New Manuscripts under Review
updated on 4-July,2010

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Proteomics approaches: New Technologies and Clinical Applications in Breast Carcinomas
Breast cancer is the most diagnosed cancer in women, accounting for approximately 40,000 deaths annually in the USA. In Tunisia, the incidence of breast cancer is approximately 19 new cases per 100,000 women per year. Significant advances have been made in the areas of detection and treatment, but a significant number of breast cancers are detected late. The advent of proteomics provides the hope of discovering novel biological markers that can be used for early detection, prognosis, diagnosis, and therapy. Several proteomics technologies have been used to uncover molecular mechanisms associated with breast carcinoma at the global level to discover protein patterns that distinguish disease and disease-free states with high sensitivity and specificity. Two dimensional gel electrophoresis coupled to mass spectrometry constitute a new proteomics-based paradigm for detecting disease in pathology specimens and monitoring disease response to therapy. This review describes theses proteomics technologies and their application in the analysis of breast carcinoma.

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Kaposi's Sarcoma
Kaposi’s Sarcoma is a proliferative multifocal disease. We can distinguish the classical form, the endemic form, the iatrogenic form and the epidemic form with AIDS. The histopathological aspect is the same,with angiogenesis, edema, perivasal erythocytes, lymphocytes, monocytes and spindle cells. Local cytokinases act on activated endothelial cells and on monocyto-macrophagic cells and acquire different characteristics for regulation of FVIII-RA or stimulate proliferation of Kaposi’cells. Now we known that HHV8 virus is considered to be the etiological agent of all Kaposi forms. Authors debate the origin of the spindle cells and show 14 cases of Kaposi’s sarcoma by histological investigations and by immunohistochemical peroxidase anti peroxidase (PAP) for presence of Factor VIII. The assume that Kaposi’ s sarcoma does not have an exclusive origin.

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Laryngeal synovial sarcoma: Case report and Literature review
Synovial sarcoma is a rare malignant mesenchymal neoplasm of youth with no benign counterpart. The involvement of the head and neck region is rare, and the laryngeal location is exceptional, which make the correct diagnosis challenging for the surgical pathologist. Up to our knowledge, only 14 cases have been reported so far within this site. Here we add a new case with literature review.

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Comparison of Dosimetric Characteristics of Physical and Enhanced Dynamic Wedges
In this study the dosimetric properties of Varian Enhanced Dynamic Wedge (EDW) and Physical wedges (PW) were analyzed and compared. The physical wedge filters on the Varian Clinac DHX Accelerator have nominal wedge angles of 150, 300, 450 and 600. In Enhanced Dynamic Wedge technique no external beam modifier is used to create wedge dose profiles, instead wedged isodose profiles are created by the sweeping action of the jaw from open to closed position while the beam is on. The physical wedge output factor for 6 and 18 MV photons are compared with the open field output factors. The variation in the output factor is small for smaller field sizes and it increases with increase in field size and wedge angle. The physical and enhanced dynamic wedge factors were compared. The wedge factor was found to decrease with increase in field size for the enhanced dynamic wedge, whereas for the physical wedges the wedge factor doses not vary significantly. The difference in percentage depth dose (PDD) for open and physical wedge fields have been observed for both photon beams. The wedge field depth dose data are greater than the corresponding open field values, indicating hardening of the beam by the physical wedge filter. The measured isodose plots for physical and enhanced dynamic wedges were compared for both photon beams. Dose contribution to the ‘toe’ side of the EDW is more. The measured profiles of physical and enhanced dynamic wedges at the depth of dmax, 10 cm and 20 cm were compared. The results show that the profiles obtained at various depths are comparable. The dosimetric characteristics like profile and isodose of enhanced dynamic wedge closely match with that of the physical wedge. The number of monitor units to deliver a particular dose with EDW field is less than that of PW field due to change in wedge factor.

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Early Infections in the Stem Cell Transplant Recipients at AIIMS, New Delhi: A prospective study
The pattern of infections in neutropenic patients including those undergoing stem cell transplant in the west has changed but the same may not be the case in the developing countries as brought out through some earlier observations in some transplant centers in India. The department of medical oncology IRCH, AIIMS has been providing bone marrow transplant facility for over a decade now. It is one of the few bone marrow transplant units in northern India. A prospective study conducted on 70 consecutive bone marrow transplant subjects at this center was carried out with this perspective in view. Objectives: To determine the frequency and pattern of infections in haemopoietic stem cell transplant (HSCT) recipients at this center in India.

