Biomedical subjects
P Pullicino
Publications and source records attributed to P Pullicino.
Incremental response to repetitive stimulation in Guillain-Barré syndrome.
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Inter- and intrarater scoring agreement using grades 1.0 to 3.5 of the Kurtzke Expanded Disability Status Scale (EDSS). Multiple Sclerosis Collaborative Research Group.
We determined inter- and intrarater Kurtzke Expanded Disability Status Scale (EDSS) scoring agreement for four trained examining physicians who evaluated 10 clinically stable multiple sclerosis patients. These patients had previously been determined to have EDSS scores of 1.0 to 3.5 and were scheduled to participate in a funded clinical trial of intramuscular recombinant interferon-beta. Intrarater reliability was greater than interrater reliability for scoring the EDSS and all of its component functional systems scores (FSS). Specifically, individual examiners were able to reproduce three serial examination scores on the same patient on the same day (intrarater agreement) within 1.0 EDSS or 2.0 individual FSS points. Reproducible scoring across examiners (interrater agreement), however, could only be accomplished within 1.5 EDSS or 3.0 individual FSS points. Additionally, the interrater scoring variability in our patients is greater than that previously reported for patients with higher EDSS scores. We conclude that clinical trials that employ the EDSS as an outcome measure of treatment efficacy should include inter- and intrarater agreement data for all examining physicians. Most importantly, studies using a single examining physician to evaluate individual patients throughout the course of a clinical trial will require less change in the EDSS to reliably measure disease activity than will studies using more than one examining physician to evaluate individual patients throughout the trial.
Recurrent cerebral infarction and central retinal artery occlusion following mandibular zoster.
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[Cerebellar hemorrhage and unilateral asterixis].
A hypertensive woman presented with asterixis ipsilateral to a cerebellar hemorrhage. Asterixis has not previously been described in association with a cerebellar lesion. The presence of asterixis in this patient may have been due to a reduction of afferent information through the loss of the dentato-thalamo-cortical input. Unilateral asterixis denotes a dysfunction of the mechanism underlying sustained muscular contraction and not a precise cerebral localisation.
The demonstration of the auditory ossicles by high resolution CT.
The high resolution CT scanning system introduced by EMI in 1978 has added a new dimension to computerised tomography in otology. The apparatus used for this study was an EMI CT 5005 body scanner adapted for head and neck scanning and incorporating a high resolution facility. The latter has proved most advantageous in areas of relatively high differential absorption, so that its application to the demonstration of abnormalities in the petrous temporal bone, and in particular middle ear disease, has been very rewarding. Traumatic ossicular disruptions may now be demonstrated and the high contrast of CT often shows them better than conventional hypocycloidal tomography. The stapes is also better visualised and congenital abnormalities of its superstructure have been recorded. These studies have been achieved with a very acceptable level of radiation to the eye, lens and cornea and the technique is clearly a rival to conventional pluridirectional tomography in the assessment of the petrous temporal bone. With further design improvements high resolution CT could completely replace existing techniques.
Comparison of consistency of meningiomas and CT appearances.
Computed tomograms of meningiomas in which the consistency of the tumour had been specifically noted at surgery were reviewed. Those showing diffuse calcification or evidence of marked cystic or necrotic changes were excluded, leaving 77 tumours of which 46 were hard and 31 soft. Ninety per cent of the hard tumours were of increased attenuation; the other 10% were isodense with brain. Forty-nine per cent of the soft meningiomas were of high attenuation, but 35% were isodense and 16% were of lower than brain attenuation. There was a greater incidence of marked intracerebral oedema around the hard tumours. All hypodense tumours enhanced to greater than brain attenuation; mean enhancement was relatively less in the tumours of high plain scan attenuation regardless of consistency and there was no relationship between degree of enhancement and either the consistency or with the amount of vascularity as estimated by the surgeon or histologist.
Xenon enhancement for computed tomography of the spinal cord.
The spinal cord is not consistently shown by plain computed tomography or with iodide enhancement. Xenon enhancement increases the attenuation of the spinal cord and visualization is improved considerably; fluid-filled cavities, including syringohydromyelia, do not enhance and are clearly defined.
Cystic intracranial tumours. Cyst fluid, biochemical changes and computerised tomographic findings.
The concentrations of five biochemical substances were studied in cyst fluid from 49 cystic intracranial tumours and the findings were compared with the computerised tomographic (CT) scan and histological appearances of the tumours. The attenuation of the cyst wall on unenhanced CT was found to be related to cyst fluid alkaline phosphatase levels. Enhancement of the cyst wall with contrast medium was associated with higher levels of protein, cholesterol, alkaline phosphatase, phosphohexose isomerase (PHI) and lactate dehydrogenase (LDH) in the cyst fluid. Lesions of high grade malignancy had higher levels of protein, cholesterol, alkaline phosphatase, LDH and PHI than lesion of low grade malignancy and also higher levels of alkaline phosphatase, LDH and PHI than benign lesions. Oedema around a lesion was associated with increased malignancy.
Difficulties in diagnosis of supratentorial gliomas by CAT scan.
The false positive and false negative computed tomography diagnoses of glioma made using an EMI 1010 machine on a consecutive series of patients seen over a period of two years are recorded. About 1.5% of gliomas were not detected on initial CAT scan, 6.5% were misdiagnosed as benign lesions, and in 6.5% of the cases identified as glioma a non-malignant condition was subsequently diagnosed.