%0 Journal Article %J Acta Cytol %D 2014 %T Making cytological diagnoses on digital images using the iPath network. %A Dalquen, Peter %A Savic Prince, Spasenija %A Spieler, Peter %A Kunze, Dietmar %A Neumann, Heinrich %A Eppenberger-Castori, Serenella %A Adams, Heiner %A Glatz, Katharina %A Bubendorf, Lukas %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Child %K Child, Preschool %K Computers, Handheld %K Cytodiagnosis %K Diagnosis, Differential %K Female %K Humans %K Hyperplasia %K Infant %K Male %K Metaplasia %K Middle Aged %K Neoplasms %K Observer Variation %K Reproducibility of Results %K Sensitivity and Specificity %K Telemedicine %X

BACKGROUND: The iPath telemedicine platform Basel is mainly used for histological and cytological consultations, but also serves as a valuable learning tool.

AIM: To study the level of accuracy in making diagnoses based on still images achieved by experienced cytopathologists, to identify limiting factors, and to provide a cytological image series as a learning set.

METHOD: Images from 167 consecutive cytological specimens of different origin were uploaded on the iPath platform and evaluated by four cytopathologists. Only wet-fixed and well-stained specimens were used. The consultants made specific diagnoses and categorized each as benign, suspicious or malignant.

RESULTS: For all consultants, specificity and sensitivity regarding categorized diagnoses were 83-92 and 85-93%, respectively; the overall accuracy was 88-90%. The interobserver agreement was substantial (κ = 0.791). The lowest rate of concordance was achieved in urine and bladder washings and in the identification of benign lesions.

CONCLUSION: Using a digital image set for diagnostic purposes implies that even under optimal conditions the accuracy rate will not exceed to 80-90%, mainly because of lacking supportive immunocytochemical or molecular tests. This limitation does not disqualify digital images for teleconsulting or as a learning aid. The series of images used for the study are open to the public at http://pathorama.wordpress.com/extragenital-cytology-2013/.

%B Acta Cytol %V 58 %P 453-60 %8 2014 %G eng %N 5 %R 10.1159/000369241 %0 Journal Article %J Med Klin Intensivmed Notfmed %D 2012 %T [Thyroid storm]. %A Dietrich, J W %K Antithyroid Agents %K Cross-Sectional Studies %K Diagnosis, Differential %K Humans %K Intensive Care Units %K Prognosis %K Risk Factors %K Survival Rate %K Thyroid Crisis %K Thyroxine %K Triiodothyronine %X

Thyroid storm is a complicated, life-threatening form of thyrotoxicosis. The causes are multifactorial and elevated iodothyronine levels are only one of many components. Usually, the transition from thyrotoxicosis to thyroid storm is ignited by non-thyroidal triggers. This is a rare condition observed with an incidence between 0.8 and 1.4 cases per 100,000 inhabitants. Diagnosis relies primarily on clinical criteria. Multimodal therapy aims at disrupting positive feedback loops between elevated levels of free T3 or T4 and their effects on target tissues and organs. Timely diagnosis and therapy help to reduce mortality to below 35%.

%B Med Klin Intensivmed Notfmed %V 107 %P 448-53 %8 2012 Sep %G eng %N 6 %R 10.1007/s00063-012-0113-2