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Mutations in EGFR Signal Pathway in Correlation with Response to Treatment of Head and Neck Cancers
The prognostic and predictive value of the epidermal growth factor receptor (EGFR) expression and some genetic alterations in an EGFR signal pathway, such as the EGFR amplification, the EGFR activating tyrosine kinase mutations or the k-ras gene mutation were investigated in our study. The aim of the research was to evaluate the occurrence of the above-mentioned biomarkers in the correlation with a therapeutic response and survival in patients with spinocellular head and neck cancers. The presence of activating mutations in the EGFR tyrosine kinase domain, the k-ras mutation and the correlation between the EGFR gene amplification and the receptor expression were proven.

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Late Presentation of Breast Cancer in Aden, Yemen
The aim of this study is to determine the frequency and characteristics of patients presented with late stage breast cancer in Al-Amal Oncology Unit in Aden. It was conducted retrospectively in Aden, at Al-Amal Oncology Unit of Al-Gamhouria Modern General Hospital, by reviewing all records of breast cancer patients at any stage, attended with histopathologically documented breast cancer, from the time of establishment of the unit, Dec. 1st, 2007, till Dec. 31st, 2009. The total number of documented breast cancer patients was 197; they were classified according to the stage at presentation after exclusion of 21 patients who were not staged. We selected those patients with late inoperable stages, they were 118 patients, and evaluated carefully their demographic characteristics, and we found that they represented 67.0% from the total staged breast cancers. Most of them are in the reproductive age, residents in Aden governorate and the neighboring governorates. Metastasis was mainly evident to the lymph nodes, bones, liver and lungs. The case fatality rate is 8.5 per 100 patients with late stage breast cancer. This study concluded that high percentage of Yemeni patients in Aden presented with late stage breast cancer that led to failure of curative surgical intervention as well as metastatic disease and higher case fatality rate.

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Case report and Review of Literature: Temporary Asymptomatic Sinus Bradycardia with Carboplatin, Paclitaxel and Bevacizumab: Under-reported in Clinical Trials and under-disclosed in practice.
Carboplatin, Paclitaxel and Bevacizumab (PCB) one of the standard chemotherapy regimens for the treatment of non small cell lung cancer. Temporary asymptomatic bradycardia is recognized toxicity of paclitaxel. However, it is under-disclosed to patients during consent for treatment and is under-reported in clinical phase III trials. Case report: Here, we report a case of severe but temporary asymptomatic sinus bradycardia (heart rate 39 bpm) in a patient immediately after receiving PCB. The patient was not informed of this risk during consent to therapy leading to non-compliance with future plan of management. Literature search showed that bradycardia is documented. However, it is not reported adequately in land mark phase III trials’ reports. Conclusion: The cause of bradycardia in this patient is probably paclitaxel. Oncologists should disclose this potential risk to patients during consent to chemotherapy. Investigators should monitor and report it when conducting land mark trials.

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Proteomic approach to remove albumin for the analysis of low abundance biomarkers in human breast plasma
Breast cancer is the most diagnosed cancer in women, accounting for approximately 40,000 deaths annually in the USA. In Tunisia, the incidence of breast cancer is approximately 19 new cases per 100,000 women per year. Significant advances have been made in the areas of detection and treatment, but a significant number of breast cancers are detected late. The advent of proteomics provides the hope of discovering novel biological markers that can be used for early detection, prognosis, diagnosis, and therapy. Several proteomics technologies have been used to uncover molecular mechanisms associated with breast carcinoma at the global level to discover protein patterns that distinguish disease and disease-free states with high sensitivity and specificity. Two dimensional gel electrophoresis coupled to mass spectrometry constitute a new proteomics-based paradigm for detecting disease in pathology specimens and monitoring disease response to therapy. This review describes theses proteomics technologies and their application in the analysis of breast carcinoma.

