Localization on the palmar face of the hand of a Darier-Ferrand dermatofiborosarcoma. About a case

Darier-Ferrand dermatofibrosarcoma is a rare but not exceptional malignant mesenchymal skin tumor, representing 0.1 % of malignant skin tumors. It is characterized by high recurrence, slow growth and low metastatic potential. Although several clinical cases of an unusual variant of Darier-Ferrand dermatofibrosarcoma have been reported in the literature, localization on the palmar face of the hand is not common. We report a case of Darier and Ferrand dermatofibrosarcoma at the level of the fourth commissure of the palm of the left hand in a 43- year-old young Malagasy adult treated by a large surgical excision with a healthy margin of two centimeters associated with adjuvant chemotherapy with Imatinib.

Pakistan-Us Security Relationship 1947-2006 Analysis of Areas of Convergence and Divergence

The US – Pakistan Security Relationship is almost as old as Pakistan itself. Its origin dates back to the initial days of partition, when a nascent, weak nation, born with a major birth defect “The Kashmir Issue”, looked for external help and support against a hegemonic neighbour. Since then, the US-Pakistan security relationship has been a roller – coaster ride of intimate interaction and a pariah state status during Pakistan’s 63 years existence. The world’s major military and economic power has maintained, what has been termed by many as “transactional” relationship, with its much smaller South Asian ally. During the height of the cold war struggle and the heydays of pacts and alliances, as US looked to form an anti - communist ring around the Soviet Union, Pakistan emerged as a staunch ally in the South – Asia region. It was called by many as the “Most Allied Ally” of the United States. In the ardent quest for gaining military and economic benefits from the US, it invited the wrath of the Soviet Union, hoping to use the US support in resolution of the long – standing dispute with India over Kashmir, and bolster its security against Indian military threat. The seismic changes brought about by the Indo – China War of 1962, radically altered this cozy equation for Pakistan. Its rapprochement with China became a major stumbling block in the security relationship and resulted in estrangement with the US. Pakistan’s military gamble in 1965 to settle the Kashmir dispute resulted in disappointment. Not only did the country fail to achieve anything tangible in Kashmir but the war also exposed all the inconsistencies and differences in the strategic perception of US and Pakistan, ultimately ending the security partnership. Though the alliances continued to exist on paper, yet they did not carry any real weight. President Nixon’s quest for rapprochement with China in 1969-1970 ironically brought Pakistan to the centre stage once again. Now the same issue on China, which had been a source of discord, revitalized the mutual relationship. While General Yahya acted as an intermediary in the US – China dialogues, the country drifted towards anarchy and breakup, owing to years of mismanagement and neglect towards the Eastern Wing. India’s invasion of East Pakistan, resulted in dismemberment of the country and a humiliating defeat, which owed much to the problems of successive regimes in West Pakistan. Yet the US response during crisis once again came under sharp criticism, as it was considered to be Pakistan’s patron and ally, and expected to support the country in the time of need. The thesis tries to identify and analyze the differing strategic perspectives during the two Indo-Pakistan Wars, as well as perceptions that resulted in disappointment and disenchantment in Pakistan. In the aftermath of the 1971 debacle, Prime Minister Bhutto looked towards nuclear deterrence as a security against Indian hegemony, because of failure of the security relationship with US to deliver at the critical time. This led to a new source of divergence in the security relationship, as the US non – proliferation goals clashed with Pakistan’s security imperatives. The Soviet invasion of Afghanistan led to a period of close security relationship, which was terminated abruptly by the US, in the wake of Soviet withdrawal from Afghanistan. This decision reinforced perceptions in Pakistan that US is an unreliable partner. The coming decade was that of Pakistan being put under pressure for its nuclear and missile programs. It also pursued an Afghan policy according to its own national interests that further estranged it from its closest ally, with every passing year. Pakistan’s support to the obscurantist Taliban regime resulted in gradual estrangement of the US Government. Even more sinister for Pakistan’s interests, was the nexus between Taliban and Al-Qaeeda. This was however glossed over by Pakistan, till the fateful events of September 11, 2001. The September 11 attack on the World Trade Center in 2001, was a defining moment in the security relationship, as President Musharraf was asked to make a tough policy decision. This time Pakistan was threatened with military action, if it decided to continue support for the Taliban. Pakistan’s decision to join the war on terrorism has resulted in a renewed security relationship with added economic and political benefits. Yet the tough decisions have resulted in internal discontent and unrest, which Pakistan is still grappling with. Now, as the Obama Administration looks towards an exit strategy from Afghanistan, Pakistan figures out as an essential component of any successful US disengagement. Will the security relationship last after the present partnership of war on terror, or wither away as the historical precedent indicates? What are the ideal building blocks of a stable, sustainable and mutually rewarding partnership? These are the questions which this thesis attempts to answer, in the light of the analysis of area of convergence and divergence over the last 63 years.