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Verrucous carcinoma should be distinguished from typical squamous cell carcinoma. The clinicopathological features, differential diagnosis, and therapy are discussed here together with the molecular biologic aspects of the tumor.

Objectives:An exploratory investigation is reported into the role of spirituality and religious practice in protecting against depression among older people living in rural villages in Bulgaria and Romania, two neighbouring countries with similar cultural, political and religious histories, but with differing levels of current religiosity. Methods:In both countries interviews were conducted with samples of 160 persons of 60 years and over in villages of similar socio-economic status. The HAD-D scale and the Royal Free Interview for Religious and Spiritual Beliefs were used to assess depression and spiritual belief and practice respectively. In addition social support, physical functioning and the presence of chronic diseases were assessed. One year later follow-up interviews were conducted with 58 of the original sample in Bulgaria, in which additional measures of depression and of spiritual belief and practice were also included. Results:The study demonstrates, as expected, significantly lower levels of spiritual belief in the Bulgarian sample, as well as significantly higher levels of depression, the latter attributable in large part to higher morbidity and disability rates, but less evidently to differences in strength of belief. However analyses from both the cross-sectional study and the one year follow-up of the Bulgarian sample do suggest that spiritual belief and practice both influence and reflect physical and mental illness. Conclusions:Religious and spiritual belief and practice constitute important means of coping with both physical and mental health problems in later life. Further investigation of their protective role is encouraged in populations of diverse religiosity.

Disabling pansclerotic morphea of childhood (DPMC) is a rare and severe variant of scleroderma. This report presents 3 cases that presented to the authors and studies 25 patients from the literature (English language only) for the presence of chronic nonhealing ulcers of skin and skin cancer. The authors identified a total of 30 patients (9 male and 21 female) aged between 1 and 37 years at time of presentation. All cases were less than 14 years old when the disease started. The majority of patients had an aggressive course with deep sclerotic lesions leading to joint contractures and immobility. Five patients suffered from chronic nonhealing leg ulcers (17%), but ulcers were present on other parts of the body (upper limbs, trunk, head) as well (n = 6). Four patients died because of complications of the disease such as sepsis or gangrene. Two patients developed a squamous cell carcinoma at the age of 16 years and 19 years, respectively (6.7%). The available treatment of DMPC-associated ulcers is unsatisfying. Only temporary improvements have been seen in a minority of patients. We report on marked improvement of chronic leg ulcers by a combination of sildenafil 3 x 20 mg/day and repeated application of a porcine small intestinal submucosal acellular matrix.

Backgroundthe European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations.Methodsunder the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators.Resultsthe final recommendations include four different domains: ‘General Considerations’ on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), ‘Knowledge in patient care’ (36 sub-items), ‘Additional Skills and Attitude required for a Geriatrician’ (9 sub-items) and a domain on ‘Assessment of postgraduate education: which items are important for the transnational comparison process’ (1 item).Conclusionthe current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.

The dramatic changes in overall mode of life experienced since 1989 by the people in Central and Eastern Europe (CEE) provides a good opportunity to study the aging processes and the status of the elderly. In the 1980s, CEE countries were already at an advanced stage of demographic aging of their populations. The first years of the period of transition from totalitarianism to democracy and market economies were marked with an abrupt but varying degree of economic and social deterioration in CEE. This was followed by partial improvement. Earlier, in the late 1960s and 1970s, mortality rates had increased along with a stagnation and decrease of life expectancy in CEE. This contrasted with the steady improvement in the European Union (EU) during the 1970s and 1980s. By 1989, there already was a striking gap in life expectancy between eastern and western Europe, revealing the existence of an East-West health divide. The most important health problems contributing to greater mortality in CEE proved to be cardiovascular and alcohol-related diseases as well as violence and injury. Suicide rates also were found higher among the (elderly) population in the countries of CEE and Russia compared with the West. The gap was most expressed among the men. The reasons for deterioration in health are complex. There is evidence that negative economic and social changes can lead to psychosocial stress and to unhealthy behaviors. The morale of the elderly people in transition was affected and many-sided. The Sofia study described here has revealed positive as well as negative personal attitudes toward the changes in life. Feelings of liberation, hope, and new perspectives were reported along with sentiments of disappointment, pessimism, and fear. In sum, transition processes have run unevenly in different countries and have had differing impacts on individuals. Nevertheless, general trends toward improving the economic, psychosocial, and health aspects of the elderly are recently prevailing.

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