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Gastrointestinal Stromaltumours (GISTs): Case Report and Review of the literature
We report a 56-year old male patient with recurrent and metastatic gastrointestinal stromal tumors (GISTs) who presented with hepatic and brain metastases. Despite the patient's GISTs was negative for c-Kit (CD 117), he responded to imatinib mesylate (Glivec) treatment with complete resolution of his liver and brain lesions. The patient has been and still in complete remission for 18 months of follow up.

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Few other cases with asymptomatic primary colonic cancers have been reported in literature including metastases to spleen, subcutaneous tissue, vulva, pericardial involvement with tamponade, and lung or presenting as post menopausal bleeding. Patients with pelvic malignancies should be evaluated with caution in view of possibility of overlapping primaries and this emphasizes the need for a more careful evaluation of these tumors in their three-dimensional aspect, including cystoscopic and colonoscopic evaluation.

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Replaced Common Hepatic Artery from Superior Mesenteric Artery during Pancreaticoduodenectomy
The hepatic arterial anatomy is anomalous in nearly 50% of all individuals. The most common anomalies include the right hepatic artery arising from the superior mesenteric artery and the left hepatic artery arising from the left gastric artery. The incidence of the common hepatic artery (CHA) originating from the superior mesenteric artery (SMA) has been estimated to be 1.5% - 4.0%. Pancreatoduodenectomy (PD) is the standard operative procedure for periampullary cancer and other pancreatic diseases. When planning for PD, knowledge of the hepatic arterial blood supply is essential to avoid unnecessary surgical complications, and this can best be achieved by preoperative imaging evaluation of the vasculature.

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Bilateral Adenoid Cystic Carcinoma Breast – A case report with review of literature
Though more common in salivary glands and relatively common in other organs like lacrimal glands and trachea, the incidence of adenoid cystic carcinoma (ACC) in breast is very rare. Only around one hundred and fifty such cases have been reported worldwide. It has no predilection towards laterality. However, we could not find any bilateral lesions of ACC breast in the available literature. For the first time in world literature, we have diagnosed a forty-eight-year-old woman with ACC of both breasts, when she presented with bilateral painful and tender breast lumps. After mammogram and fine needle aspiration cytology were suspicious of malignancy on both sides, the patient was posted for bilateral modified radical mastectomy. Frozen sections of both lesions were suggestive of invasive carcinoma and the surgical pathology report turned out to be bilateral high-grade adenoid cystic carcinoma. She was treated with adjuvant chemotherapy and radiation, and then put on hormonal therapy. The patient has completed two years post initial diagnosis and is on regular follow-up till date without any clinical or radiological evidence of disease recurrence. The case is reported here with review of relevant literature.

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Breast Conservative Surgery For Operable Invasive Ductal Carcinoma After Neoadjuvant Chemotherapy Or Hormonal Therapy- A Challenge For Breast Surgeon
Neo adjuvant chemotherapy or hormonal therapy is based on biological data and enables more patients to be treated with breast conserving surgery for locally advanced T2 and T3 without significantly increasing the rates of ipsilateral breast recurrence. Careful consideration of an optimal preoperative planning aims at accurately determining the patterns of primary tumour down staging and at the amount and location of any residual tumour in the breast ,besides converting patients from mutilating surgery candidates to candidates for breast conservative procedure. The use of induction chemotherapy has the potential to improve the cosmetic results but free margins must be achieved and surgery must be planned in onco- plastic surgery . Axillary lymph node clearance is still the gold standard surgery. Sentinel lymph node biopsy can be done for clinically N0 patients but only in control trials.

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Aleukemic Myeloid Sarcoma Presenting as Compressive Myelopathy
Myeloid sarcoma, earlier called granulocytic sarcoma or chloroma is a localized extramedullary tumor composed of malignant cells of the myeloid cell line. It occurs most frequently in association with acute myelogenous leukemia or as extramedullary relapse in AML but can present primarily without frank acute leukemia, frequently involving spinal cord, as in a case summarized below or other sites of central or peripheral nervous system.

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Role of Pemetrexed in Advanced or Metastatic Non-Squamous Non-Small Cell Lung Cancer
Background: Adenocarcinoma and large cell types constitute around 45% of lung cancer. Pemetrexed is a multitargeted antifolate chemotherapy agent used in lung cancer. Its variable effective responses on different pathological subtypes of lung cancer are still under research and evaluation. The aim of the study was to find the additive benefits of pemetrexed as antifolate chemotherapy on non-squamous non-small cell lung cancer.

