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The epidemiology of inguinal hernia was investigated in a community survey in a neighbourhood of western Jerusalem in 1969-71. The current prevalence rate, excluding operated hernias, was 18 per 100 men aged 25 and over, and the lifetime prevalence, including operated hernias, was 24 per 100. Prevalence rose markedly with age; the lifetime prevalence rate reached 40 per 100 men at the ages of 65-74 and 47 per 100 at 75 and over. The prevalence of hernia was significantly higher in the presence of varicose veins, in men who reported symptoms of prostatic hypertrophy, and, among lean men only, in the presence of haemorrhoids. These associations may reflect the role of increased abdominal pressure. The prevalence of hernia was low in the presence of overweight or adiposity, suggesting that obesity is a protective factor. No significant age-independent associations were found with chronic cough, constipation, physical activity at work, or a number of other variables. Two-thirds of the hernias had not been operated upon. The prevalence of unrepaired hernias rose with age; 13% of all men aged 65-74 and 23% of those aged 75 and over had unoperated groin swellings. One in every five operated hernias showed evidence of recurrence. No significant age-independent associations were found between evidence of occurrence and other characteristics. A comparison of interview responses and examination findings showed that interview data on the presence of hernias were of low validity, mainly because of under-reporting.
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PMID:The epidemiology of inguinal hernia. A survey in western Jerusalem. 9 77

From a conceptual standpoint, the tests of pulmonary function can be divided into those that assess the ventilatory function of the lungs and those concerned with gas exchange. Tests of ventilatory function reflect alterations of the elastic resistance and flow resistance of the respiratory apparatus. The elastic properties of the lungs are assessed by determining the position and shape of the curve representing the relationship between the pressure across the lungs and absolute lung volume. When there is reduced distensibility of either the lungs or the chest wall, the volume-pressure curve is shifted down and to the right. The slope of the curve is reduced in the patient with pulmonary fibrosis, while it is normal in the patient with obesity. In asthma (or chronic bronchitis) and emphysema, the volume-pressure curve is shifted up and to the left. In emphysema, the slope of the curve is increased, while it is normal in patients with asthma or bronchitis. In practice, lung volume is used as an index of alterations of the volume-pressure characteristics of the lungs and/or chest wall. The vital capacity is often used as a surrogate for the TLC but it is lower than expected in both restrictive and obstructive disorders. The FEV1.0 reflects the degree of expiratory flow limitation. In a restrictive disorder, lung volume and the FEV1.0 are reduced, but the FEV1.0/FVC ratio is normal. In airflow limitation, lung volume, the FEV1.0, and the FEV1.0/FVC ratio are lower than expected. In airflow limitation, the reversibility with inhaled bronchodilator should be determined. Tests of airway responsiveness are indicated when evaluating patients with unexplained chronic cough, chest tightness, or wheezing, particularly if other lung function tests are normal. The adequacy of gas exchange is assessed by determining the arterial blood gas tensions--PaO2 and PaCO2--and the alveoloarterial pO2 gradient--P(A-a)O2. A lower-than-expected PaO2 can result from several different physiologic disturbances. When alveolar hypoventilation is the sole disturbance, the oxygen in the alveoli and in the blood perfusing them virtually comes into equilibrium, so that the P(A-a)O2 is normal. An elevated P(A-a)O2 is caused by either mismatching of ventilation and perfusion, true venous admixture, a diffusion abnormality, or a combination of these disturbances. Because dyspnea on exertion is a cardinal symptom of respiratory disease, exercise tolerance should be assessed. A reduced exercise tolerance may result from ventilatory limitation, impaired gas exchange, cardiac impairment, impaired delivery of the oxygen to the working muscles, or an inability to use the energy.
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PMID:Evaluation of respiratory function in health and disease. 160 91

In the present study, generally accepted risk factors for developing a primary incisional hernia are reviewed for their influence on the development of recurrent incisional hernia. The records of 417 patients undergoing an incisional hernia repair between 1980 and 1989 at the University Hospital Rotterdam were reviewed retrospectively, and in the event no hernia recurrence was documented, patients were asked to visit the outpatient department for physical examination. Patients having a primary incisional hernia (n = 302) were selected and patient related factors of gender, age, obesity, chronic cough, prostatism, constipation, diabetes mellitus and the use of corticosteroids were analyzed. In addition, operation related factors, including the technique of operation (mainly, one layer interrupted and one layer continuous closures), use of drains, use of antibiotics, wound contamination (fecal or purulent spill), duration of operation, technique of anesthesia, wound complications, mortality and period of hospitalization, were analyzed. Hernia related factors--the hernia-free interval, original operation, type of incision and the size of the hernias--were also analyzed. Statistical analysis of the data was performed using the chi-square test to compare percentages between groups. Cumulative percentages of patients having a recurrence along time were calculated using life-table methods. Of the group of primary incisional hernias, four patients lacked follow-up evaluation and were excluded, leaving 298 patients for study. With a mean follow-up period of 34.9 months, the recurrence rate was 36 percent; 45 percent had recurrence in the first year, 64 percent in the second year and 78 percent of all recurrences occurred within three years. Therefore, a follow-up evaluation of at least three years is recommended. The cumulative (life-table) recurrence rate after five years was 41 percent. After second, third and fourth incisional hernial repair, recurrence rates were higher (56, 48 and 47 percent, respectively). Except for the size of the hernia, none of the studied parameters led to a significantly higher recurrence rate. Obesity, diabetes mellitus, lower midline incision and wound infection did have higher recurrence rates, but these were not significant. Incisional hernias, smaller than 4 centimeters, had a significantly (p = 0.01) lower recurrence rate (25 percent) than larger hernias (41 percent). Considering these facts, a better technique is badly needed. In large defects, the use of inlay of prosthetic material consistently has the lowest recurrence rates. The question remains whether or not prosthetic material is also needed for repair of smaller hernias.
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PMID:An evaluation of risk factors in incisional hernia recurrence. 843 93

