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Ind T. Fertility-sparing treatment for patients with endometrial carcinoma. Facts Views Vis Obgyn 2023; 15:1-2. [PMID: 37010329 PMCID: PMC10392108 DOI: 10.52054/fvvo.15.1.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Rusch P, Ind T, Kimmig R, Maggioni A, Ponce J, Zanagnolo V, Coronado PJ, Verguts J, Lambaudie E, Falconer H, Collins JW, Verheijen RHM. Recommendations for a standardised educational program in robot assisted gynaecological surgery: Consensus from the Society of European Robotic Gynaecological Surgery (SERGS). Facts Views Vis Obgyn 2019; 11:29-41. [PMID: 31695855 PMCID: PMC6822956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The Society of European Robotic Gynaecological Surgery (SERGS) aims at developing a European consensus on core components of a curriculum for training and assessment in robot assisted gynaecological surgery. METHODS A Delphi process was initiated among a panel of 12 experts in robot assisted surgery invited through the SERGS. An online questionnaire survey was based on a literature search for standards in education in gynaecological robot assisted surgery. The survey was performed in three consecutive rounds to reach optimal consensus. The results of this survey were discussed by the panel and led to consensus recommendations on 39 issues, adhering to general principles of medical education. RESULTS On review there appeared to be no accredited training programs in Europe, and few in the USA. Recommendations for requirements of training centres, educational tools and assessment of proficiency varied widely. Stepwise and structured training together with validated assessment based on competencies rather than on volume emerged as prerequisites for adequate and safe learning. An appropriate educational environment and tools for training were defined. Although certification should be competence based, the panel recommended additional volume based criteria for both accreditation of training centres and certification of individual surgeons. CONCLUSIONS Consensus was reached on minimum criteria for training in robot assisted gynaecological surgery. To transfer results into clinical practice, experts recommended a curriculum and guidelines that have now been endorsed by SERGS to be used to establish training programmes for robot assisted surgery.
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Affiliation(s)
- P Rusch
- Department of Obstetrics and Gynaecology, University Hospital Duisburg-Essen; Hufelandstr. 55, 45147 Essen, Germany. .
| | - T Ind
- Department of Gynaecological Oncology, The Royal Marsden, London, UK;,St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London,
| | - R Kimmig
- Department of Obstetrics and Gynaecology, University Hospital Duisburg-Essen; Hufelandstr. 55, 45147 Essen, Germany. .
| | - A Maggioni
- Division of Gynaecology, European Institute of Oncology, Via Ripamonti, 435,
20141 Milano, Italy. .
| | - J Ponce
- Department of Gynaecological Oncology, Hospital Universitari de Bellvitge, c/ Feixa Llarga, sn, 08907 L’ Hospitalet de Llobregat. Barcelona, Spain.
| | - V Zanagnolo
- Division of Gynaecology, European Institute of Oncology, Via Ripamonti, 435,
20141 Milano, Italy. .
| | - PJ Coronado
- Department of Gynaecological Oncology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Avda. de Séneca, 2, Ciudad Universitaria, 28040 Madrid, Spain.
| | - J Verguts
- Division of Gynaecology, European Institute of Oncology, Via Ripamonti, 435,
20141 Milano, Italy. . ;,Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium;,Department of
Obstetrics and Gynaecology, Jessa Hospital, 3500 Hasselt, Belgium,
| | - E Lambaudie
- Department of Gynaecologic Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France;,Aix Marseille Université, Site Timone, Timone 27, boulevard Jean Moulin, 13385 Marseille cedex 5, France.
| | - H Falconer
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/University Hospital, 171 76 Stockholm, Sweden.
| | - JW Collins
- Department of Urology, Karolinska University Hospital, Karolinska Universitetssjukhuset, Solna, D1:01 171 76 Stockholm, Sweden.
| | - RHM Verheijen
- Department of Gynaecological Oncology, UMCU Cancer Center,
University Medical Center, Utrecht, Netherlands.
