RESUMEN
BACKGROUND: The minor allele of two caspase 8 polymorphisms, namely CASP8 -652 6N InsDel (rs3834129) and CASP8 Asp302His (rs1045485), were repeatedly associated with reduced breast cancer susceptibility. Contrarily, the presence of the -652 6N Del or the CASP8 302His variant was reported to be an unfavorable prognostic factor in colorectal cancer or neuroblastoma. However, prognostic relevance of these genetic variants for breast cancer is completely unknown and is therefore adressed by the current study. METHODS: Genotyping was performed by pyrosequencing. Caspase 8 mRNA expression was quantified by comparative RT-qPCR. RESULTS: We observed an allele-dose dependent association between CASP8 -652 6N InsDel and caspase 8 mRNA expression in breast cancer tissue, with homozygous deletion carriers showing lowest relative caspase 8 expression (p = 0.0131). Intriguingly, the presence of the -652 6N Del or the 302His variant was shown to be a negative prognostic factor for breast cancer in terms of an allele-dose dependent influence on overall survival (OS, p = 0.0018, p = 0.0150, respectively). Moreover, both polymorphisms were independent predictors of OS after adjusting for co-variats (p = 0.007, p = 0.037, respectively). Prognostic relevance of both polymorphisms were confirmed to be independent from each other and combined analysis of diplotypes revealed an additive influence upon OS (p = 0.0002). CONCLUSION: This is the first report, showing negative and independent prognostic impact of the CASP8 -652 6N Del and the 302His variant for breast cancer. Our data provide rationale to further validate clinical utility of these polymorphisms for breast cancer and to extend this investigation to a broad scope of other malignancies.
Asunto(s)
Neoplasias de la Mama/genética , Caspasa 8/genética , Predisposición Genética a la Enfermedad/genética , Adulto , Anciano , Neoplasias de la Mama/mortalidad , Estudios de Casos y Controles , Femenino , Genotipo , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Pronóstico , Modelos de Riesgos Proporcionales , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
Aquaporin1 (AQP1) is a water channel protein which facilitates water flux across cell membranes. AQP1 is found in epithelial and endothelial cells in various tissues. There is increasing evidence that AQP1 is expressed in malignant tumours and that it may play a role in tumour angiogenesis, cell migration and metastasis. We studied the immunohistochemical expression of AQP1 in a cohort of 203 invasive breast carcinomas with long-term follow up. AQP1 expression was detected in 11 cases (5.4%), and showed a significant correlation with high tumour grade, medullary-like histology, "triple-negativity", as well a cytokeratin 14 and actin expression. In univariate analysis, AQP1 was associated with a significantly poorer prognosis. Multivariate analysis showed that AQP1 expression has an independent predictive value for outcome if stratified by age, tumour size, lymph node status, histological grade and ER status. AQP1 expression in invasive breast carcinomas is associated with a basal-like phenotype and poor prognosis.
Asunto(s)
Acuaporina 1/genética , Biomarcadores de Tumor/genética , Neoplasias de la Mama/genética , Carcinoma Ductal/genética , Carcinoma Lobular/genética , Neoplasias Hormono-Dependientes/genética , Receptores de Estrógenos/genética , Receptores de Progesterona/genética , Actinas/genética , Mama/patología , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Carcinoma Ductal/mortalidad , Carcinoma Ductal/patología , Carcinoma Lobular/mortalidad , Carcinoma Lobular/patología , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Queratina-14/genética , Metástasis Linfática/patología , Análisis Multivariante , Invasividad Neoplásica , Neoplasias Hormono-Dependientes/patología , Fenotipo , PronósticoRESUMEN
BACKGROUND AND AIM: The production of prostaglandins is regulated by cyclo-oxygenases (COXs), which also have a role in tumour development and progression in various malignancies, including breast cancer. The mechanisms by which COX-2 contributes to unfavourable prognosis are still poorly understood. The association between expression of COX-2 and possible linked signalling pathways-namely, Akt, extracellular regulated kinases (ERK1/2), the stress-activated kinase p38 or Her-2/neu-is assessed in a series of 113 node-negative breast cancers. RESULTS: COX-2 was identified as an independent prognostic factor (p = 0.034) in node-negative breast cancer by survival analysis. The lack of a relationship between COX-2 expression and activated Akt, Erk1/2, p38 and Her-2/neu was indicated by statistical analysis. CONCLUSIONS: The prognostic effect of COX-2 expression on lymph node-negative breast cancer is confirmed-COX-2 is probably not regulated by HER-2, Akt, Erk1/2 or p38. Further studies are necessary for the elucidation of the signalling pathways responsible for the modification of COX-2 expression and the increased aggressiveness of breast cancers overexpressing COX-2.
