The impact Epothilones have demonstrated in tumors that are resistant to conventional treatment in advanced stages and metastásicasLa Mexican Society of Oncology, AC (SMeO) presented the recommendations of the Expert Panel on Mexican metastatic breast cancer with the aim of presenting an update on the diagnosis and treatment options for patients in Mexico.

The presentation of these recommendations complements the Mexican Consensus Breast Cancer, presented the 2008 SMeO and considers the inclusion of epothilone, a new therapeutic class thus far been absent in our country and whose first product is now available in Mexico through Laboratory Bristol-Myers Squibb.

Media conference, Dr. Cristian Villanueva, Argentine specialist assigned to the University Hospital of Besançon, France, said that “Epothilones have proven effective in tumors resistant to traditional treatments, and a manageable safety profile in cancer patients of locally advanced or metastatic breast cancer who had not previously responded to treatment. “

The Food and Drug Administration USA (FDA for its acronym in English) and approved the use of epothilone for the treatment of patients with breast cancer resistant locally advanced or metastatic, or for patients whose cancer is resistant to regular treatments.

In Mexico, the first epothilone already authorized by the health authorities and is now available. This treatment is the result of nearly 10 years of oncology drug research from Bristol Myers Squibb.

Breast cancer has become a public health problem worldwide and is the most common cancer in women and causes the most deaths. According to WHO, every 30 seconds is diagnosed with breast cancer in the world.

In Mexico every 2 hours a woman dies as a result of breast cancer and this disease now represents the second cause of death among women 30 to 54 years of age. Only in 2006 killed an estimated 4.451 women and that by 2010 there will be a mortality rate of 13 per 100,000 adult women and nearly 4,500 deaths per year.

This increasing trend of disease is related to the aging population and greater prevalence of risk factors for the female population. Unlike other countries where the incidence of such illnesses affect women over 60 years in our country 46% of women affected by breast cancer have less than 50 years.

Metastatic Breast Cancer: a worrisome reality

Over 60% of diagnosed cases are detected late, which means less chance for recovery and survival. Although the median survival of patients has increased in recent years, the Metastatic Breast Cancer (MBC) remains a difficult condition to treat and an ongoing challenge for oncologists, and to prove just enough to review some figures:

• Between 5 and 10% of the women present at diagnosis CMM.

• From 20 to 50% of which were diagnosed at an earlier stage may develop.

• Of women who undergo treatment at an early stage, 40% eventually will develop CMM in a span of 3 years.

• The average survival is only 2 to 3 years.

• The survival rate at 5 years is only 26%.

Dr. Rogelio Martinez Macias, President of the Mexican Society of Oncology from January 2010, said the Expert Panel recommendations are aimed at keeping Mexicans updated treatment regimens in order to safeguard the lives of women today with this type of cancer as well as to have a guide for physicians nationwide to guide them on treatment options in advanced stages and in the metastatic phase.

A study in the Mexican Social Security Institute said Nayarit, Guerrero, Mexico State had a 300% increase in mortality in women over 20 years for this type of cancer. Hence the concern to keep these updated recommendations.

Breast cancer can also be called breast cancer and is the disorderly growth of cells in the mammary glands that is usually detected as a lump in the breast. According to the Histopathological Registry Malignancies in Mexico are found approximately 12 thousand new cases annually and 45.5 percent of these occur before age 50.

The locally advanced breast cancer can occur from stage II, while the metastatic stage IV presents the disease and may present both clinical variables and evolution.

In all cases, the chances of survival improve considerably when you have an early diagnosis, hence the importance of having an appropriate and effective treatment, which has evolved in recent years, hence, the range of options first-line treatments for metastatic breast cancer has increased in complexity, depending on the interaction between tumor, patient and medical variables.

Dr. Juan Alejandro Silva, Chief of Medical Oncology Siglo XXI IMSS, noted that “innovation in treatment has led to a decline in mortality rates of about 20% over the past decade” and currently, treatment decisions should take into account tumor characteristics, toxicity, potential impact on quality of life and patient preference, in addition to the safety and efficacy data.

