Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The late appearance ofincisional hernias several years after laparotomy and the high recurrence rates after operation strongly imply the presence of a disorder of the connective tissue, although a specific defect in patients with incisional hernias has not yet been identified. In the present study we used both immunohistochemistry and Western blot analysis to evaluate the ratio of collagen I and III and the expression of the metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional or recurrent incisional hernias. Samples of healthy skin or stable skin scar in patients without hernias served as controls. Altogether, our data indicated a significantly decreased ratio of collagen I/III in the fascia of patients with incisional hernias and recurrent incisional hernias. Furthermore, in these patients the expression of MMP-1 was decreased compared to the controls, whereas MMP-13 could not be detected in any fascia sample, with or without hernias present. For the first time, our results give evidence of the existence of a possible collagen disorder in these patients. The decreased ratio ofcollagen I/III is explainable due to a relative increase of collagen type III, which is known to be characterized by thin fibril diameters and lowered mechanical strength. The altered collagen ratio might be the result of the decreased activity of MMP-1, whereas the absent MMP-13 expression did not seem to modify the scar formation. Thus, our data indicate the presence of collagen metabolic disorders in patients with incisional hernias and recurrent incisional hernias. Furthermore, these results might explain the poor results of a mesh-free hernia repair, which again builds up scar tissue of inadequate collagen composition and strength.
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PMID:Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. 1129 60

An association between abdominal aortic aneurysm (AAA) and abdominal wall hernia has been suggested, possibly reflecting a common collagen disorder. The same mechanism may also cause a greater frequency of diastasis recti among patients at risk of developing AAA. Diastasis recti could be used to identify patients at risk of AAA, with implications for AAA screening. The aim of this study was to determine whether an association between diastasis recti and AAA could be demonstrated.The preoperative computed tomographic (CT) scans of 75 male patients undergoing elective AAA repair were retrospectively examined and linea alba width recorded at supraumbilical and subumbilical levels. Measurements were compared with controls frequency matched for age.Fifty patients with AAA were observed to have supraumbilical diastasis recti on preoperative CT compared with 47 controls. Mean linea alba width was not significantly different between the two groups at either the supraumbilical (19.3 mm vs 20.7 mm, p = .45) or subumbilical (3.6 mm vs 4.3 mm, p = .43) level.The findings do not support the hypothesis that the presence of diastasis recti can serve as an indication to select male patients for screening for AAA.
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PMID:Diastasis recti and abdominal aortic aneurysm. 1990 79

Inguinal hernia surgery has been one of the most extensively debated and continues to evolve in search for the ideal technique. Even though the method to diagnose hernia has largely remained clinical, recently other modalities have detected hernias that are not picked up on clinical examination or are incorrectly labeled. Laparoscopy, for the first time has given surgeons the unique opportunity to look at both sides of the groin and to detect and study the contra lateral groin in a patient of clinically unilateral hernia. This has given rise to some interesting findings. In the pediatric age group the value of bilateral detection and repair has been extensively debated. However, the same is not true for the adults despite the facts that there are better methods for detection, better understanding of pathogenesis of hernia and better repair techniques that can take care of bilateral repair without adding to morbidity.That hernia is not a simple derivative of patent processus vaginalis or strain related cause is beginning to be better understood now. It may primarily be a disorder of collagen metabolism with genetic basis. Laparoscopy has also made us wiser in detection of type of hernia and examination of both groin areas. In several studies there have been a high percentage of undetected hernias or additional defects. This was never realized earlier as in open surgery there is no question of exploring the asymptomatic groin. Laparoscopy in bilateral repair is safe and does not add significantly to the operating time, cost or morbidity.At our Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India we have been performing Endoscopic Totally Extraperitoneal (TEP) repair for all simple and complicated inguinal hernia since 1994. We now routinely perform a bilateral repair based on our understanding that the pathogenesis of hernia is a complex process and any genetic basis of collagen disorder has to affect the patient bilaterally. The clinical examination may have unacceptably low sensitivity. Early identification and repair obviates the need for reoperation, reduces overall costs and eliminates further anaesthetic and operative risks for the patient.
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PMID:Totally extraperitoneal repair of inguinal hernia: A case for bilateral repair. 2118 91