Inguinal hernia in patients with congenital dislocation of the hip: A sign of general connective tissue disorder

Udén, Alf; Lindhagen, T

doi:10.3109/17453678809149421

Cited by 56 publications

(23 citation statements)

References 11 publications

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“…Research aimed at evaluating the role played by biologic factors has centered on possible alterations in connective tissue metabolism. This idea is also supported by the fact that diseases such as Marfan and Ehlers-Danlos syndromes, cutis laxa, osteogenesis imperfecta, 3 and congenital hip dislocation 4 have been associated with hernial processes.…”

Section: Resultsmentioning

confidence: 53%

Fibroblasts From the Transversalis Fascia of Young Patients With Direct Inguinal Hernias Show Constitutive MMP-2 Overexpression

et al. 2001

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ObjectiveTo determine the expression pattern of certain metalloproteinases (MMPs) known to be involved in the degradation of the extracellular matrix in cultured fibroblasts from the transversalis fascia (TF) of patients with inguinal hernia. Summary Background DataInguinal hernia is a common pathology, the cause of which remains unknown. It is, however, clear that the TF is one of the anatomical structures that may impede the formation of hernias, and particularly the direct type of hernia. In previous studies the authors found enhanced MMP-2 expression in TF specimens in vivo. The persistence of increased expression in cultured fibroblasts might support the idea of a genetic defect as the cause for this pathology. MethodsFibroblasts from the TF of patients with direct and indirect inguinal hernia were cultured and compared with those obtained from control TF in terms of MMP (MMP-2 and MMP-9) expression. ResultsSignificant active MMP-2 expression was shown by TF fibroblasts from young patients with direct hernias. These findings were confirmed by immunosorbent assay, immunoblotting, and zymography of the fibroblast culture media. No MMP-9 expression was detected. ConclusionThese results indicate that MMP-2 may be involved in the TF matrix degradative process in patients with direct hernia. The persistence of changes in MMP-2 levels in the cell cultures appears to suggest a genetic defect or irreversible change as the origin of this pathology rather than environmental factors, which may later participate in the development of the hernial process.Inguinal hernias are among the disorders that most frequently require surgery: their repair accounts for 10% to 15% of all general surgical procedures.1 Although the cause remains unknown, it has been established that the integrity of the abdominal wall in the groin area is dependent on the transversalis fascia (TF), the oblique orientation of the inguinal canal, and a sphincterlike structure of the internal ring. 2Despite numerous predisposing factors, including anatomical features (persistence of the peritoneal-vaginal conduit, high insertion point of the transverse arch) and those associated with other diseases (obesity, chronic obstructive pulmonary disease, constipation), the underlying cause of the development of the different types of hernias is of a biologic nature. Research aimed at evaluating the role played by biologic factors has centered on possible alterations in connective tissue metabolism. This idea is also supported by the fact that diseases such as Marfan and Ehlers-Danlos syndromes, cutis laxa, osteogenesis imperfecta, 3 and congenital hip dislocation 4 have been associated with hernial processes.Tissue specimens from patients with hernias for this type of experimental study include the abdominal anterior rectus muscle sheath, 5 cremaster, hernial sac, 6 and even skin tis-

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Section: Resultsmentioning

confidence: 53%

Fibroblasts From the Transversalis Fascia of Young Patients With Direct Inguinal Hernias Show Constitutive MMP-2 Overexpression

et al. 2001

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“…Matrix metalloproteinases (MMP) that can break down extracellular matrix proteins are over-expressed in hernia patients as well, although this was first shown by Jackson et al in vaginal tissue of women with prolapse [6,7]. A subpopulation of hernia patients may be affected by other signs of connective tissue abnormalities, such as joint hypermobility or aneurysmata [8,9], and their lesions show the same molecular alterations as described above. Obviously, some genetic conditions, among which is Marfan's or Ehlers-Danlos syndrome, directly affect collagen metabolism, hence, predispose to hernia.…”

Section: Parallels To Herniologymentioning

confidence: 88%

The biology behind fascial defects and the use of implants in pelvic organ prolapse repair

et al. 2006

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Implant materials are increasingly being used in an effort to reduce recurrence after prolapse repair with native tissues. Surgeons should be aware of the biology behind both the disease as well as the host response to various implants. We will discuss insights into the biology behind hernia and abdominal fascial defects. Those lessons from "herniology" will, wherever possible, be applied to pelvic organ prolapse (POP) problems. Then we will deal with available animal models, for both the underlying disease and surgical repair. Then we will go over the features of implants and describe how the host responds to implantation. Methodology of such experiments will be briefly explained for the clinician not involved in experimentation. As we discuss the different materials available on the market, we will summarize some results of recent experiments by our group.

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“…The presence of both in a patient should raise the possibility of an underlying connective tissue disease. Developmental dysplasia of the hip has been shown to occur more commonly in infants who develop inguinal hernia [86]. Bladder and bowel diverticulae and inguinal hernia occur more commonly together in several connective tissue syndromes including Williams syndrome.…”

Section: Clinical Factors That Raise Suspicion Of Underlying Genetic mentioning

confidence: 99%

Looking past the lump: genetic aspects of inguinal hernia in children

Barnett

Langer

Hinek

et al. 2009

Journal of Pediatric Surgery

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Inguinal hernia in patients with congenital dislocation of the hip: A sign of general connective tissue disorder

Cited by 56 publications

References 11 publications

Fibroblasts From the Transversalis Fascia of Young Patients With Direct Inguinal Hernias Show Constitutive MMP-2 Overexpression

Fibroblasts From the Transversalis Fascia of Young Patients With Direct Inguinal Hernias Show Constitutive MMP-2 Overexpression

The biology behind fascial defects and the use of implants in pelvic organ prolapse repair

Looking past the lump: genetic aspects of inguinal hernia in children

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