Treatment of CMM: chemotherapeutic agents

There are different classes of chemotherapeutic agents alone or in combination with other drugs (chemotherapy or other) are used to treat the CMM. Chemotherapeutic agents act in different ways according to their biochemical activity, its origins or its activity on the cell cycle.

Choice of treatment: what is most effective chemotherapeutic agent: Taking into account factors such as age, general health status, symptoms, duration of disease, previous treatment and relapse, therapeutic objectives, the state of HER2 receptor status of estrogen and progesterone, the tumor mass, and some factors, the oncologist selects the treatment considered most appropriate for treating each patient CMM.

When treatment does not work: resistance to chemotherapy.

Although various chemotherapeutic agents available to treat the CMM, the rate of resistance to these agents is a common problem in patients, in fact it is estimated that the resistance is responsible for treatment failure in more than 90% of patients, having two types of resistance:

The mechanisms of resistance are many and varied and are related to the mechanism of action of each class of chemotherapeutic agent.

Resistance to taxanes is mediated by multiple mechanisms:

Anthracyclines and taxanes are two of the most widely used agents in the treatment of CMM.

The mechanisms of resistance to these drugs include: increased drug ejector pumps and alterations in therapeutic drug targets. Currently, the taxanes have become the backbone of cytotoxic treatment in breast cancer. Even its use has been extended to early stages of the disease.

Unfortunately, these agents are highly susceptible mainly to two of these mechanisms of resistance efflux pumps that control the drug concentration within the cell and disruption of the beta tubulin that prevents the taxane accede to and stabilizes microtubules; both prevent the agent achieve its goal of induction of apoptosis.

The goal is to better understand the mechanisms of resistance, the implications for the choice of appropriate treatment and less vulnerable to develop new agents to overcome this problem.

Why is physical therapy important?
Physiotherapy is important in terms of orthopedic for two main reasons
· First, the type of orthopedic patients have a deficiency that requires treatment. For example, patients with carpal Tunel syndrome (tunnel syndrome at the wrist bone) has a particular weakness in the muscles of his arms and takes target practice to restore fugsinya. Or at the knee joint as an example has chondromalacia imbalance in the muscles around the knee joint. A physiotherapist can teach patients with specific exercises for these muscles in order to improve function and reduce the problem.
· Second, physiotherapy knowledgeable about operating procedures, purpose of the exercise, muscle and bone anatomy, and can adjust the conditions to improve motion and function of the patient. After learning the operating procedures such as hip replacement, it is very important to know the treatment given to patients according to operating procedures. Several limitations affect the operation of motion and joint motion area, for that someone who knows more about the issues surrounding the operation procedures required to restore motion and function of the patient so that the goal is reached separate dapt

Many orthopedic problems can be handled without interfering hands of a physiotherapist. Often a simple exercise or penguluran can help patients to improve his condition. However, too many complications of orthopedic conditions that require special training with physiotherapy to treat patients.

