin-2 and there was no detectable change in the timetable by which ENPs colonize the gut in mice lacking neuropilin-2.     

Prey size of single-prey loaders as an indicator of prey abundance

In this paper I am concerned with the behaviour of seabirds that bring back just one prey item at a time to their young. I use a simple model from central place foraging theory to show that the size of fish that a parent bird brings back may increase or decrease with an increase in the abundance of fish. This means that it may not be possible to use the size of fish that is fed to the young as an indicator of prey abundance.     

Mechanisms of flagellar motility deduced from backward-swimming bull sperm

Under certain conditions of cryopreservation, bull spermatozoa undergo an interesting structural alteration. The sperm tail becomes bent back on itself to form a hairpin shape. The bend in the tail occurs at a very precise point, 11 microns behind the neck, and it causes the tail to become kinked. Flagellar microtubules and dense fibers become broken and the ninefold symmetry of the flagellum is greatly distored. Although the portion of the flagellum between the kink and the sperm head does not propagate a wave, the distal portion of the flagellum propagates a base-to-tip wave, causing the spermatozoan to progress backward. These observations suggest that the mammalian spermatozoon does not need basal structures to propagate a flagellar wave.     

The dorsal scapular island flap: an alternative for head,neck, and chest reconstruction

The back has become an increasingly popular donor site for flaps because it can provide thin, pliable tissue, with minimal bulk, and the scar can be easily hidden under clothing. The authors performed a cadaveric and clinical study to evaluate the anatomy of the dorsal scapular vessels and their vascular contribution to the skin, fascia, and muscles of the back. On the basis of anatomical studies in 28 cadavers and clinical experience with 32 cases, it was concluded that the dorsal scapular vessels provide a reliable blood supply to the skin of the medial back, making it a versatile flap to use as an island flap. A flap raised on the dorsal scapular vessels can be harvested with a long pedicle and can be rotated to reach as far as the anterior regions of the head, neck, and chest wall. Delaying and expanding the flap may help to facilitate venous drainage. The authors recommend the use of this versatile island pedicle flap as an alternative to microvascular free-tissue transfer for the reconstruction of defects in the head, neck, and anterior chest.     

Some physiological and developmental considerations of the temperature-gradient hypothesis of bone marrow distribution

In adult humans, active bone marrow is confined to the proximal portion of the skeleton. Huggins and Blocksom (J. Exp. Med., 64: 253, '36) concluded that a high temperature is needed for hematopoiesis in rats. However, precise thermal regulation of human marrow was not found (Petrakis, J. Appl. Physiol., 4: 549, '52). Because these experiments made on the rat tail are the basis for a commonly accepted hypothesis attempting to explain marrow distribution in man, it was considered of importance to re-examine the caudal vertebra model upon which the temperature-gradient hypothesis is based. The sacral and coccygeal vertebrae were examined in rats, mice and humans with respect to marrow cellularity and temperature. In rats and mice and man it was observed that the transition between hematopoietically-active and inactive (fatty) vertebral marrow cavities is abrupt, occurring at the level of the first and second caudal and coccygeal vertebrae. All vertebrae distal to this point have fatty marrow. Of significance was the finding that the vertebral and coccygeal temperatures, as measured with a thermister needle, remain unaltered over this area of changing cellular activity. These anatomical and thermal observations of the caudal vertebrae of rats, mice, and humans indicate that the use of the tail as an experimental model does not support the hypothesis that temperature is a primary factor in the physiological maintenance of hematopoiesis in bone marrow. The possible relationship of hematopoietic activity to developmental and other factors peculiar to the caudal vertebra model is under study.