St Stephen Hospital

Budapest, Hungary

St Stephen Hospital

Budapest, Hungary
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Lintner B.,St Stephen Hospital | Saso S.,Institute of Reproductive and Developmental Biology | Tarnai L.,St Stephen Hospital | Novak Z.,St Stephen Hospital | And 4 more authors.
International Journal of Gynecological Cancer | Year: 2013

Objective: Invasive cervical cancer is one of the most common cancers, with 500,000 new cases diagnosed annually. Fertility preservation has become an important component of the overall quality of life of many cancer survivors. Expert opinion has suggested that fertility-sparing surgery should be limited to those patients diagnosed with cervical cancer less than 2 cm in diameter. Our objective was to report our abdominal radical trachelectomy (ART) experience in the opposite group of patientsVthose with a cervical cancer more than 2 cm in diameter. Methods: Between 1999 and 2006, a total of 45 patients with cervical carcinoma at International Federation of Gynecology and Obstetrics stage IB1-IB2 measuring more than 2 cm in diameter underwent fertility-sparing ART and pelvic lymphadenectomy at the 3 institutions where the authors are based (Budapest, Hungary; London, United Kingdom; New York, United States). They were followed up for more than 5 years. Results: For 69% of patients (n = 31), completed ART was considered to have been curative, and no adjuvant treatment was advised. Of those patients, 93.5% (n = 29) were alive at the time of follow-up. Thirty-one percent of patients (n = 14) underwent immediate completion of radical hysterectomy. Three of 8 patients who wished to fall pregnant delivered healthy neonates. Conclusions: The 5-year survival rate (93.5%) for this case series is equal (or better) to rates reported in the literature for patient treated with radical hysterectomy. Our survival data seem to support the hypothesis that ART is a safe treatment option for patients with invasive cervical cancer lesions of more than 2 cm. © 2013 by IGCS and ESGO.


Saso S.,Hammersmith Hospital Campus | Ghaem-Maghami S.,Queen Charlottes Hospital | Chatterjee J.,Hammersmith Hospital Campus | Brewig N.,Hammersmith Hospital Campus | And 3 more authors.
Reproductive Sciences | Year: 2012

The idea of using organ transplantation to solve quality-of-life issues was first introduced a century ago, with cornea transplants and thrusted before the world again in 1998, following a controversial hand transplant. Uterus transplantation (UTn) has been proposed as another quality-of-life transplant for the cure of permanent uterine factor infertility. In order to proceed in humans, a greater appreciation of the immunological mechanisms that underlie UTn is desirable. Allogeneic UTn (animal model) was first described by 2 studies in 1969. The first and only human UTn, performed in 2000, was an early attempt with limited use of animal model experiments prior to moving onto the human setting. Since then, work using rat, mouse, ovine, goat, and nonhuman primate models has demonstrated that the uterus is a very different but manageable organ immunologically compared to other transplanted organs. Therefore, specifically exploring immunological issues relating to UTn is a valuable and necessary part of the inevitable scientific process leading to successful human UTn. © The Author(s) 2012.


Chatterjee S.S.,Nil Ratan Sircar Medical College | Chumber S.K.,St Stephen Hospital | Khanduri U.,St Stephen Hospital
Journal of Clinical and Diagnostic Research | Year: 2016