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Extensive Visceral Calcification Demonstrated on Tc-99m MDP Bone Scan in Patient with Sphenoidal Sinus Carcinoma and Hypercalcaemia of Malignancy: A Bad Prognostic Sign
Sphenoidal sinus carcinoma is a rare cause of hypercalcemia of malignancy. We report on a 37-year-old male with sphenoidal sinus carcinoma with intracranial extension who developed hypercalcemia of malignancy with progressing disease and demonstrated diffuse metastatic visceral calcifications of lungs, myocardium, stomach, kidneys and thyroid on follow-up 99mTc-methylene diphosphonate bone scan. In the absence of extensive skeletal metastases bone scan help confirm humoral nature of hypercalcaeimia.

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Adrenocortical Tumors in Children
Introduction: Adrenocortical tumors (ACT) are rare tumors of childhood. The majority of these tumors are hormone-producing and cause virilization and Cushing’s syndrome or feminization. Methodology: The authors describe 6 cases of adrenal cortical tumors treated in the Kuwait Cancer Center; which were presented over a period of 20 years (1989-2009). Results: The mean age was 5.5 years (range 15 months – 12 years). All had signs of virilization. One child had hypertension, while 2 had a metastatic disease at presentation. The diagnosis was made by clinical signs and symptoms, high levels of relevant adrenal hormones and imaging. Two children were not fit for surgery; one was too sick for any treatment and died shortly after diagnosis, while the other died after receiving one cycle of palliative chemotherapy. Four patients underwent complete surgical resection and achieved complete remission, three of whom later had recurrence (distant in one and local in two patients) and succumbed due to progressive disease. Mitotane was used in two children. Only one patient is currently surviving and well nearly 13 years after her surgery. In our series, the long term outcome of children with adrenocortical tumors was very poor. Conclusions: Virilization is an important clue to the diagnosis of ACT. Early diagnosis and complete surgical resection are important for survival. Metastasis at presentation or as recurrence carries very dismal prognosis.

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Verruciform xanthoma of the penis in a young male masquerading as squamous cell carcinoma
Verruciform xanthoma(VX) is a relatively rare benign lesion of unknown etiology with a predilection for oral mucosa. Penis is an uncommon location and to date only 17 cases of VX of penis have been reported. The lesion assumes importance as it can be easily mistaken for verrucous carcinoma or squamous cell carcinoma. We present herein a case of penile VX in a 25-year-old man who was referred to our institute with a histopathologic diagnosis of squamous cell carcinoma reported elsewhere. On microscopy the lesion demonstrated florid verruciform hyperplasia of the epidermis with hyperkeratosis, parakeratosis and acanthosis. There was a dense infiltrate of foam cells in the papillary dermis(a hallmark of VX), which were positive for CD68 and negative for S-100 protein. We present this case to highlight the significance of recognizing VX in extra oral location. An awareness of this entity is crucial to prevent misdiagnosis and halt inappropriate therapeutic intervention.

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Population-based study of Hodgkin's lymphoma in Kuwait
Hodgkin lymphoma (HL) comprises about 25% of all malignant nodal lymphomas worldwide. Incidence of HL has been increasing in many countries around the world, in the west in particular. Cancer incidence Variations in different ethnic groups in the same country can lead to some important information about the search of etiological factors. Some researchers found an association between ethnicity and increased risk of HL. In this study, we evaluated the epidemiologic and clinical characteristics of patients with HL and the HL subtypes in Kuwait who were diagnosed between 1998 and 2006 and analyzed the changes in the incidence of HL over time based on age, sex, and ethnicity.

