Metastatic Emphysema

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Abstract
Veterans with inguinal herniation demonstrated qualitative and quantitative changes in connective tissue. The hypothesis that a possible mechanism for the defect was chronic exposure to circulating proteases generated in the lung by cigarette smoke was studied. Men (59, average age 60 yr) with primary direct or indirect hernias were studied. Most patients smoked. Circulating serum elastolytic activity was significantly greater in patients with direct hernias who smoked when compared with controls (P < 0.001). Serum .alpha.-1-antitrypsin inhibitory capacity was significantly lower in this category than controls (P < 0.001). Patients with indirect defects who smoked also had significantly higher elastolytic values but to a lesser degree (P < 0.01). Serum antiprotease and protein concentrations were within the normal range in all categories. An imbalance between blood proteases and antiproteases, resulting from chronic smoking damaged connective tissue in the groin and lung.