The first pubovaginal fascial sling was reported in 1907, however, until recently this procedure was rarely utilized except after other incontinence procedures had failed. Currently, a pubovaginal sling is indicated as the primary incontinence procedure if intrinsic sphincter deficiency or coexisting intrinsic sphincter deficiency and urethral hypermobility are diagnosed preoperatively. Additionally, incontinence secondary to urethral hypermobility should be treated with a pubovaginal sling if the patient has a high risk of postoperative failure due to obesity, chronic cough, or repetitive strenuous activity. Pubovaginal slings are relatively easy to perform and yield reliably good results with minimal morbidity. We describe our current technique and results using pubovaginal slings for stress incontinence in women.
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PMID:Pubovaginal fascial slings. 953 Nov 2

A 58-year-old woman presented with chronic cough felt to be multifactorial secondary to asthma, gastroesophageal reflux disease, and chronic sinusitis. Additional medical history included obstructive sleep apnea, type 2 diabetes, and hypertension. She had a 40- year history of tobacco use, but quit 10 years ago. Her examination was significant for obesity and cobble stoning of the oropharynx. Pulmonary function testing and arterial blood gases were unrevealing. Chest films were normal. High-resolution computed tomography revealed multiple focal lucencies in a mosaic pattern consistent with air trapping and small airways disease. Bronchoscopy revealed normal airways and a noninflammatory bronchoalveolar lavage. Transbronchial biopsies revealed inflammatory infiltrates of the peribronchiolar interstitium. Lung biopsy revealed pulmonary neuroendocrine cell hyperplasia with tumorlets that stained positive for neuroendocrine tissue. We present the case of a woman with chronic cough, multiple medical problems, and pulmonary neuroendocrine cell hyperplasia with tumorlets.
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PMID:The demonstration of pulmonary neuroendocrine cell hyperplasia with tumorlets in a patient with chronic cough and a history of multiple medical problems. 1597 15

Asthma and obesity in children are common chronic conditions and both disorders have been increasing in the last 2 to 3 decades. The changes of dietary habits and a sedentary life style could have played a role in increasing the prevalence of both conditions. The aim of this report is to analyse the relation between some respiratory conditions (current wheezing, asthma and chronic cough) with dietary habits, body mass index (BMI), the physical activity and the habit to watch television. A total of 19,995 children (10,294 males and 9701 females) were investigated. Current wheezing is associated with increased BMI (V quintile OR=1.65), TV watching (more than 5 h/day OR=1.53), adding salt to the foods (OR=2.45), and fizzy drink (5 times or more per week OR=1.31). Children who often eat tomatoes, fruits, cooked vegetables and citrus fruits have a lower risk of current wheeze. The pattern of association is similar for asthma. High BMI, TV watching, adding salt to foods, and fizzy drink are risk factors for chronic cough. An increased BMI and TV watching are strongly related to respiratory symptoms. Our data confirm that dietary factors such as salt, vegetables and fruits are associated with the prevalence of respiratory symptoms in children.
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PMID:[Dietary habits, life styles and respiratory symptoms in childhood]. 1612 53

Obesity has been reported to be associated with an increase in asthma in children. If there is any association, it could be attributed to an effect of obesity on lung volume and thus airway's obstruction. Data from 2413 children aged 7-12 years in Isfahan were analyzed. The subjects were included in this study if data were available for: height, weight, age, lung volume, and any measure of asthma, including history of diagnosed asthma, wheeze, chronic cough, and medication as obtained by questionnaire. Body mass index (BMI) percentiles, divided into quintiles per year age, were used as a measure of standardized weight.After adjusting for, sex, age, smoking and family history, BMI was a significant risk factor for wheeze ever (p = 0.000) and asthma ever (p = 0.000), diagnosed asthma (P=0.000) and current asthma (p = 0.000). There was no significant correlation between BMI and obstructive spirometry. Increased BMI was significantly associated with an increased airway resistance.Despite the fact that higher BMI is a risk factor for, wheeze ever, wheeze and dyspnea in the last 12 months, and diagnosed asthma, higher BMI is not a risk factor for obstructive pattern in pulmonary function test.
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PMID:Association between Asthma and Body Mass Index in Children. 1730 21