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Ind T, McIndoe A, Butler-Manuel S, Tailor A, Prietzel-Meyer N, Smith JR, Nobbenhuis M, Gillespie A, Ellis P, Bali A, Elghobashy A, Moss E. Re: economic evaluation of robot-assisted hysterectomy: a cost-minimisation analysis. BJOG 2015; 122:754. [PMID: 25800387 DOI: 10.1111/1471-0528.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- T Ind
- The Royal Marsden & St George's Hospitals, London, UK
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Ind T, Iles R, Desouza K, Carter P, Lowe D, Shepherd J, Hudson C, Chard T. Serum placental-type alkaline-phosphatase levels in patients with epithelial ovarian-carcinoma. Int J Oncol 2012; 6:385-9. [PMID: 21556549 DOI: 10.3892/ijo.6.2.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Serum placental alkaline phosphatase (PLAP)-type immunoreactivity was measured in 190 women with epithelial ovarian malignancy, 27 women with borderline ovarian cancer and 334 control subjects with non-neoplastic or benign gynaecological disease. Smoking, ABO blood group and menopausal status affect serum concentrations of PLAP and results were corrected for these. Circulating levels were elevated in patients with cancer and increased with stage. Levels were unaltered in borderline ovarian disease. Two-year stage corrected survival analysis demonstrated a significant worsening of prognosis in patients with serum PLAP-type levels greater than the 100th centile for controls.
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Affiliation(s)
- T Ind
- UNIV LONDON ST BARTHOLOMEWS HOSP & MED COLL,DEPT REPROD PHYSIOL,LONDON EC1A 7BE,ENGLAND. UNIV LONDON ST BARTHOLOMEWS HOSP & MED COLL,DEPT GYNAECOL ONCOL,LONDON EC1A 7BE,ENGLAND. UNIV LONDON ST BARTHOLOMEWS HOSP & MED COLL,DEPT PATHOL,LONDON EC1A 7BE,ENGLAND
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Hess V, A'Hern R, Nasiri N, King DM, Blake PR, Barton DPJ, Shepherd JH, Ind T, Bridges J, Harrington K, Kaye SB, Gore ME. Mucinous epithelial ovarian cancer: a separate entity requiring specific treatment. J Clin Oncol 2004; 22:1040-4. [PMID: 15020606 DOI: 10.1200/jco.2004.08.078] [Citation(s) in RCA: 236] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Invasive mucinous carcinoma of the ovary (mucinous epithelial ovarian cancer [mEOC]) is a histologic subgroup of epithelial ovarian cancer (EOC). Chemotherapy for mEOC is chosen according to guidelines established for EOC. The purpose of this study is to determine whether this is appropriate. PATIENTS AND METHODS Women with advanced mEOC (International Federation of Gynecology and Obstetrics stage III or IV) who underwent first-line platinum-based chemotherapy were compared with women with other histologic subtypes of EOC in a case-controlled study. RESULTS Eighty-one patients (27 cases, 54 controls) treated with platinum-based regimens were analyzed. The response rates for cases and controls were 26.3% (95% CI, 9.2% to 51.2%) and 64.9% (95% CI, 47.5% to 79.8%), respectively (P=.01). The odds ratio for complete or partial response to chemotherapy for mEOC was 0.19 (95% CI, 0.06 to 0.66; P=.009) compared with other histologic subtypes of EOC. Median progression-free survival was 5.7 months (95% CI, 1.9 to 9.6 months) versus 14.1 months (95% CI, 12.0 to 16.2 months; P<.001) and overall survival was 12.0 months (95% CI, 8.0 to 15.6 months) versus 36.7 months (95% CI, 25.2 to 48.2 months; P<.001) for cases and controls, respectively. The hazard ratio for progression and death was 2.94 (95% CI, 1.71 to 5.07; P<.001) and 3.08 (95% CI, 1.69 to 5.6; P<.001), respectively, for mEOC patients as compared with controls. CONCLUSION Patients with advanced mEOC have a poorer response to platinum-based first-line chemotherapy compared with patients with other histologic subtypes of EOC, and their survival is worse. Specific alternative therapeutic approaches should be sought for this group of patients, perhaps involving fluorouracil-based chemotherapy.