Is the most important thing to do physiotherapy
Physiotherapy has a lot of rehabilitation equipment, some special skills that are owned by a physiotherapist:
Streetching If patients have joint stiffness, normal activities such as opening a bottle or up the stairs sometimes disrupted. With proper , limitations of this function can be overcome. If there is injury or surgery, scar tissue and soft tissue contraction is the result and penguluran important to do.
o Strengthening / strengthening
strengthening exercises done to help patients improve the functioning of the muscle. The ultimate goal is to increase strength, endurance and keep improving joint range of motion. The most common type of strengthening exercises are:
o Closed Chain
Dilakuka closed chain exercises with your feet locked to the ground. For example is the leg Squat. The purpose of this exercise for balance and muscle strength. By doing this legsquat weak muscles of quadriceps and hamstring his opponent, the two contracts so that both strength and muscle balance is achieved. Open chain exercises like leg extensions and balance the muscle strength is not reached.
o proprioceptive
Propiosepsi is a sense to know where the parts of the body. This may be difficult when you konsepe decree anything holding it until you lose the thing, because so much propiosepsi work without your knowing it. When you lose propiosepsi, as for example the joint after ankle sprain / ligament injury, patients often complain of instability sensation in the joint. Exercise your body directs propiosepsi to control the position of the injured joint.
• Ice and Heat Therapy
Cold and hot intended to warm and cool the muscles, as the record of this modality can increase blood flow and can reduce swelling. This is probably the most important aspect in the therapeutic process
• Ultrasound
Ultrasound uses high frequency sound waves (not within the range we can hear) to stimulate the deep tissues within the body. By passing an ultrasound probe over the body, deep tissues are stimulated by the vibration of the sound wave. This leads to warming and increased blood flow to these tissues.
• Electrical Stimulation
Electrical stimulation therapy is using electricity. By installing the electric current in the relevant area / experiencing pain, the nerves that deliver pain changed. Patients often feel the pain is reduced after treatment.
• Aquatic Therapy
Aquatic therapy or treatment with water is the best way to restore back movement and maintain the strength and the exercise is performed dikolam pool. This exercise became very famous later this year because many patients are difficult to be able to exercise when done in water. The power to help the body to float and the water also gives prisoners gentle / slowly increasing strength and stamina.
• Biofeedback
Biofeedback is to use various tools to enhance one or a weak muscle group.

Occurs frequently in sports activities that require repetitive motions of the forearm (racquet sports, golf, baseball), but also can be an occupational disease.

The pain may be constant or occur only with / or after performing repetitive movements of the forearm.

Localized pain on the outside of the elbow that is exacerbated by resisted supination or resisted extension of the wrist or fingers is indicative of tennis elbow (lateral epicondylitis is the medical term).

The pain is located on the inside of the elbow and is exacerbated by resisted forearm pronation or resisted flexion of the wrist is indicative gofista elbow (medial epicondylitis).

The treatment for tendinitis of the elbow include:

* Rest, in acute cases can be placed in a splint.
* Massage with Hot. (Compresses)
* Analgesics non-inflammatory steroids.
* Physical therapy: stretching, muscle strengthening, ultrasound, phonophoresis, laser, etc..
* Cortisone injection: no more than two.
* Bracing: specially designed ribbons and wristbands.
* Shock waves.

Because this disease is caused by Overuse is very important to determine the cause and correct it to ensure healing. For example if the patient is an athlete who play tennis should be reviewed:

* The tech sportswear, faulty technique may be the cause of the disease.
* The team, often the patient is not using the proper racquet (very large fist, a lot of tension in the strings, etc.).
* If the patient is not an athlete but is a worker must review and modify activity played.

In patients conservative treatment has failed often and can offer the alternative of surgical treatment which basically consists of removing the tissue inflammation of the tendons and sometimes free the nerves that go to the affected area.

1. Introduction The need for early intervention physical therapy in respiratory disorders of children, the more justified by its effectiveness. Incidence of childhood respiratory disease to grow by several factors: the pathogen evolved and become more viruses and bacteria, at least, pollution advances in neonatal resuscitation, environmental factors (, lead in the air, passive smoking) and the style of life (living communities encourage the spread of disease, type of domestic heating, overcrowding). The structure of their respiratory system is being developed, along with genetic predisposition, that children more susceptible to respiratory infections, more frequent and severe, often bronchiolitis and pulmonary disease. Main objective is chest physiotherapy against bronchial obstruction and lung distension, not including structural or anatomical malformations or tumors of origin.

2. Bronchial obstruction Definition: consisting of a reduction in the light of the airways that affects air circulation and debit cards. Partial or total, reversible or irreversible. The Physiotherapist works in the pathology can be reversible and the type, location and degree of obstruction.

