Development of Cancer Management and Care in Central India.

This is a survey report regarding the facilities of Cancer Management in Central India, consisting of Madhya Pradesh, Chhatisgarh and Rajasthan. These three states are considered less developed states medically in comparison to the northern, western and southern states. Madhya Pradesh with large population has more than 7 cities having many cancer institution/hospitals with advanced radiation centre and surgical/radiological units to improve diagnosis and management. Similarly, Chhatisgarh, a tribal state, is advancing forward with 3 centres of Advance Management for Cancer Patient. Rajasthan, Jaipur is the main centre of Advance Cancer Management with many private units operating, benefitting a large population in the state. Beside this, 5 more cities have centres of excellence in treating cancer patients with advanced radiation facilities, expert oncology surgeon and investigative facilities required in investigation and diagnosis.

Primary hyperparathyroidism: retrospective 10-year study of 32 cases.

BACKGROUND: Parathyroid glands are endocrine glands that regulate calcium metabolism. Usually four in number, they lie mostly on the posterior aspect of thyroid glands. Primary hyper-parathyroidism (PHPT) refers to a condition wherein they secrete an excess of parathyroid hormone leading to signs and symptoms of hypercalcemia. PATIENTS AND METHODS: Thirty-two patients of primary hyper-parathyroidism were seen by us in the ten years. Majority of patients were below 40 years of age (88%). Male: female ratio was 1:4. The diagnosis was made incidentally in patients who reported for various signs and symptoms not responding to treatment. High serum calcium pointed to the diagnosis of primary parathyroid hyperplasia. It was confirmed by high level of serum parathyroid hormone and localization of enlarged parathyroid glands by USG / MRI and / or Tc-99 Technetium scan. Of the 32 patients examined, 43 parathyroid glands were excised, five cases had two glands excised; out of these 4 cases underwent parathyroid reimplantation in neck/forearm muscles. One unusual case underwent operation for giant-cell tumor of the head of humerus. This patient presented with excessive vomiting not responding standard medical management in post-operative period. RESULTS: During investigations serum calcium was found to be very high, the diagnosis was confirmed by finding high parathyroid hormone and corroborated by T(99) Technetium scan. Parathyroidectomy was done in all cases, of which 59% (18 cases) developed mild to severe tetany due to hypocalcaemia. CONCLUSION: Primary hyperplasia of thyroid gland is the most important cause of hypercalcemia. Hypercalcemia is found in all cases of PHPT in our series with high parathyroid hormone levels. Majority of our cases have one gland involvement and hypocalcaemia in our series is unusually high following excision of involved gland.