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Affiliation(s)
- Viviane Hess
- Gynecology Unit, Royal Marsden Hospital, Fulham Rd, London SW3 6JJ, UK
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Affiliation(s)
- D O Selo-Ojeme
- The Gynaecological Cancer Centre, St Bartholomew's Hospital, West Smithfield, London, UK
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Ind T, Iles R, Shepherd J, Chard T. Serum concentrations of cancer antigen 125, placental alkaline phosphatase, cancer-associated serum antigen and free beta human chorionic gonadotrophin as prognostic markers for epithelial ovarian cancer. Br J Obstet Gynaecol 1997; 104:1024-9. [PMID: 9307529 DOI: 10.1111/j.1471-0528.1997.tb12061.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the prognostic significance of elevated levels of cancer antigen 125 (CA125), placental alkaline phosphatase (PLAP), free beta human chorionic gonadotrophin (hCG) and cancer-associated serum antigen (CASA) in women with primary epithelial ovarian carcinoma. DESIGN A two year follow up study of survival. SETTING A tertiary care gynaecological oncology unit. PARTICIPANTS One hundred and eleven women with histologically confirmed epithelial ovarian cancer. MAIN OUTCOME MEASURES Survival over a two year period. RESULTS Stage corrected log-rank chi 2 tests demonstrated a significant effect on survival for all four tumour markers (CA125 P = 0.0142; PLAP P < 0.0001; CASA P = 0.0098; hCG P = 0.0002). This was confirmed when each variable was fitted together with disease stage in Cox proportional hazard models. When fitted as multiple variables in a Cox proportional hazard model, the addition of free beta-hCG and CASA to disease stage, PLAP concentrations and CA125 levels did not demonstrate further prognostic value. CONCLUSIONS Levels of all four markers correlate with survival in patients with epithelial ovarian cancer. The combination of PLAP and CA125 concentrations together with disease stage may be used to predict survival but the addition of hCG and CASA levels do not give additional prognostic information.
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Affiliation(s)
- T Ind
- Department of Obstetrics and Gynaecology, Hillingdon Hospital, Uxbridge, UK
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Abstract
We have examined the possibility of using multiple markers in maternal urine rather than serum in order to screen for Down's syndrome. Urine samples were available from 36 cases (24 Down's syndrome, five Edwards' syndrome, three Turner's syndrome, one Klinefelter's syndrome, one triploidy, one triple-X, one twin discordant for Down's syndrome) and 294 controls, including three twins. Three markers were tested: the beta-core fragment of human chorionic gonadotrophin (hCG), total oestrogen (tE) and the free alpha subunit of hCG. Levels were corrected for creatinine excretion and expressed as multiples of the gestation-specific median (MOM) level from the singleton controls. The median value for the singleton Down's syndrome cases was 6.02, 0.74, and 1.08 MOM for beta-core-hCG, tE, and alpha-hCG, respectively. The increases in beta-core-hCG and the reduction in tE levels were highly significant (P < 0.0001 and 0.005, respectively; Wilcoxon rank sum test) but the increase in free alpha-hCG was not (P = 0.40). On the basis of a mathematical model, the expected detection rate for a 5 per cent false-positive rate was 79.6 per cent for beta-core-hCG alone, which increased to 82.3 per cent when combined with tE. Aneuploidies other than Down's syndrome were characterized by low levels of tE and either low or high beta-core-hCG.
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Affiliation(s)
- H S Cuckle
- Institute of Epidemiology and Health Services Research, Research School of Medicine, University of Leeds, U.K
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Abstract
The aim of this study was to measure the levels of erythropoietin in amniotic fluid from normal and trisomy 21 pregnancies at 10 to 20 weeks gestation. Samples of amniotic fluid were collected from 142 women with singleton pregnancies after genetic amniocentesis; 110 had a normal fetal karyotype and 32 had trisomy 21. Erythropoietin was measured using a double antibody radioimmunoassay. Amniotic fluid erythropoietin levels in normal pregnancies increased from 10 weeks (mean 3.2 mU/ml; range < 2.0-6.3 mU/ml) to 20 weeks gestation (mean 7.9 mU/ml; range 2.0-11.5 mU/ml). There was a significant linear correlation between gestational age and erythropoietin levels (r = 0.543; P < 0.0001). For the 32 patients with trisomy 21 pregnancies the median multiple of the median (MoM) was 1.11 (range 0.42-2.1). There was no difference between erythropoietin levels in amniotic fluid from normal and Down's syndrome pregnancies (U = 2352, P = 0.75, 95% CI = -0.11, 0.18); (Mann-Whitney U-test).
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Affiliation(s)
- J Campbell
- Department of Obstetrics, Gynaecology, St. Bartholomew's Hospital, London, UK
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Affiliation(s)
- T Ind
- Department of Obstetrics, Gynaecology and Reproductive Physiology, St. Bartholomew's Hospital, West Smithfield, London, England
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Ind T, Gabriel C, Ditchfield A, Howes T, Bunch T, Diaz H, Sawert H, Burling S, Nualart M, Fan S, Hayes A, Hui C, Eweje P, Mcintyre C, Kelly S. Redundancies in NHS trusts: effect on junior house officers. West J Med 1991. [DOI: 10.1136/bmj.302.6786.1212-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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