Introduction: Disinfection process validation is mandatory before introduction of a new disinfectant in hospital services. Commercial disinfection brands often question existing hospital policy claiming greater efficacy and lack of toxicity of their products. Inadvertent inadequate disinfection leads to morbidity, patient’s economic burden, and the risk of mortality. Aim: To evaluate commercial disinfectants for high, intermediate and low-level disinfection so as to identify utility for our routine situations. Materials and Methods: This laboratory based experiment was conducted at St Stephen Hospital, Delhi during July-September 2013. Twelve commercial disinfectants: Sanidex®, Sanocid®, Cidex®, SekuSept Aktiv®, BIB Forte®, Alprojet W®, Desnet®, Sanihygiene®, Incidin®, D125®, Lonzagard®, and Glutishield® were tested. Time-kill assay (suspension test) was performed against six indicator bacteria (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Salmonella Typhi, Bacillus cereus, and Mycobacterium fortuitum). Low and high inoculum (final concentrations 1.5X106 and 9X106 cfu/ml) of the first five bacteria while only low level of M. fortuitum was tested. Results: Cidex® (2.4% Glutaraldehyde) performed best as high level disinfectant while newer quarternary ammonium compounds (QACs) (Incidin®, D125®, and Lonzagard®) were good at low level disinfection. Sanidex® (0.55% Orthopthalaldehyde) though mycobactericidal took 10 minutes for sporicidal activity. Older QAC containing BIB Forte® and Desnet® took 20 minutes to fully inhibit P. aeruginosa. All disinfectants effectively reduced S. Typhi to zero counts within 5 minutes. Conclusion: Cidex® is a good high-level disinfectant while newer QACs (Incidin®, D125®, and Lonzagard®) were capable low-level disinfectants. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.


PubMed | Nil Ratan Sircar Medical College and St Stephen Hospital
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

Disinfection process validation is mandatory before introduction of a new disinfectant in hospital services. Commercial disinfection brands often question existing hospital policy claiming greater efficacy and lack of toxicity of their products. Inadvertent inadequate disinfection leads to morbidity, patients economic burden, and the risk of mortality.To evaluate commercial disinfectants for high, intermediate and low-level disinfection so as to identify utility for our routine situations.This laboratory based experiment was conducted at St Stephen Hospital, Delhi during July-September 2013. Twelve commercial disinfectants: Sanidex, Sanocid, Cidex, SekuSept Aktiv, BIB Forte, Alprojet W, Desnet, Sanihygiene, Incidin, D125, Lonzagard, and Glutishield were tested. Time-kill assay (suspension test) was performed against six indicator bacteria (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Salmonella Typhi, Bacillus cereus, and Mycobacterium fortuitum). Low and high inoculum (final concentrations 1.5X10(6) and 9X10(6) cfu/ml) of the first five bacteria while only low level of M. fortuitum was tested.Cidex (2.4% Glutaraldehyde) performed best as high level disinfectant while newer quarternary ammonium compounds (QACs) (Incidin, D125, and Lonzagard) were good at low level disinfection. Sanidex (0.55% Ortho-pthalaldehyde) though mycobactericidal took 10 minutes for sporicidal activity. Older QAC containing BIB Forte and Desnet took 20 minutes to fully inhibit P. aeruginosa. All disinfectants effectively reduced S. Typhi to zero counts within 5 minutes.Cidex is a good high-level disinfectant while newer QACs (Incidin, D125, and Lonzagard) were capable low-level disinfectants.


Tarnai L.,University of Szeged | Ungar L.,St Stephen Hospital | Palfalvi L.,St Stephen Hospital | Nagy Z.,Semmelweis University
European Journal of Gynaecological Oncology | Year: 2011

Introduction: Since 1993 an operative technique without adjuvant therapy (laterally extended parametrectomy, the LEP procedure) has been in use at our institution for the treatment of Stage IIB cervical cancer and for patients with pelvic lymph node metastases in Stages IA-IIA. Iliac/femoral artery embolic occlusion in the cohort of LEP operated patients was studied in an 11 years long period. Methods: The LEP-Wertheim procedure was used in 320 patients between 1994 and 2005. Embolic occlusion of the iliac and/or femoral arteries was detected in four out of 255 (1.6%) cases. Thrombectomy was done on one blood vessel in three cases, on both the deep and superficial femoral arteries in one case were executed to restore the vessel patency. Results: Three out of four patients following external iliac/femoral artery emboli removal healed up without any arterial occlusion-related symptoms. In one case preventive fasciotomy was needed to treat tumescence of the legs. This patient developed transient peroneal palsy, which necessitated the use of plantar support for one month and physiotherapy for one year for gait rehabilitation. Conclusions: Embolus occlusion of the iliac/femoral artery during the LEP-Wertheim procedure was observed in 1.6% of cases. This complication has not been reported in the literature before in relation to radical surgery in cervical cancer. Operating teams using LEP operations should be aware of that risk, and should be prepared for treatment.


