Changes in organ function from birth to old age were investigated from published data. In essence, the observations of Shock and colleagues on maximal breathing capacity, vital capacity, glomerular filtration rate, renal plasma flow, basal metabolic rate (BMR), ulnar nerve conduction velocity, cardiac index, and intracellular water (ICW) for the age period 30 to 85 years were extended to the time of birth. There were two principal findings. First, with the exception of BMR and ICW, these functional indices increased from a low point at birth to a maximum between 3 and 20 years of age and then after 30 years declined progressively to 85 years; BMR declined from a maximum in infancy and ICW peaked at about 30 years and then declinded. Second, the coefficient of variation increased regularly from birth to old age. Because the peak of organ function coincided with the period of minimal mortality, the curve of organ function across the life sequence was considered to represent changes in adaptive capacity. Supporting evidence from studies of physical fitness, thermoregulation, and seasonal change of mortality was considered. It was concluded that these shifts in adaptive capacity between birth and old age were fundamental baselines for investigations of the epidemiology of health.
Ventral abdominal hernias are a common abdominal wall defect in the United States. We present a 50-yearold Caucasian male with a large (>18 cm) abdominal wall defect. An extensive complex abdominal wall reconstruction with advanced bilateral fascial flaps/component separation and repair of the abdominal wall defect was planned to restore the appropriate abdominal wall anatomic contour. The use of double mesh in large abdominal wall defects is still a relatively new documented technique. Only two case series detail the same technique used on this patient, with no articles on using a hybrid mesh with a synthetic absorbable mesh. This case uses an underlay and onlay mesh technique, with a hybrid mesh, Tela Biologics (Malvern, PA, USA), under the muscle, in this case, intraperitoneal bridging the gap. The anterior rectus sheath was reinforced with intercepted 0-Ethibond sutures (Ethicon/J&J, Bridgewater, NJ, USA) and then reinforced with a synthetic absorbable mesh (Phasix TM , Becton Dickinson, Franklin Lakes, NJ). The outcome with this patient shows more research should be conducted on considering long-term results with the types of mesh and the question of whether there are additional benefits when using two different types of mesh and their placement in the sandwich technique.
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