Asunto(s)
Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/enzimología , Ciclooxigenasa 2/metabolismo , Proteínas de Neoplasias/metabolismo , Anciano , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Femenino , Estudios de Seguimiento , Humanos , Hibridación Fluorescente in Situ , Persona de Mediana Edad , Pronóstico , Proteínas Proto-Oncogénicas c-akt/metabolismo , Receptor ErbB-2/metabolismo , Transducción de Señal , Análisis de Supervivencia , Proteínas Quinasas p38 Activadas por Mitógenos/metabolismoRESUMEN
The Akt signalling pathway plays a central role in tumourigenesis. Activation of Akt is related to a more aggressive phenotype in various human cancers, including breast cancer. Its activation contributes to cancer progression via pleiotropic effects, including suppression of apoptosis and modulation of cell cycle regulation. Murine double minute 2 (MDM2) is an oncoprotein that inhibits the function of p53 tumour suppressor protein. Cell culture studies show that Akt-related phosphorylation of MDM2 at serine 166 allows MDM2 to gain nuclear entry and fulfil its p53 regulating function. This study was designed to analyse the relationship of phospho-MDM2 (pMDM2) expression with Akt activation to determine a possible prognostic relevance of pMDM2 in node-negative breast cancer with respect to Akt activation and p53 status. pMDM2, phospho-Akt (pAkt) and p53 protein expression status were analysed immunohistochemically in 121 paraffin-embedded breast cancer cases. Expression of pMDM2 correlated with Akt activation (P<0.001). Univariate analysis identified pMDM2 as a prognostic factor (P=0.0458) in node-negative breast cancers. The unfavourable prognostic significance was even more pronounced in tumours with a pMDM2(+)/pAkt(+) immunophenotype (P=0.0205). Stratification into a p53-negative subgroup further strengthened the adverse prognostic influence. These data confirm that MDM2 phosphorylation at serine 166 is mediated by Akt kinase. Besides the prognostic impact of pMDM2, our findings suggest that Akt-mediated modulation of the MDM2/p53 complex contributes to increased tumour aggressiveness especially in p53-negative breast cancers. However, due to the relatively small number of patients in this cohort, the results obtained need to be confirmed by larger cohorts.
Asunto(s)
Neoplasias de la Mama/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Proteínas Proto-Oncogénicas c-mdm2/metabolismo , Receptor Cross-Talk/fisiología , Proteína p53 Supresora de Tumor/metabolismo , Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/patología , Femenino , Humanos , Inmunohistoquímica , Metástasis Linfática/patología , Persona de Mediana Edad , Fosforilación , PronósticoRESUMEN
Estrogen deprivation by aromatase inhibition is an effective treatment in breast cancer. Between October 1986 and March 1988, 91 postmenopausal patients with advanced breast cancer entered a phase II study performed jointly in three center to investigate the new aromatase inhibitor 4-hydroxyandrostenedione. Patients received 500 mg 4-hydroxyandrostenedione intramuscularly (IM) every 2 weeks for 6 weeks, and 250 mg every 2 weeks thereafter. There were two complete (CRs) and 19 partial remissions (PRs) (response rate, 23%). Disease stabilization (no change; NC) was seen in 26 patients, and in 44 patients (48%), disease progression occurred. Duration of the CRs is 20+ months, median durations of PR and NC are 13+ and 8 months, respectively. Receptor status, relapse-free interval, and sites of metastatic lesions did not appear to influence treatment results. However, efficacy of previous tamoxifen treatment favorably predicted response to 4-hydroxyandrostenedione. Serum estradiol levels decreased significantly in patients after 2 weeks of treatment. Side effects were mostly nonspecific and of low degree, requiring discontinuation of treatment in only 3% of the patients. We conclude that aromatase inhibition with 4-hydroxyandrostenedione is efficacious in the treatment of postmenopausal breast cancer.