Ungar L.,St Stephen Hospital | Palfalvi L.,St Stephen Hospital | Tarnai L.,University of Szeged | Nechushkina V.,Nn Blokhin Russian Cancer Research Center | And 2 more authors.
International Journal of Gynecological Cancer | Year: 2012

Introduction: Recurrence originating from the pelvic lymph node containing fibro-fatty tissue has consistently been identified as the most frequent pattern of treatment failure in early-stage cervical cancer. A surgical technique for the complete removal of the connective tissue content of the pelvis was introduced at St. Stephen Hospital in 1993 to improve oncological outcome by reducing the risk of recurrence from the pelvis. Efficacy and toxicity of the procedure were studied in 563 patients with stage IB cervical cancer with a completed 5-year follow-up. Methods: Final pathology in 492 (87.4%) of 563 consecutive completed radical hysterectomies suggested that all tissue, which could contain tumor dissemination, was removed from the pelvis; thus, no adjuvant treatment was applied. Adjuvant chemoradiotherapy was advised in 71 cases (12.6%), where pathologic finding alluded tumor spread beyond the study criteria. Finding: At completed 5-year follow-up, the overall survival of 492 patients who had surgery without adjuvant therapy was 94.0%. Pathologic stage, lymphovascular space involvement, pelvic lymph node metastases, histology classification, and grade had no significant influence on prognosis. The only factor that influenced the overall survival was International Federation of Gynecology and Obstetrics stage (IB1 or IB2). Five-year overall survival of 71 patients to whom adjuvant therapy was recommended was 56.3%. Five-year overall survival of the whole cohort (n = 563) was 88.8%. The complication rate did not seem to be different from the published data on traditional radical surgery in cervical cancer. Conclusions: Our results (in accordance with other recent publications) suggest that complete excision of the connective tissue content of the pelvis provides equal or better survival chances without any adjuvant treatment for almost 90% of operable patients with stage IB cervical cancer than less radical surgery with or without adjuvant treatment. We suggest this strategy to be mentioned as one alternative in future treatment protocols. Copyright © 2012 by IGCS and ESGO.


Ungar L.,St Stephen Hospital | Palfalvi L.,St Stephen Hospital | Tarnai L.,University of Szeged | Horanyi D.,St Stephen Hospital | Novak Z.,University of Szeged
Gynecologic Oncology | Year: 2011

Introduction: In 2003, we published our preliminary experience with the use of an operative technique (laterally extended parametrectomy, the LEP procedure) without adjuvant therapy, in the treatment of 29 stage IB, cervical cancer patients with pelvic lymph node metastases. In our present paper, by an extended recruiting period, with a completed 5 year follow up, we studied the outcome of LEP operations, used with the same indications. Methods: In 70 out of 106 LEP-Wertheim operated patients, no adjuvant treatment was used. In 36 patients, where histology suggested tumor spread beyond the threshold of our surgery, adjuvant chemo-radiotherapy was advised. 5 year follow up was completed (without any patient lost for follow up) for the whole cohort of patients. Results: In 70 patients treated by LEP procedure alone, the overall 5-year survival was 91.4%. For those 36 patients, who were excluded due to disease spread above study criteria, 5 year survival was 44%. Complications in 10% of the cases necessitated a second operation. Apart from transient hyper continence and one case of permanent incontinence, no severe quality of life consequence of the operation was observed. Conclusions: Our results suggest that in two-thirds of pelvic lymph node positive, stage IB cervical cancer cases surgery alone could provide equal or better survival (without the toxicity of chemo-radiotherapy), than any kind of multimodality treatment alternatives. LEP procedure should be considered a treatment option for stage IB cervical cancer patients with pelvic lymph node metastases. © 2011 Elsevier Inc. All rights reserved.