The authors examined risk factors for incident inguinal hernia among US adults (5,316 men and 8,136 women) participating in the First National Health and Nutrition Examination Survey (1971-1975) who were followed through 1992-1993 for a hospital (International Classification of Diseases, Ninth Revision, Clinical Modification, code 550) or physician diagnosis of inguinal hernia. Ninety-six percent of the baseline cohort was recontacted, with a median follow-up of 18.2 years (range, 0.02-22.1 years). Because the cumulative incidence of inguinal hernia was higher among men (13.9%) than among women (2.1%), more detailed analyses were conducted in men. Among men in multivariate analysis, a higher incidence (p < 0.05) of inguinal hernia was associated with an age of 40-59 years (hazard ratio (HR) = 2.2, 95% confidence interval (CI): 1.7, 2.8), an age of 60-74 years (HR = 2.8, 95% CI: 2.2, 3.6), and hiatal hernia (HR = 1.8, 95% CI: 1.2, 2.7), while Black race (HR = 0.58, 95% CI: 0.42, 0.79), being overweight (HR = 0.79, 95% CI: 0.66, 0.95), and obesity (HR = 0.51, 95% CI: 0.36, 0.71) were associated with a lower incidence. Among women, older age, rural residence, greater height, chronic cough, and umbilical hernia were associated with inguinal hernia. In the United States, inguinal hernias are common among men, especially with aging. The lower risk among heavier men was unexpected and bears further study.
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PMID:Risk factors for inguinal hernia among adults in the US population. 1737 52

Gastroesophageal reflux disease (GERD) is a common cause of chronic cough, heartburn, epigastric or retrosternal discomfort, chest pain and abdominal pain or esophagitis. Our patients with OSAS seldom manifest GERD symptoms. We suspected that obesity and high pressure in abdominal cavity may induce acid gastroesophageal reflux in these patients. The aim of the study was to test the hypothesis that obesity, cigarettes smoking or ventilatory and gas exchange abnormalities provoke GERD. We studied 21 consecutive patients with severe OSAS (mean AHI 44.9+/-23.8) before CPAP treatment, all without GERD clinical symptoms. Standard polysomnography, gastroscopy and 24-h oesophageal pH monitoring was performed. There were 6 females, 15 males, mean age 57+/-9 years, mean BMI 38+/-6 kg/m2. All patients presented with normal spirometric and gas exchange values (mean VC 3.64+/-1.23 1, 90% of normal, mean FEV1 2.61+/-0.95 1, 83% of normal, mean FEV1%VC 72%, mean PaO2 68.1+/-7.7 mmHg, mean PaCO2 40.8+/-5.8 mmHg, mean pH 7.42+/-0.02). GERD was diagnosed in 14 patients. Patients with GERD were younger, more often were cigarettes smokers (5/14). We did not fi nd statistically significant differences between severity of OSAS, BMI, ventilatory or gas exchange parameters and GERD.
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PMID:[Gastroesophageal reflux disease (GERD) in patients with obstructive sleep apnoea syndrome (OSAS)]. 1742 43

Based on the painful effects of exposure to capsaicin, TRPV1 (transient receptor potential vanilloid subfamily member 1) localization is most readily associated with peripheral sensory neurons, however, TRPV1 is now known to be expressed, albeit at lower levels, in the spinal cord, brain and a wide-range of non-neuronal cells. The latter includes epithelial cells (e.g. keratinocytes, urothelium, gastric epithelial cells, enterocytes, and pneumocytes) through vascular endothelium and cells of the immune system (e.g. T-cells and mast cells) to smooth muscle, fibroblasts and hepatocytes. Despite extensive research, the physiological function of TRPV1 in the brain and in non-neuronal tissues remains elusive. The preliminary results are exciting, but many are unconfirmed and/or contradictory. As yet, studies with TRPV1 knock-out mice have proven unhelpful in clarifying such biological roles. Now that a range of potent and selective TRPV1 antagonists are available in this rapidly expanding research field, further understanding of the biological roles of TRPV1 throughout the body is within reach. In this article, we will summarize the known roles of peripheral TRPV1 receptors in physiology and disease and review the current perspectives for the therapeutic potential of TRPV1 agonists and antagonists in the treatment of a wide range of conditions such as pain, cancer, migraine, chronic cough, asthma, rectal hypersensitivity, inflammatory bowel disease, obesity, overactive bladder and diabetes. New applications of targeting central TRPV1 receptors are reviewed in the accompanying article by Starowicz et al. (in this issue).
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PMID:Peripheral TRPV1 receptors as targets for drug development: new molecules and mechanisms. 1822 Aug 16


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