Radiation therapy for early stages of morbus Ledderhose.

PURPOSE: To evaluate the efficacy of radiation therapy (RT) in the treatment of early stages of benign plantar fibromatosis (Morbus Ledderhose [ML]). PATIENTS AND METHODS: From 2003 to 2008, 24 patients (33 sites) with a mean age of 52 years received RT for symptomatic ML. Prior to RT, 19 patients complained of pain and 15 had walking difficulties. 21 patients (28 sites) were irradiated with orthovoltage X-rays and three (five sites) received electron-beam irradiation. The RT protocol consisted of five weekly fractions of 3.0 Gy (15 Gy), repeated after 6 weeks to a total dose of 30 Gy in 20 patients (28 sites). In four patients (five sites), two single fractions of 4.0 Gy were applied, repeated at intervals of 4 weeks to total doses of 24-32 Gy. Primary study endpoints were the prevention of disease progression and the avoidance of a surgical intervention. Secondary endpoints were pain relief, improvement of gait, and patients' subjective satisfaction measured with a linear analog scale (LAS). RESULTS: After a median follow-up of 22.5 months, none of the patients experienced a progression of number and size of the lesions or the clinical symptoms. In eleven sites (33.3%) complete remission of cords or nodules occurred, in 18 (54.5%) a reduced number or size was noted, and four sites (12.1%) were unchanged. Pain relief was achieved in 13/19 patients (68.4%), and an improvement of gait abnormalities was noted in 11/15 patients (73.3%). The patients' subjective satisfaction measured by means of the LAS revealed a median improvement of 3.5 points in 22/24 patients (91.6%). Skin or soft tissues toxicities RTOG grade > 2 were not noted. CONCLUSION: RT is effective for treatment of the early stages of ML and may obviate the need for a surgical intervention. Long-term follow-up studies including a larger number of patients are required to define the role of RT in the management of this disorder.

[Parenthood and mental illness]. / Elternschaft bei psychisch Kranken.

UNLABELLED: OBJECTIVE, METHODS: To estimate the impact of various independent variables on "parenthood", "number of off-springs", "living together with off-springs" information from 438 patients was gathered. RESULTS: 193 patients were parents of 375 off-springs. "Living alone", "schizophrenia", "organic psychiatric syndrome" decreased, "being an immigrant", "older age", and "female gender" (as a trend) increased the chance of "parenthood". "Being an immigrant" and "cohabitating relationship" increased whereas "schizophrenia" decreased the number of off-springs. 184 children lived together with 103 patients. "Cohabitating relationship", "being an immigrant", "child-care support" and "affective disorder" increased, "addiction" decreased the chance of "living together with children". "Being an immigrant" and "affective disorder" increased the number of children living together with their mentally ill parents. In families with schizophrenic fathers who live together with their children, the age of the first and second child was rather low. In contrast the child-care services were used only by 10.7 %. CONCLUSIONS: Our data show the relevance of parenthood and associated therapeutic issues.