Asunto(s)
Androstenodiona/análogos & derivados , Antineoplásicos/uso terapéutico , Inhibidores de la Aromatasa , Neoplasias de la Mama/tratamiento farmacológico , Menopausia , Adulto , Anciano , Anciano de 80 o más Años , Androstenodiona/efectos adversos , Androstenodiona/uso terapéutico , Antineoplásicos/efectos adversos , Neoplasias de la Mama/enzimología , Neoplasias de la Mama/metabolismo , Evaluación de Medicamentos , Estradiol/sangre , Femenino , Alemania Occidental , Humanos , Tablas de Vida , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Receptores de Estrógenos/metabolismo , Inducción de Remisión , Tamoxifeno/uso terapéuticoRESUMEN
Mammography is an appropriate method for the detection of early forms of cancer of the breast, and for reducing mortality. Whether this actually succeeds depends upon the quality of the early detection strategies employed. Currently the data on reduction of mortality by mammographic screening remain ambivalent.
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Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/prevención & control , Mamografía , Tamizaje Masivo , Adulto , Factores de Edad , Anciano , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/mortalidad , Reacciones Falso Positivas , Femenino , Humanos , Incidencia , Mamografía/efectos adversos , Mamografía/psicología , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/diagnóstico por imagen , Lesiones Precancerosas/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
OBJECTIVES: The steroid receptor concentration and the histological morphology of uterine leiomyomata in premenopausal patients undergoing myomectomy therapy with and without a preoperative GnRH analogue, was analysed to evaluate whether the GnRH analogue therapy leads to important hormonal receptor changes, histomorphological changes and a significant shrinkage of the leiomyomata. STUDY DESIGN: Sixty-one GnRH analogue pretreated leiomyomata and 28 untreated leiomyomata were analysed. To determine the estrogen and progesterone receptor concentrations, immunohistochemical techniques were used and quantified with the immuno-reactive score (IRS-score). The leiomyomata were divided into cellular rich, normal, hyaline or cystic degenerated and necrotic according to their histology. RESULTS: The GnRH analogue pretreated leiomyomata group showed higher levels of estrogen and progesterone receptors than the untreated group (37.7% of the GnRH analogue group had a high positive and 29.5% a moderate positive estrogen receptor status whereas high levels of estrogen receptor could be found in only 14.3% of the untreated group). The leiomyomata of both groups with the exception of the necrotic ones, were estrogen and progesterone receptor positive. CONCLUSIONS: Our study suggests that pretreatment of uterine leiomyomata leads to a significant increase in the hormonal receptor concentration of these benign tumors. If pretreated leiomyomata are not removed surgically immediately after the therapy, a rapid regrowth can occur and again cause clinical symptoms.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Leiomioma/metabolismo , Leuprolida/uso terapéutico , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Neoplasias Uterinas/metabolismo , Femenino , Humanos , Inmunohistoquímica , Leiomioma/tratamiento farmacológico , Leiomioma/cirugía , Premenopausia , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/cirugíaRESUMEN
The concentration of c-erbB-2 oncoprotein (HER-2/neu) was examined in the membrane fraction of 196 breast cancer and 39 benign breast specimens using a recently introduced ELISA-assay. The results were compared with established clinical and laboratory prognostic factors, 19% of all breast cancer specimens showed a c-erbB-2 protein level above 10 HNU/micrograms extract protein and were so classified as positive. Considering only the samples of primary tumors the rate was 21%. Surprisingly the rate was only 13.5% in the tissue samples of recurrent disease. Significant correlations were found between high c-erbB-2 protein levels and the tumor diameter, the axillary lymph node status and the progesterone receptor status. In contrast no correlation was found with estrogen receptor or menopausal status. All specimens of benign tumors showed levels < 10 HNU/micrograms extract protein and were classified as negative. The measurement of the c-erbB-2 protein using this ELISA assay was simple to perform and revealed reliable results. Nevertheless the prognostic power of the c-erbB-2 protein seems to be of minor relevance in comparison with established clinical and laboratory parameters, as the positive rates are too small in regard to the much higher recurrence rates of breast cancer. Probably the serum levels of this oncoprotein will be of greater clinical interest in the course of breast cancer.
