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. 1981 Sep;194(3):270–278. doi: 10.1097/00000658-198109000-00004

Metastatic emphysema: a mechanism for acquiring inguinal herniation.

D J Cannon, R C Read
PMCID: PMC1345348  PMID: 7023395

Abstract

Since our previous work had indicated that veterans with inguinal herniation demonstrated qualitative and quantitative changes in connective tissue, we tested the hypothesis that a possible mechanism for the defect was chronic exposure to circulating proteases generated in the lung by cigarette smoke. We investigated 59 men (average age: 60 years) with eigher primary direct of indirect hernias. Most of the patients smoked. Circulating serum elastolytic activity was significantly greater in patients with direct hernias who smoked when compared with controls (p less than 0.001). In addition, the serum alpha-1-antitrypsin inhibitory capacity was significantly lower in this category than controls (p less than 0.001). Patients with indirect defects who smoked also had significantly higher elastolytic values but to a lesser degree (p less than 0.01). Serum antiprotease and protein concentrations were within the normal range in all categories. Our results indicate that an imbalance between blood protease and antiproteases, resulting from chronic smoking can damage connective tissue in the groin as well as the lung.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allegra S. R., Broderick P. A. Desmoid fibroblastoma. Intracytoplasmic collagenosynthesis in a peculiar fibroblastic tumor: light and ultrastructural study of a case. Hum Pathol. 1973 Sep;4(3):419–429. doi: 10.1016/s0046-8177(73)80102-9. [DOI] [PubMed] [Google Scholar]
  2. Bellon G., Hornebeck W., Derouette J. C., Robert L. Méthodes simples pour quantifier l'élastase et ses inhibiteurs dans le sérum humain. Pathol Biol (Paris) 1978 Nov;26(8):515–521. [PubMed] [Google Scholar]
  3. Belton J. C., Crise N., McLaughlin R. F., Jr, Tueller E. E. Ultrastructural alterations in collagen associated with microscopic foci of human emphysema. Hum Pathol. 1977 Nov;8(6):669–677. doi: 10.1016/s0046-8177(77)80095-6. [DOI] [PubMed] [Google Scholar]
  4. Blue M. L., Janoff A. Possible mechanisms of emphysema in cigarette smokers. Release of elastase from human polymorphonuclear leukocytes by cigarette smoke condensate in vitro. Am Rev Respir Dis. 1978 Feb;117(2):317–325. doi: 10.1164/arrd.1978.117.2.317. [DOI] [PubMed] [Google Scholar]
  5. Brendel T. H., Kirsh I. E. Lack of association between inguinal hernia and carcinoma of the colon. N Engl J Med. 1971 Feb 18;284(7):369–370. doi: 10.1056/NEJM197102182840709. [DOI] [PubMed] [Google Scholar]
  6. Byers P. H., Holbrook K. A., Hall J. G., Bornstein P., Chandler J. W. A new variety of spondyloepiphyseal dysplasia characterized by punctate corneal dystrophy and abnormal dermal collagen fibrils. Hum Genet. 1978 Jan 19;40(2):157–169. doi: 10.1007/BF00272296. [DOI] [PubMed] [Google Scholar]
  7. Böhm N., Shah I., Totović V., Karitzky D. Combined alpha 1-antitrypsin and alpha 2-macroglobulin deficiency syndrome: lightmicroscopic evidence of collagenolytic, elastolytic and myolytic tissue lesions. Pathol Res Pract. 1980;168(1-3):17–35. doi: 10.1016/s0344-0338(80)80205-6. [DOI] [PubMed] [Google Scholar]