Multifaktor and the origin is associated with edema, convulsions and hipersecrección, factors to consider when improving the physiotherapy treatment. Hyperinflation Toracopulmonar: it is an abnormal increase in functional residual capacity (FRC), which places the tidal volume (tidal volume) in the volume of reserves of inspiration (Irv). That is, this is the level of increase in ventilation at rest. The most common cause is loss of elasticity of the lung parenchyma and removal of bronchial obstruction more common. Mechanism of slowing inflation bronchial closure homeostatic mechanisms that promote the exchange of gases, but at a time can be very damaging to the exaction of excessive respiratory muscles, causing fatigue. Increased energy expenditure further aggravate the anatomic configuration of the child’s chest, the main actions to the same intercostal muscles . Bronchiolitis or Bronquioalveolitis: It is a syndrome that affects 70-80% of cases in children under two years. This is the most common pediatric respiratory disease, causes 90% of cases of respiratory syncytial virus. The most often initiated by extrathoracic respiratory conditions, and then stretches the airway edema and infiltration intrathoracic produces bronchiolar and bronchospasm. Diagnosis primarily provided by: wheezing, expiration and especially easy to hear. Spasmodik cough Pseudotosferínica and in the acute phase, which remains thick and productive. Mainly present as tachypnea, dyspnea. Hyperinflation is given to us by the increase of percussion sounds. This was stated by the inspiration suprasternal and intercostal retractions. It is evident radiographically.

3. Physiotherapy clinical examination and evaluation.

Babies suffering from obstructive respiratory diseases, clinical examination should provide a series of signs that must always be connected. Although there are no doctors instrumental measurements, which will certainly help validate the techniques of chest physiotherapy, we must recognize that not be used in the field regularly. Physiotherapy examination requires specific training to quickly determine the most appropriate technique, after identifying the location, nature and level of airway obstruction. Equipment needed at least: a stethoscope, pulse oximeter and the ball of emergency resuscitation. The lung auscultation: This is the basis of specific exploration of respiratory therapists. A careful that the indication of auscultation of the technical guidelines and gave us results. This allows us to classify the sounds of breathing target, meaning the sound emitted by the intra-or extrathoracic respiratory noises Respiratory, orchids breath, crackles, thick runcus both crackles, wheezing. To be effective auscultation should be systematic. Children begin in the supine position and then another to compare hemothorax breath sounds in both. This begins with the foundation and advanced to the paraspinal regions, regions subaxilares side, then the knot. Discussed below anterior thoracic, subclavian and supraclavicular fossa. Play and record sounds of breathing in young children have some difficulty given by age: no breath control to not work together, their breathing rate is high and the variables that need further attention, crying, and often sound nasopharyngeal intrathoracic respiratory mask sounds. It is also important to hear directly without a stethoscope, the sound in the mouth. Physics provocative maneuvers. To determine the types of physiotherapy interventions we can use due care to identify which of the four possible types of ventilation problems in children before us. So we can not determine a diagnostic label.

Our technique is based solely on the four modes of ventilation possible: slow or forced inspiration and exhale slowly or forced. Prescription provides information on diagnosis and proper treatment and clinical examination gives us a treatment strategy.

Consistent to the above here is how to implement this manipulation on muscle attachments points:

1. Palpate carefully for muscle mass of the lumbar spine or back or both as appropriate.

2. Identify the areas or hard spots (areas with increased muscle tone)

3. Start with the pressure with the thumbs from the area more caudal to the most cephalad muscle pressure points holding it for 10 seconds.

4.Después initial pressure with thumbs make circular paths for and against the hands of reloj.20 times in favor and 20 times anti-clockwise.

5. The next step is to lobby fast with a frequency of 1 per second to make forty.

As we can observe is an extremely simple technique in soft tissue treatment especially where there are trigger points, muscle spasms, increased tension in the tonic muscle and back pain syndromes.
Emphasize the simplicity of the technique, but I really hope that if anyone has applied this technique to be a physical therapist and not a professional masseur or false empirical or other professional.

Maybe you have often heard the word  Physiotherapy , but it’s not a lot, too  who knows what the hell that can be done on patients in the physiotherapy. Some say that if you’ve been to physiotherapy once wrote, we can addiction to be treated again .. and again, well … like a drug . When most people come to doctors because they feel sick, funny … there are patients who come to physiotherapy were not for that, because in addition to reducing the patient’s pain complaints, no physical therapy equipment that also can be used for relaxation such as to eliminate feeling stiff and tense the muscles of our body.