Asunto(s)
Enfermedades de la Mama/metabolismo , Neoplasias de la Mama/química , Receptor ErbB-2/análisis , Neoplasias de la Mama/ultraestructura , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunohistoquímica , Menopausia , Estadificación de Neoplasias , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Fijación del TejidoRESUMEN
UNLABELLED: BACKGROUND AND QUESTION: A retrospective study was performed. To check the hypothesis whether there is an inverse connection between age and prognosis. PATIENTS AND METHODS: We investigated a total group of 1000 cases with breast cancer primarily and consecutively treated between 1968 and 1986. After grouping the patients by tumor stage and median age various life table analyses were performed to calculate and compare the overall survival. Entry date was the date at diagnosis of a first breast cancer or date at first diagnosis of distant metastasis. RESULTS: Young patients with a tumor size T1 and T2 had a significantly better prognosis than older patients with the same tumor stage. Influence of age became significantly weaker in patients with a T3 and T4 tumor. At least in the patients with a primarily M1 stage hardy any more dependence of age could be demonstrated. Similar results were obtained for the 198 patients which presented a distant recurrence. CONCLUSION: Better general life expectancy of young patients is the cause of substantially better overall survival in curable stages. Advanced breast cancer is a strongly life-threatening factor. The fatal influence of large tumor mass is independent of age.
Asunto(s)
Envejecimiento/fisiología , Neoplasias de la Mama/patología , Anciano , Neoplasias de la Mama/terapia , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
INTRODUCTION: Mutations of the tumor suppressor gene p53 are common in multiple cancer forms, including breast cancer. Data are available that suggest, that the loss of the wild type form of p53 and the appearance of the mutant forms of p53 are correlated with a poorer overall survival rate in patients with breast cancer. The accumulation of the mutant forms of p53 in the cytoplasmatic rooms of the tumor cells leads to the production of human auto-antibodies against these mutant p53 proteins. Therefore, the aim of this study was to analyse and quantify the levels of serum auto-antibodies against p53 protein in patients with an intact immunological system having an active and new recurrence of breast cancer and to compare the obtained results with the recurrence free interval and with established prognostic parameters at the time of first diagnosis, to see if patients with a positive p53 auto-antibody status had a poorer prognosis than those who were p53 auto-antibody positive. MATERIALS AND METHODS: The ser of 61 patients with breast cancer, who experienced a new, clinical and biophysically identified local or distant recurrence and that showed an intact immunological system were analysed with an ELISA assay of Dianova to determine the concentration of auto-antibodies against mutant p53. RESULTS: 14.5% of the patients showed a positive p53 auto-antibody serum status. The recurrence free interval between the p53 auto-antibody positive and negative patients was almost the same: 4.12 years for the p53 auto-antibody positive patients versus 3.72 years for the p53 auto-antibody negative patients (independent t-test value = 0.224 and p value = 0.824; statistically not a significant difference). When comparing the p53 auto-antibody status with established prognostic parameters we could only find a statistically significant correlation with tumor size. No correlations were obtained when comparing the p53 auto-antibody status with the N- and M status, the ER- and PR status, the menopausal status and the cathepsin-D status. DISCUSSION: We were able to demonstrate that the expression of serum auto-antibodies against mutant p53 can not be used as a prognostic parameter in patients with breast cancer as the recurrence free interval between the p53 auto-antibody positive and negative patients did not differ. The determination of the auto-antibodies against p53, though easy to perform, is therefore not a test that helps clinicians in their treatment options, but it remains a useful test for the description of the biological mechanisms of breast cancer.