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A comparative dosimetric study of adjuvant 3D conformal radiotherapy for operable stomach cancer versus AP-PA conventional radiotherapy in NCI-Cairo
The purpose of this study was to compare this multiple-field conformal technique to the AP–PA technique with respect to target volume coverage and dose to normal tissues. Materials and methods: Seventeen patients with stages II–III denocarcinoma of the stomach were treated with adjuvant postoperative chemoradiotherapy presented to radiotherapy department in National Cancer Institute , Cairo in period between February 2009 to March 2010 using 3D conformal radiotherapy technique that consisted of a monoisocentric arrangement Employing 4- 6 radiation fields. For each patient, a second radiotherapy treatment plan was generated utilizing AP–PA fields , the two techniques were then compared for target volume coverage and dose to normal tissues using dose volume histogram (DVH) analysis. Results: The planning target volume (PTV) was adequately covered in both ( 3D & 2D ) plans , comparative DVHs for the right kidney, left kidney and spinal cord demonstrate lower radiation doses using the conformal technique especially for left kidney & spinal cord , but the liver doses is higher but still well below liver tolerance.

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Clinico-pathological study and treatment results of 1009 operable breast cancer cases: Experience of NCI Cairo University
Aim of study: This retrospective study was designed to evaluate clinico-pathological data including stage, results of treatment, and prognostic factors which affect the overall survival & disease free survival. Patients and methods: This is a retrospective study carried out at the radiotherapy department, National Cancer Institute, Cairo University on 1009 patients treated for primary breast cancer between1999 – 2003. Results: The median follow-up was 68 months. Loco regional relapse occurred in 23 patients (2.3%) and distant relapse occurred in 203 patients (20.1%). Both loco regional and distant relapse were reported in 32 patients (3.2%). The DFS at 3 and 5 years were 87% and 78% respectively , while OAS at 3 and 5 years were 96.4% and 91.4% respectively. Multivariate analysis of different prognostic factors showed that the independent bad prognostic factors in the study for disease relapse are positive lymph nodes (more than 10) , tumor size T3, T4 with significance of 0.0001 for each. And pathologic grade with significance of 0.003. Adjuvant chemotherapy showed no significant improvement in the survival for node negative patients as a whole, but for T3 andT4 lymph nodes negative patients, significant improvement in the median survival in favor of the use of adjuvant chemotherapy was reported. (P value = 0.03). As regard timing of radiotherapy the 3 and 5 year disease free survival was significantly higher in patients who started radiotherapy within three months after date of surgery (93% and 85% respectively) (p value = 0.0001) , while the delay in starting chemotherapy didn’t affect the prognosis significantly in the studied group as a whole.

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Peripheral dose from a dual energy linear accelerator equipped with tertiary multileaf collimators and enhanced dynamic wedge
Peripheral dose (PD), or the dose outside the geometrical boundaries of the radiation field, is of clinical importance. The aim of the current study was to estimate the PD on linear accelerators without multileaf collimator (MLC) and different type of wedges. Measurements were performed on a dual energy linear accelerator equipped with tertiary MLC and enhanced dynamic wedge (EDW). Measurements were made using an ionization chamber embedded in a Radiation Field Analyser (RFA 300) with the secondary collimator and MLC setting of 5x5, 10x10, 15x15, and 20x20 cm2, and with the MLC fully retracted. The effect of SSD on PD were measured at three SSDs of 90, 100, and 110 cm for the irradiation fields of 5x5, 10x10, 15x15, and 20x20 cm2 and the effects of the three different wedges (Upper wedge, Lower Wedge and Enhanced Dynamic Wedge) on PD were measured for 450 wedges with field size of 15x15 cm2. Data were taken from 3 cm to 24 cm away from the field edge. From the results obtained, due to the tertiary MLC, PD can be reduced by means as a factor of two to three, at certain distance from the edge of the field, compared with TG-36 data. In between the wedges, the PD was less for the EDW when compared to the both upper and lower physical wedges. It is concluded that the reduction in PD is significant enough to reduce or eliminate the need for external peripheral shielding to reduce the dose to the critical organs. Keywords: peripheral dose, multileaf collimator, enhanced dynamic wedge, linac, MLC

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Hashimoto's disease in a bilateral benign cystic ovarian teratoma- a case report
A wide array of tissues derived from all the three germinal layers is seen in ovarian teratomas. Among these thyroid tissue is present in 10 % cases of all mature cystic teratomas. While the histological features of several disorders of thyroid tissue may be discovered, Hashimotos' thyroiditis is extremely rare finding. We report this case of Hashimotos’ thyroiditis in a clinically euthyroid patient who tested positive for antithyroid peroxidase antibodies inspite of normal thyroid hormone profile.