  8. Cohen A. B. The effects in vivo and in vitro of oxidative damage to purified alpha1-antitrypsin and to the enzyme-inhibiting activity of plasma. Am Rev Respir Dis. 1979 Jun;119(6):953–960. doi: 10.1164/arrd.1979.119.6.953. [DOI] [PubMed] [Google Scholar]
  9. Conner W. T., Peacock E. E., Jr Some studies on the etiology of inguinal hernia. Am J Surg. 1973 Dec;126(6):732–735. doi: 10.1016/s0002-9610(73)80059-5. [DOI] [PubMed] [Google Scholar]
  10. Corre F., Lellouch J., Schwartz D. Smoking and leucocyte-counts. Results of an epidemiological survey. Lancet. 1971 Sep 18;2(7725):632–634. [PubMed] [Google Scholar]
  11. GROSS P., PFITZER E. A., TOLKER E., BABYAK M. A., KASCHAK M. EXPERIMENTAL EMPHYSEMA: ITS PRODUCTION WITH PAPAIN IN NORMAL AND SILICOTIC RATS. Arch Environ Health. 1965 Jul;11:50–58. doi: 10.1080/00039896.1965.10664169. [DOI] [PubMed] [Google Scholar]
  12. Gadek J. E., Fells G. A., Crystal R. G. Cigarette smoking induces functional antiprotease deficiency in the lower respiratory tract of humans. Science. 1979 Dec 14;206(4424):1315–1316. doi: 10.1126/science.316188. [DOI] [PubMed] [Google Scholar]
  13. Gadek J. E., Fulmer J. D., Gelfand J. A., Frank M. M., Petty T. L., Crystal R. G. Danazol-induced augmentation of serum alpha 1-antitrypsin levels in individuals with marked deficiency of this antiprotease. J Clin Invest. 1980 Jul;66(1):82–87. doi: 10.1172/JCI109838. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hunninghake G., Gadek J., Crystal R. Mechanism by which cigarette smoke attracts polymorphonuclear leukocytes to lung. Chest. 1980 Feb;77(2 Suppl):273–273. doi: 10.1378/chest.77.2_supplement.273. [DOI] [PubMed] [Google Scholar]
  15. Janoff A., Carp H., Lee D. K., Drew R. T. Cigarette smoke inhalation decreases alpha 1-antitrypsin activity in rat lung. Science. 1979 Dec 14;206(4424):1313–1314. doi: 10.1126/science.316187. [DOI] [PubMed] [Google Scholar]
  16. Janoff A., Dearing R. Prevention of elastase-induced experimental emphysema by oral administration of a synthetic elastase inhibitor. Am Rev Respir Dis. 1980 Jun;121(6):1025–1029. doi: 10.1164/arrd.1980.121.6.1025. [DOI] [PubMed] [Google Scholar]
  17. Janoff A., White R., Carp H., Harel S., Dearing R., Lee D. Lung injury induced by leukocytic proteases. Am J Pathol. 1979 Oct;97(1):111–136. [PMC free article] [PubMed] [Google Scholar]
  18. Lee P. C., Howard J. M. Fat necrosis. Surg Gynecol Obstet. 1979 May;148(5):785–789. [PubMed] [Google Scholar]
  19. Levene C. I., Ockleford C. D., Barber C. L. Scurvy; a comparison between ultrastructural and biochemical changes observed in cultured fibroblasts and the collagen they synthesise. Virchows Arch B Cell Pathol. 1977 Apr 15;23(4):325–338. doi: 10.1007/BF02889141. [DOI] [PubMed] [Google Scholar]
  20. Mancini G., Carbonara A. O., Heremans J. F. Immunochemical quantitation of antigens by single radial immunodiffusion. Immunochemistry. 1965 Sep;2(3):235–254. doi: 10.1016/0019-2791(65)90004-2. [DOI] [PubMed] [Google Scholar]
  21. Maxwell J. W., Jr, Davis W. C., Jackson F. C. Colon carcinoma and inguinal hernia. Surg Clin North Am. 1965 Oct;45(5):1165–1171. doi: 10.1016/s0039-6109(16)37684-8. [DOI] [PubMed] [Google Scholar]
  22. Mehregan A. H., Lee S. C., Nabai H. Cutis laxa (generalized elastolysis). A report of four cases with autopsy findings. J Cutan Pathol. 1978 Jun;5(3):116–126. doi: 10.1111/j.1600-0560.1978.tb00948.x. [DOI] [PubMed] [Google Scholar]