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Autoanticuerpos/sangre , Neoplasias de la Mama/inmunología , Recurrencia Local de Neoplasia/inmunología , Proteína p53 Supresora de Tumor/inmunología , Neoplasias de la Mama/terapia , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Mutación , PronósticoRESUMEN
OBJECTIVE: Cellular adhesion molecules ICAM-1 and VCAM-1 have been implicated in tumor progression and metastasis. As the sequential interaction of neoplastic cells with the endothelium of tumor neovascularisation is believed to be essential for tumor metastasizing processes, we analysed the concentration of ICAM-1 and VCAM-1 in the cytosol of patients with human breast cancers and their corresponding sera. We compared the obtained values with established prognostic parameters for breast cancer. Benign breast tissues were also analyzed. PATIENTS AND METHODS: Levels of ICAM-1 and VCAM-1 of 62 patients with invasive breast cancer and 17 patients with benign breast tissue were measured using commercially available sandwich enzyme-linked immunoassays with monoclonal antibodies. To establish a reference and control group, levels of ICAM-1 and VCAM-1 were measured in the sera of 66 women without breast tumors. RESULTS: The mean cytosol concentration of ICAM-1 and VCAM-1 was significantly higher in the breast cancer specimens than in the tissue of patients with benign breast diseases. This could be found not only in the tumor cytosol but also in the corresponding sera of the patients. No correlations between the ICAM-1 and VCAM-1 expressions and established prognostic parameters could be observed. CONCLUSIONS: Our findings suggest that malignant breast cancer cells could induce neovascularisation with subsequent high expressions of ICAM-1 and VCAM-1. These upregulations of adhesion molecules might contribute to changes in invasive phenotypes by promoting endothelial cell adhesion and angiogenesis, as well as being responsible for the recognition of tumor cells by the human immune system. Prognostic relevance for the development of breast cancer could not be established.
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Neoplasias de la Mama/sangre , Neoplasias de la Mama/metabolismo , Mama/metabolismo , Molécula 1 de Adhesión Intercelular/metabolismo , Molécula 1 de Adhesión Celular Vascular/metabolismo , Adulto , Neoplasias de la Mama/diagnóstico , Citosol/metabolismo , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Molécula 1 de Adhesión Intercelular/sangre , Persona de Mediana Edad , Pronóstico , Molécula 1 de Adhesión Celular Vascular/sangreRESUMEN
The rare case of a decidualized endometriosis of the appendix vermiformis is reported in a woman who developed HELLP syndrome during the 32nd week of a twin pregnancy. Cesarean section and simultaneous appendectomy were performed. An inspection of the appendix should always be carried out if an endometriosis-associated anamnesis is known. No pathophysiological correlations between the HELLP syndrome and the endometriosis of the appendix vermiformis could be found.
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Apéndice , Cesárea , Endometriosis/complicaciones , Síndrome HELLP/complicaciones , Complicaciones del Embarazo/cirugía , Adulto , Apendicectomía , Apéndice/patología , Endometriosis/patología , Endometriosis/cirugía , Femenino , Síndrome HELLP/patología , Síndrome HELLP/cirugía , Humanos , Embarazo , Complicaciones del Embarazo/patología , Embarazo Múltiple , GemelosRESUMEN
We have used diffusion-weighted 1H NMR micro-imaging and localized spectroscopy techniques to monitor the growth and distribution of mammalian cells in a hollow-fiber bioreactor. Non-invasive NMR measurements of this type should also allow investigation of metabolic heterogeneity and assist in future designs of hollow-fiber systems.