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Transitional cell carcinoma of cervix: a case report with clinical, histologic and cytologic findings
Papillary carcinoma of the uterine cervix with features reminiscent of transitional cell carcinoma of urothelial origin is a poorly recognized subtype of cervical carcinoma. This tumour has a propensity for late metastasis and local recurrence inspite of the fact that histologically it could be misinterpretefd as cervical intraepithelial neoplasia grade III with a papillary configuration or as a squamous cell papilloma. This tumour occurs mainly in postmenopausal females , is potentially aggressive and presents at a more advanced stage. Here we present a case of 65 year old female who presented with postmenopausal bleeding and pelvic pain.

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Do our patients have different tolerance to TAC protocol for early breast cancer from western population?
Background :To assess the efficacy and the tolerability of TAC protocol in early breast cancer patients with node positive in the adjuvant treatment in comparison with original TAC protocol study. Methods: We included 64 patients with early node positive breast cancer in our study during October 2003 – May 2009 according to the inclusion criteria. They received TAC protocol chemotherapy, Disease free survival (DFS), Overall Survival (OS) and toxicity profile were assessed. Results: Median age of the patiens was 46 years. All patients except one received 6 cycle of chemotherapy according to TAC protocol. Median follows up was found 60 months. Disease free (DFS) and Overall Survival (OS) were 77% and 87%. Respectively. The chemotherapy was well tolerated and the toxicity profile was better when compared to the previous published studies. Conclusion: TAC protocol in the adjuvant treatment of early breast cancer was effective and better tolerated than western population as evident by the toxicity profile provided the G-CSF to be started as primary prophylaxis from the first cycle. Keywords: breast cancer, adjuvant treatment, chemotherapy, TAC protocol

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Lipoadenoma of the parathyroid gland – A rare cause of hyperparathyroidism. Report of one case
Lipoadenoma of parathyroid gland is an unusual morphologic variant of parathyroid adenoma in which the glandular elements are associated with abundant mature adipose tissue. The lesion has also been reported as parathyroid lipohyperplasia, parathyroid hamartoma, and parathyroid adenoma with myxoid stroma. Most cases are functioning and are associated with hyperparathyroididsm. Lipoadenoma of parathyroid gland are difficult to diagnose as a cause of hyperparathyroidism because of rarity of these lesions. Only few cases have been documented in the literature so far. The lesion may be overlooked by both surgeon and pathologists alike, if they are not aware of this specific clinicopathologic entity.

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Second Primary Tumour in the Intraoral Skin Pedicle of Pectoralis Major Myocutaneous Flap Seven years after Reconstruction
Secondary primary tumor developing in the skin paddle of a myocutaneous flap is a rare event. We are reporting a case of squamous cell carcinoma arising in the skin of pectoralis major myocutaneous flap (PMMC) used for the reconstruction of oral cavity. Keywords: Squamous cell carcinoma, PMMC flap, Second primary tumour

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Multiple Ancient Schwannoma of the accessory nerve - A Case Report
We are reporting a case of multiple ancient schwannoma of the accessory nerve in a 57 year old male. Accessory schwannomas are rare with only 19 cases reported in literature so far. Ancient schwannoma is even rarer in the head and neck region with no other cases associated with the accessory nerve being reported in literature so far. Keywords: schwannoma, neurilemomma, ancient, accessory nerve, neck

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Hepatoid Adenocarcinoma of the Stomach – A rare pathological entity
Hepatoid adenocarcinoma is a rare cancer with an extremely poor prognosis. Here, we describe two cases referred to our hospital with suspected gastric cancer. Gastrointestinal endoscopy revealed lesions in the stomach. Biopsy from the lesions was reported as adenocarcinoma. Both the patients underwent exploratory laparotomy. One was an operable lesion and the other was an inoperable lesion. Total gastrectomy was done in the operable lesion and feeding jejunostomy was done in the inoperable case. Histologically both turned out to be hepatoid adenocarcinomas. Retrospective analysis showed the serum level of alpha-fetoprotein (AFP) to be markedly elevated in both the cases. We describe this rare entity of hepatoid adenocarcinoma of the stomach, and review the literature concerning the clinicopathological aspects. Keywords: Gastric cancer, Hepatoid adenocarcinoma, Alpha Feto Protein, Stomach