In addition, for the little brothers who should not take too many drugs when coughing or runny nose, physiotherapy can also help cure coughs and colds more quickly and effectively as drugs given directly inserted into the respiratory tract, so that more  smaller than drugs that must be taken.

Physiotherapy can also be applied to women who have a complaint in the lower abdomen area due to inflammation of the womb or for married women who do not have children, where the therapist works to open the cervix so that drugs can be given to doctors uterus properly.

If you have a complaint-you around the ears, like a buzzing sound, hearing becomes less good, until there is pain in the ear, in addition to taking drugs from doctors, therapists also can help reduce these complaints.

Muscles in the abdominal wall consists of several muscles, including:
o Rectus abdominis: this muscle in the front and is often referred to as the “six pack” if it continued to be trained.
o Internal and External Oblique: these muscles are in addition to the body and serves to side rotasion

What are the symptoms of stomach muscle injury?
Abdominal muscle injury often causes pain suddenly in areas that experienced muscle injury. And when did flexion / bending back pain comes to the fore. The most common symptoms are muscle tension frequently. Sometimes swelling occurs as a result of muscle injury
abdominal muscle injury is divided into several grade / degree based on the severity of injury are:
• Grade I (Mild): a little uncomfortable, no limitations. Usually does not interfere with the activity.
• Grade II (Moderate): Moderate discomfort, activities such as flexion or rotation of the stomach side a bit disturbed.
• Grade III (Severe): the normal activities that involve the stomach there is pain. Often patients complain of tension and swelling occur in the stomach.

Treatment is most appropriate for abdominal muscle injury?
Treatment for abdominal muscle injuries is difficult, there is no other way is by  stomach / abdominal splint and rest in total. After that the other most important thing is to let your stomach muscles to keep it relaxed sam pies berakhire inflammatory process. Then avoid certain exercises that dapt cause injury to muscles  recovery process. Activities that can cause pain or muscle tension avoided.
A gentle very helpful, but should not cause pain. Maximum  can be dangerous and hinder the process of muscle recovery. Apply ice to the area that suffered injuries in the acute phase (first 48 hours after the injury). by detecting light warm-up can help muscles relax.

When do I need a doctor for this injury?
If you are experiencing a muscle injury is evaluate the symptoms and impacts arising from these symptoms on your activities such as roads, sitting, or during sleep, then you did another medical evaluation.
If you believe that you suffered injury in your abdominal muscles or the symptoms do not occur quickly lost and you have to evaluate it. Your doctor or physiotherapist can help you in your muscles Agra treatment recover soon. Some people do this by using modalities such as ultrasound, massage therapy and special exercises to help recovery. You have to listen to your doctor if everything is in accordance with the conditions that you feel.

Secondary lymphedema is an important chronic complication after surgery for breast cancer or radiotherapy. It is caused by damage to the lymphatic system during treatment, leading to fluid retention and swelling of the arm. Subsequent to 71% of women in the 12 months after surgery and can also cause disfigurement, anxiety, depression and emotional distress.

Currently, women with breast cancer have a 77% probability of surviving at least 10 years, effectively preventing and treating complications that can impair the functioning and affect quality of life after treatment are important .

Thus, a research team set out to Madrid to study the effectiveness of early physical therapy to reduce the risk of secondary lymphedema after surgery for breast cancer.

They identified 120 women who had undergone breast cancer surgery involves removal of lymph nodes between May 2005 and June 2007.

Sixty patients were assigned to the strategy of education and early physiotherapy (intervention group) and 60 to the strategy of education only (control group). Both programs have lasted three weeks and patients were followed for four weeks after surgery, and again at three, six and 12 months after surgery.

Physical therapy including manual lymphatic drainage, massage scar tissue and shoulder exercises by a physiotherapist. The strategy includes educational materials about the lymphatic system and advice on how to avoid injury and prevent infection.