  23. Meyer J. F., Bieth J., Metais P. On the inhibition of elastase by serum. Some distinguishing properties of alpha1-antitrypsin and alpha2-macroglobulin. Clin Chim Acta. 1975 Jul 9;62(1):43–53. doi: 10.1016/0009-8981(75)90278-8. [DOI] [PubMed] [Google Scholar]
  24. Miskulin M., Moati F., Robert A. M., Robert L., Monteil R., Guilbaud J. Serum elastase and its inhibitors in the blood of heavily burnt patients. J Clin Pathol. 1978 Sep;31(9):866–871. doi: 10.1136/jcp.31.9.866. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Ohlsson K., Olsson I. The neutral proteases of human granulocytes. Isolation and partial characterization of granulocyte elastases. Eur J Biochem. 1974 Mar 1;42(2):519–527. doi: 10.1111/j.1432-1033.1974.tb03367.x. [DOI] [PubMed] [Google Scholar]
  26. Pratt S. A., Finley T. N., Smith M. H., Ladman A. J. A comparison of alveolar macrophages and pulmonary surfactant(?) obtained from the lungs of human smokers and nonsmokers by endobronchial lavage. Anat Rec. 1969 Apr;163(4):497–507. doi: 10.1002/ar.1091630402. [DOI] [PubMed] [Google Scholar]
  27. Read R. C. Attenuation of the rectus sheath in inguinal herniation. Am J Surg. 1970 Nov;120(5):610–614. doi: 10.1016/s0002-9610(70)80178-7. [DOI] [PubMed] [Google Scholar]
  28. Read R. C. Bilaterality and the prosthetic repair of large recurrent inguinal hernias. Am J Surg. 1979 Dec;138(6):788–793. doi: 10.1016/0002-9610(79)90297-6. [DOI] [PubMed] [Google Scholar]
  29. Read R. C., McLeod P. C., Jr Influence of a relaxing incision on suture tension in Bassini's and McVay's repairs. Arch Surg. 1981 Apr;116(4):440–445. doi: 10.1001/archsurg.1981.01380160052011. [DOI] [PubMed] [Google Scholar]
  30. Read R. C. Preperitoneal exposure of inguinal herniation. Am J Surg. 1968 Nov;116(5):653–658. doi: 10.1016/0002-9610(68)90341-3. [DOI] [PubMed] [Google Scholar]
  31. Read R. C. Preperitoneal prosthetic inguinal herniorrhaphy without a relaxing incision. Am J Surg. 1976 Dec;132(6):749–752. doi: 10.1016/0002-9610(76)90450-5. [DOI] [PubMed] [Google Scholar]
  32. Read R. C., White H. J. Inguinal herniation 1777--1977. Am J Surg. 1978 Dec;136(6):651–654. doi: 10.1016/0002-9610(78)90329-x. [DOI] [PubMed] [Google Scholar]
  33. Rodriguez R. J., White R. R., Senior R. M., Levine E. A. Elastase release from human alveolar macrophages: comparison between smokers and nonsmokers. Science. 1977 Oct 21;198(4314):313–314. doi: 10.1126/science.910131. [DOI] [PubMed] [Google Scholar]
  34. Senior R. M., Tegner H., Kuhn C., Ohlsson K., Starcher B. C., Pierce J. A. The induction of pulmonary emphysema with human leukocyte elastase. Am Rev Respir Dis. 1977 Sep;116(3):469–475. doi: 10.1164/arrd.1977.116.3.469. [DOI] [PubMed] [Google Scholar]
  35. Thieme E. T. Recurrent inguinal hernia. Arch Surg. 1971 Aug;103(2):238–241. doi: 10.1001/archsurg.1971.01350080154023. [DOI] [PubMed] [Google Scholar]
  36. Wagh P. V., Leverich A. P., Sun C. N., White H. J., Read R. C. Direct inguinal herniation in men: a disease of collagen. J Surg Res. 1974 Dec;17(6):425–433. doi: 10.1016/0022-4804(74)90155-3. [DOI] [PubMed] [Google Scholar]
  37. Zalokar J. B., Richard J. L., Claude J. R. Leukocyte count, smoking, and myocardial infarction. N Engl J Med. 1981 Feb 19;304(8):465–468. doi: 10.1056/NEJM198102193040806. [DOI] [PubMed] [Google Scholar]

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