Saso S.,Imperial College London | Ghaem-Maghami S.,Imperial College London | Chatterjee J.,Imperial College London | Naji O.,Imperial College London | And 7 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2012

Objective Traditionally, the surgical management of invasive cervical carcinoma that has progressed beyond microinvasion has been a radical abdominal hysterectomy. However, this results in the loss of fertility, with significant consequences for the young patient. This report describes abdominal radical trachelectomy (ART) as a potential replacement for radical hysterectomy in patients with stage IA2-IIA cervical cancer who desire a fertility-sparing procedure without decreasing the curative rates. Design Observational, retrospective study. Setting Teaching hospital and regional cancer centre in London, UK. Population Patients undergoing ART. Methods Patients presenting during the period 2000-2009 with cervical cancer stage IA2-IIA were offered a trachelectomy, if they expressed a desire to preserve fertility. The type of trachelectomy (vaginal/abdominal) was chosen based on patient anatomy and neoplastic and magnetic resonance imaging characteristics. Each patient was counselled as to the experimental nature of the procedure. Main outcome measures Survival, recurrence and fertility issues among ART patients. Results A total of 30 patients underwent ART (open and laparoscopic) between 2001 and 2009. Three patients presented with a recurrence, two of which have died (median follow-up: 24 months). Only three patients required further surgical re-intervention because of operative complications. Ten patients attempted to conceive, resulting in three conceptions (30%) and two live children. Conclusions Abdominal radical trachelectomy provides a feasible, cost-effective and safe treatment option for young women who have been diagnosed with early-stage cervical cancer and wish to preserve their fertility. © 2012 RCOG.


Manchanda S.,St Stephen Hospital | Saikia B.,St Stephen Hospital | Gupta N.,St Stephen Hospital | Chowdhary S.,St Stephen Hospital | Puliyel J.M.,St Stephen Hospital
PLoS ONE | Year: 2011

Objective: Sex-ratio at birth in families with previous girls is worse than those with a boy. Our aim was to prospectively study in a large maternal and child unit sex-ratio against previous birth sex and use of traditional medicines for sex selection. Main Outcome Measures: Sex-ratio among mothers in families with a previous girl and in those with a previous boy, prevalence of indigenous medicine use and sex-ratio in those using medicines for sex selection. Results: Overall there were 806 girls to 1000 boys. The sex-ratio was 720:1000 if there was one previous girl and 178:1000 if there were two previous girls. In second children of families with a previous boy 1017 girls were born per 1000 boys. Sex-ratio in those with one previous girl, who were taking traditional medicines for sex selection, was 928:1000. Conclusion: Evidence from the second children clearly shows the sex-ratio is being manipulated by human interventions. More mothers with previous girls tend to use traditional medicines for sex selection, in their subsequent pregnancies. Those taking such medication do not seem to be helped according to expectations. They seem to rely on this method and so are less likely use more definitive methods like sex selective abortions. This is the first such prospective investigation of sex ratio in second children looked at against the sex of previous children. More studies are needed to confirm the findings. © 2011 Manchanda et al.


PubMed | St Stephen Hospital
Type: Journal Article | Journal: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society | Year: 2013

Invasive cervical cancer is one of the most common cancers, with 500,000 new cases diagnosed annually. Fertility preservation has become an important component of the overall quality of life of many cancer survivors. Expert opinion has suggested that fertility-sparing surgery should be limited to those patients diagnosed with cervical cancer less than 2 cm in diameter. Our objective was to report our abdominal radical trachelectomy (ART) experience in the opposite group of patients-those with a cervical cancer more than 2 cm in diameter.Between 1999 and 2006, a total of 45 patients with cervical carcinoma at International Federation of Gynecology and Obstetrics stage IB1-IB2 measuring more than 2 cm in diameter underwent fertility-sparing ART and pelvic lymphadenectomy at the 3 institutions where the authors are based (Budapest, Hungary; London, United Kingdom; New York, United States). They were followed up for more than 5 years.For 69% of patients (n = 31), completed ART was considered to have been curative, and no adjuvant treatment was advised. Of those patients, 93.5% (n = 29) were alive at the time of follow-up. Thirty-one percent of patients (n = 14) underwent immediate completion of radical hysterectomy. Three of 8 patients who wished to fall pregnant delivered healthy neonates.The 5-year survival rate (93.5%) for this case series is equal (or better) to rates reported in the literature for patient treated with radical hysterectomy. Our survival data seem to support the hypothesis that ART is a safe treatment option for patients with invasive cervical cancer lesions of more than 2 cm.

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