title: The Nyhus-Wantz lectureship: etiology, herniosis, diverticulosis coli, and cancer.
abstract: The Nyhus-Wantz Lectureship honors two giants who represent the few who formed a new surgical specialty: herniology. My topics are etiology, herniosis, diverticulosis coli, and cancer. Hippocrates blamed wear and tear for herniation. Russell's (Lancet 1:1519-1523, 1902) explanation was congenital peritoneal "buds" extending down to the pelvis. Harrison (Arch Surg 4:680-689, 1922) attributed herniae to transversalis fascial degradation. Keith (Lancet 2(17):1398-1399, 1906) concluded that pathology was involved, even though Russell (Lancet 1:1519-1523, 1902) had denied it. Nevertheless, the congenital theory prevailed. According to McVay (Christopher's textbook of surgery, W.B. Saunders, Philadelphia, 1960, p. 159), defects arise in normal musculo-aponeurotic structures. Research showed that atrophy was caused by damaged fibroblasts producing less collagen, which was abnormal (having a reduced I/III ratio). The disease was systemic, later named herniosis. Nicotine addiction increased the incidence of herniation by an inflammatory process named metastatic emphysema. In 1948, Saint's Triad, an aggregation of hiatus hernia (later, any primary hernia), gallstones, and diverticulosis coli, was introduced. This association occurred eight times more often than expected, with herniosis appearing to be its cause, abetted by high blood cholesterol causing gallstones. In 2006, Krones et al. (Int J Colorectal Dis 21:18-24, 2006) provided evidence that colon cancer is accompanied by a reduction in diverticula. Klinge et al. (Hernia 8(4):300-301, 2004) showed that these entities require different extracellular matrices (ECMs). Ghajar and Bissell (Histochem Cell Biol 130:1105-1118, 2008) pointed out that the ECM, which comprises 80% of the breast, influences its epithelial genetic expression, likewise with other organs (kidney, skin, lung, colon, and ovaries). Recently, a fundamental change in our understanding of cancer growth and metastasis has taken place. Whereas the degradation of connective tissue was thought to encourage invasion, eliciting concern for the herniated, now, investigators report the reverse, a reactive vascularized stroma resembling wound healing with an increase in fibroblasts and collagen I. Words such as desmoplasia, fibrosis, and stiffening abound. In conclusion, degradation of the ECM may be why herniosis appears to be hostile to the development of cancer throughout the body. Studies are needed of patients with and without a history of hernia to determine their incidence of cancer. Data from smokers should be separated, since they carry their own high risk of malignancy.
authors: University of Arkansas for Medical Sciences, 304 Potomac Street, Rockville, MD 20850, USA. read@post.harvard.edu
authors: R C
authors: RC
authors: Read
references: Hernia. 2004 Dec;8(4):300-1
references: 15293112
references: Hernia. 2008 Oct;12(5):449-52
references: 18415038
references: Hernia. 2004 Aug;8(3):171-6
references: 15293113
references: Hernia. 2010 Aug;14(4):453
references: 20544365
references: Nat Rev Cancer. 2006 May;6(5):392-401
references: 16572188
references: Hernia. 2009 Feb;13(1):29-34
references: 18704619
references: Am J Surg. 1970 Nov;120(5):610-4
references: 4249908
references: Cancer Metastasis Rev. 1989 Aug;8(2):98-101
references: 2673568
references: Rev Surg. 1966 Jan-Feb;23(1):1-4
references: 5905034
references: Ann Surg. 1981 Sep;194(3):270-8
references: 7023395
references: Tumour Biol. 2009;30(3):109-20
references: 19440007
references: Eur J Cancer. 2010 May;46(7):1181-8
references: 20304630
references: Hernia. 2010 Apr;14(2):119-21
references: 19921348
references: J Surg Res. 1974 Dec;17(6):425-33
references: 4437165
references: Am J Surg. 1984 Dec;148(6):706-11
references: 6507740
references: Int J Colorectal Dis. 2007 May;22(5):515-20
references: 17021746
references: Curr Opin Cell Biol. 2006 Oct;18(5):463-71
references: 16919434
references: Curr Probl Surg. 1967 Oct;:1-50
references: 4861490
references: Cancer Cell. 2009 Jan 6;15(1):35-44
references: 19111879
references: Int J Colorectal Dis. 2006 Jan;21(1):18-24
references: 15889263
references: Int J Colorectal Dis. 2001 Sep;16(5):271-5
references: 11686522
references: Am J Surg. 1972 Dec;124(6):819-22
references: 4635227
references: Histochem Cell Biol. 2008 Dec;130(6):1105-18
references: 19009245
references: J Am Med Assoc. 1958 Sep 20;168(3):257-61
references: 13575149