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  • Baldaque-Silva, Francisco, et al. (författare)
  • Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow band imaging: Impact of structured learning and experience on the accuracy of the Amsterdam classification system
  • 2013
  • Ingår i: Scandinavian Journal of Gastroenterology. - Taylor & Francis. - 1502-7708. ; 48:2, s. 160-167
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Several classification systems have been launched to characterize Barrett's esophagus (BE) mucosa using magnification endoscopy with narrow band imaging (ME-NBI). The good accuracy and interobserver agreement described in the early reports were not reproduced subsequently. Recently, we reported somewhat higher accuracy of the classification developed by the Amsterdam group. The critical question then formulated was whether a structured learning program and the level of experience would affect the clinical usefulness of this classification. Material & methods: Two hundred and nine videos were prospectively captured from patients with BE using ME-NBI. From these, 70 were randomly selected and evaluated by six endoscopists with different levels of expertise, using a dedicated software application. First, an educational set was studied. Thereafter, the 70 test videos were evaluated. After classification of each video, the respective histological feedback was automatically given. Results. Within the learning process, there was a decrease in the time needed for evaluation and an increase in the certainty of prediction. The accuracy did not increase with the learning process. The sensitivity for detection of intestinal metaplasia ranged between 39% and 57%, and for neoplasia between 62% and 90%, irrespective of assessor's expertise. The kappa coefficient for the interobserver agreement ranged from 0.25 to 0.30 for intestinal metaplasia, and from 0.39 to 0.48 for neoplasia. Conclusion: Using a dedicated learning program, the ME-NBI Amsterdam classification system is suboptimal in terms of accuracy and inter- and intraobserver agreements. These results reiterate the questionable utility of corresponding classification system in clinical routine practice.
  • Burnand, B, et al. (författare)
  • Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE)
  • 2006
  • Ingår i: Gastrointestinal Endoscopy. - Mosby. - 1097-6779. ; 63:7, s. 1018-1026
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract in Undetermined Background Screening for colorectal cancer (CRC) has been shown to decrease mortality. Objective To examine determinants associated with having (1) a screening colonoscopy, (2) an appropriate indication for screening, and (3) a significant diagnosis at screening. Design Prospective observational study. Setting Twenty-one endoscopy centers from 11 countries. Patients Asymptomatic patients who underwent a colonoscopy for the purpose of detecting CRC and who did not have a history of polyps or CRC, a lesion observed at a recent barium enema or sigmoidoscopy, or a recent positive fecal occult blood test. Intervention Screening colonoscopy. Main Outcome Measurements Appropriateness according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria and significant diagnoses (cancer, adenomatous polyps, new diagnoses of inflammatory bowel disease, angiodysplasia). Results Of 5069 colonoscopies, 561 (11%) were performed for screening purposes. Patients were more likely to have a screening colonoscopy if they were aged 45 to 54 years (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.60-3.99). Screening colonoscopies were appropriate, uncertain, and inappropriate in 26%, 60%, and 14% of cases, respectively. Eighty-one significant diagnoses were made, including 4 cancers. Significant diagnoses were more often made for uncertain/appropriate indications (OR 3.20, 95% CI 1.12-9.17) than for inappropriate indications. Limitations Although data completeness was asked of all centers, it is possible that not all consecutive patients were included. Participating centers were a convenience sample and thus may not be representative. Conclusions About 1 of 10 colonoscopies were performed for screening, preferentially in middle-aged individuals. A higher diagnostic yield in uncertain/appropriate indications suggests that the use of appropriateness criteria may enhance the efficient use of colonoscopy for screening.
  • Elzuki, A, et al. (författare)
  • Alpha1-antitrypsin deficiency (PiZ) may be a risk factor for duodenal ulcer in patients with Helicobacter pylori infection
  • 2000
  • Ingår i: Scand J Gastroenterol. ; 35:1, s. 32-35
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract BACKGROUND: Most individuals with Helicobacter pylori infection in Western countries have no evidence of peptic ulcer disease (PUD). We therefore assessed the PiZ deficiency variant of the major plasma protease inhibitor alpha1-antitrypsin (alpha1AT) as a risk factor for PUD in H. pylori-infected individuals. METHODS: The cohort comprised 100 patients with endoscopically or surgically proven PUD (30 patients with duodenal ulcer (DU) and 70 patients with gastric ulcer (GU)) and 162 age- and sex-matched controls with PUD-negative endoscopic findings and no history of PUD. Plasma samples were screened for alpha1AT deficiency (PiZ) with an enzyme-linked immunosorbent assay (ELISA) and phenotyped by isoelectric focusing. H. pylori infection was evaluated with an IgG ELISA technique. RESULTS: Among the 262 patients 17 (6.5%) were positive for the PiZ alpha1AT deficiency, a frequency of the same magnitude as in the Swedish general population (4.7%). Of the PiZ carriers 76% (13 of 17) had H. pylori antibodies compared with 61% (151 of 245) of the non-PiZ carriers (NS). The prevalence of DU tended to be higher in H. pylori-positive PiZ carriers than in non-PiZ carriers (15.4%, 4 of 26 versus 0 of 4). Furthermore, among patients with DU a high PiZ allele frequency (13.3%, 4 of 30) was found compared with the general population (4.7%) (odds ratio (OR), 3.2; 95% confidence interval (CI), 1.09-8.94; P = 0.02). All DU patients carrying the PiZ allele were positive for H. pylori. In addition, four of five PiZ carriers with H. pylori infection and PUD had DU. CONCLUSIONS: The PiZ allele may be a contributing factor in the development of DU in H. pylori-positive individuals.
  • Fork, Thomas, et al. (författare)
  • Enteroskopikapseln- sväljbart engångsinstrument för videoundersökning av tunntarmen
  • 2002
  • Ingår i: Läkartidningen. - Swedish Medical Association. - 0023-7205. ; 99:48, s. 6-4842
  • Forskningsöversikt (refereegranskat)abstract
    • Since 1,5 years wireless enteroscopy with the GivenM2A-capsule has been tested clinically. Wireless capsule-enteroscopy (WCE) has already contributed significantly to the understanding of patients with obscure intestinal symptoms. Series of occult bleeders show that WCE detects lesions in 60%, whereas enterography only in 15%, and push-enteroscopy in 25%. Lesions detected are angiodysplasia in 55%, ulcerations in 14%, aphtoid lesions and erosions in 11%, tumours in 8%. Active bleeding was seen in 43%. In patients with Crohn’s disease further information on extent of disease and type of lesions is gained, mainly seen as erosions in 64%. WCE in hereditary polyposis disclosed more and bigger lesions, and in celiac enteropathy villous atrophy and scalloping of the mucous membrane is readily identified. Software to locate the capsule in the gastrointestinal tract is recently launched together with a graphic display of capsule track and transit times. Soon displays for motility and pressure will follow. Capsule adaptation for screening for Barrett’s esophagus and colon cancer might come true.
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