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Células/citología , Espectroscopía de Resonancia Magnética , División Celular , Técnicas Citológicas , Difusión , Cinética , Análisis Espectral , AguaAsunto(s)
Neoplasias de la Mama/diagnóstico , Adulto , Anciano , Biopsia con Aguja , Femenino , Alemania Occidental , Humanos , Metástasis Linfática , Mamografía/efectos adversos , Mamografía/métodos , Tamizaje Masivo , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Inducidas por Radiación , Palpación , Pronóstico , Termografía , Tomografía Computarizada de Emisión , Ultrasonografía , Estados Unidos , XeromamografíaRESUMEN
OBJECTIVE: About 3-4% of all pregnant women will have a fetus presenting by the breech at term. External cephalic version offers the opportunity to reduce the rate of caesarean sections caused by breech presentation. We analysed retrospectively 51 cases of external cephalic version at our clinic. METHODS: External cephalic version was performed 51 times between 37 and 41 weeks of pregnancy. RESULTS: External cephalic version was successful in 32/51 cases (62,7%) with a consecutive rate of vaginal delivery of 71,9%. The best results were seen at 37 weeks of pregnancy with 81,25% of successful versions followed by 76,9% of vaginal deliveries. Complications were rare. There was just 1 case of emergency caesarean section due to persisting fetal bradycardia. CONCLUSION: External cephalic version is an effective and safe treatment to enable vaginal delivery of cephalic presentation. For this operation, 37 weeks of pregnancy can be considered the best time.
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Presentación de Nalgas/enfermería , Presentación de Nalgas/rehabilitación , Versión Fetal/instrumentación , Versión Fetal/métodos , Adulto , Femenino , Humanos , Embarazo , Resultado del Tratamiento , Versión Fetal/efectos adversosRESUMEN
INTRODUCTION: Antibiotic prophylaxis is a standard procedure in obstetric surgery and has been discussed in various investigations. Use of treatment is judged by high efficacy and good tolerance. METHOD: In 300 patients undergoing cesarean sections we compared results of application of Piperacillin 4 g and Piperacillin/Tazobactam 4.5 g after cut of umbilical cord. Tazobactam/Piperacillin is a combination of a broad-spectrum penicillin and a beta-lactamase inhibitor with increased toxicity against staph. aureus, enterobacter, and other germs responsible for local and systemic infections in obstetric surgery. RESULTS: We did not observe any severe adverse effects. Rate of severe wound infections was 1.3 % (Tazobactam/Piperacillin) and 2 % (Piperacillin alone). The difference showed no statistic significance (p > 0.01). During postoperative course we found a higher increase of CRP (p < 0.01) in the Piperacillin group. CRP proved to be a useful objective parameter to distinguish between patients with or without postoperative infections. No differences were found in the number of leucocytes, time in hospital and other parameters.
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Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Cesárea/métodos , Ácido Penicilánico/análogos & derivados , Piperacilina/uso terapéutico , Quimioterapia Combinada , Inhibidores Enzimáticos/uso terapéutico , Femenino , Humanos , Pruebas de Sensibilidad Microbiana , Ácido Penicilánico/uso terapéutico , Embarazo , TazobactamRESUMEN
The analgesic effectiveness of physical therapy in rheumatology is dependent on the differentiated clinical picture (joint, soft parts, spinal column, musculature) and on the differentiated therapeutic remedy (intensity, duration of single treatments, frequency, duration of therapeutic series). Physico- and kinesitherapy can be distinguished with regard to objective and subjective doses; manual therapy is between them. During the last decade, particular advances were achieved in the field of medical gymnastics (muscular stretching technique), patients' schools (back school) and of cryotherapy (cold-air therapy). The pulsed high-frequency therapy and particularly laser therapy, magnetic-field therapy and high-voltage therapy are critically judged. The problem "rheumatism and pain" mainly exists at the level of "chronic"; diagnostics of movement function (articular and muscular functions) on one hand and dosage of therapeutic remedies (drugs and remedies of physiotherapy) on the other are the guidelines. Course (rehabilitation) as well as onset (prevention) of rheumatic clinical pictures determine the further strategy of pain therapy.
RESUMEN
The author emphasizes the interdisciplinary approach that is necessary to rheumatic arthropathies. The pain, inflammation and disturbance of movement must be seen as requiring physiotherapy, while a degree of differentiation is necessary in thermotherapy.