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Disease profile and treatment results of anal canal SCC: Experience from AIIMS, New Delhi
Introduction: Anal Canal squamous cell carcinoma (SCC) accounts for nearly 2% of all cancers of alimentary tracts. In the last 25 years, the management of anal canal cancer has changed from primary surgery to primary chemo- radiotherapy (CRT). Methods: Total 83 (62 males, 21 females) patients (pts) records were retrospectively reviewed. Length of disease was <5 cm in 44 and confined to primary in 46 pts. Ten pts had anti-cancer therapy outside. We delivered radiotherapy (RT) alone to 16, chemotherapy (CT) alone to 4, CRT in 51 and preop RT in 2 pts. RT dose up to 30 Gy=16; 30-50 Gy= 12 and >50 Gy = 41 pts. Results: RT compliance was optimal in 64/69, grade (Gr) ≤ 2 toxicity in 56/69 and Gr ≥ 2 in 13/69 pts. Thirteen pts (18.84%) were hospitalized during RT. No response (NR) was found in 4/83, <50% in 18/83, >50-<100% in 39/83 and complete response (CR) in 22/83 pts. Recurrence at primary site was seen in 7 and locoregional in 2 pts. Salvage therapy was done in all 9 pts (surgery= 8 and CT= 1). Status at last follow up, alive without disease= 22/83 and with disease =61/83 pts. Conclusion: This retrospective analysis revealed that the advanced disease was in 47%, the optimal anti-cancer therapy could be delivered to 63.9%. Despite heterogeneity in pts population and management, the overall disease-free survival (DFS) with sphincter-preservation was achieved in 26.5% pts. Key Words: Anal canal, squamous cell carcinoma, chemoradiotherapy, sphincter preservation, disease free survival

Prediction of Anthracyclin Induced Cardiotoxicity: Study of thirty one Iraqi adults patients
Objective: To look for a nearly ideal tool for prediction of anthracycline-induced cardiotoxicity. Method: Thirty one patients with various hematological malignancies were included in the study which was conducted from Sept.2005 to Sept.2006 in Baghdad Teaching Hospital / Hematology Unit .Initial cardiovascular assessment including cardiac troponin I,electrocardiography and echocardiography was done and repeated one month after the commencement of anthracycline-based regimen. Cardiotoxicity was considered present if the patient has clinical and electrocardiographic evidences, troponin positivity, echocardiographic evidence, or any combination of these. Results: The mean age for the study sample was 34+ 17 years, with 17 male and 14 female. Increasing age, body surface area, anthracycline dose as well as the concomitant use of cyclophosphomide/All Trans Retinoic Acid were associated with increased risk of cardiotoxicity. The cutoff point of body surface area above which the risk of anthracycline-induced cardiotoxicity is increased was 1.88 m2 while the cut off point for anthracyclines dose was 145.5 mg/m2. The constellation of clinical data, ECG, and cTnI was 92% predictive of early evidence of anthracycline-induced cardiotoxicity. More weight is added when echocardiography is used as a diagnostic tool. The incidence of cardiotoxicity attributed to treatment was 38.7%.The predictive power of cardiac troponin I alone was 58.3%, whereas it increases to 91% when combined with electrocardiography and to 95% when combined with echocardiographic study. Conclusion: The age, anthracyclines dose and the use of other chemotherapeutics increase the risk of anthracycline-induced cardiotoxicity. Cardiac troponin I is a simple non invasive indicator for the presence of anthracycline-induced cardiotoxicity especially when used in combination with other parameters. Keywords: Anthracycline, Cardiotoxicity, Troponin.

Gum hypertrophy in a patient of multiple leiomyomata cutis receiving high dose nifedepine – Report of a case and review of literature
Gum hypertrophy has been reported to occur as a side effect of long term use of calcium channel blockers, cyclosporine, tacrolimus, phenytoin, etc. Here we report a case of gum hypertrophy in a patient of (painful) cutaneous leiomyomata on prolonged and high dose nifedipine. Keywords: Nifedepine, Gum hyperplasia, Leiomyomata