R. Grahame - Academia.edu (original) (raw)
Papers by R. Grahame
Annals of The Rheumatic Diseases, 1998
OBJECTIVEEhlers Danlos syndrome (EDS) is an inherited disorder of connective tissue characterised... more OBJECTIVEEhlers Danlos syndrome (EDS) is an inherited disorder of connective tissue characterised by hyperextensible skin, joint laxity, and easy bruising. There are phenotypic similarities with osteogenesis imperfecta, but in EDS a tendency to fracture or altered bone mass has not previously been considered to be a cardinal feature.METHODThis case-control design study investigates whether 23 patients with EDS had differences in
Annals of The Rheumatic Diseases, 1970
Annals of The Rheumatic Diseases, 1971
Revue du Rhumatisme, 2000
... Pain 1990 ; Suppl 5 : S500S500. 38 Williams Ac de C, Nicholas MK, Richardson PH, Pither C Jus... more ... Pain 1990 ; Suppl 5 : S500S500. 38 Williams Ac de C, Nicholas MK, Richardson PH, Pither C Justins DM, Chamberlain JH, et al. ... 12. M Acasuso-Diaz and E Collantes-Estevez , Joint hypermobility in patients with fibromyalgia syndrome. Arthritis Care Res 11 (1998), pp. 3942. ...
Spine, 1993
Epidural corticosteroid injection is a relatively effective treatment for low back pain and sciat... more Epidural corticosteroid injection is a relatively effective treatment for low back pain and sciatica with a low incidence of side effects, although the patient's perspective in terms of outcome and satisfaction has not been studied well. The assessment of outcome in low back pain patients is complex. Three types of measure were compared: 1) a clinical score, 2) patient ratings of pain and disability, and 3) patient satisfaction ratings. There were significant discrepancies among the results. Consequently, clinical trials using different outcome measures may reach different conclusions. It therefore is vital to have planned the study carefully in advance, considering the questions to be asked, especially in this area, where patient-derived measures (e.g., "patient satisfaction") are so important. This study of 35 patients showed a fall in clinical signs/symptoms, disability, and pain 1 week after the injection, with maintenance of the reduction in disability at 3 months...
Pharmatherapeutica, 1984
A double-blind, placebo-controlled, crossover trial was carried out to assess the efficacy and to... more A double-blind, placebo-controlled, crossover trial was carried out to assess the efficacy and tolerance of nabumetone in patients with osteoarthrosis of the hip or knee. Patients were allocated at random to receive either 1 g nabumetone twice daily or matching placebo for 2 weeks and then crossed over to the alternative treatment for a further 2 weeks. Clinical assessments of pain and function were made before and at the end of each treatment period. Seventeen of 18 patients completed the trial and the results showed that most clinical parameters assessed were improved during active treatment, with significantly more patients preferring nabumetone (p less than 0.001) to placebo. Only 1 patient reported what was considered to be a drug-related adverse event (irritation of the scalp) during nabumetone treatment.
Annals of the Royal College of Surgeons of England, 1984
A series of 104 patients 'cured' by one, or at most two, manipulations in reviewed. A cli... more A series of 104 patients 'cured' by one, or at most two, manipulations in reviewed. A clinical syndrome emerges--recent and/or sudden onset of back pain and leg pain, no neurological symptoms or signs, a mechanical pattern of back movements with extension more limited than flexion, straight leg raising (SLR) more than 60 degrees and no neurological signs.
Lancet, Jan 5, 1982
1. Christensen NJ. Plasma norepinephrine and epinephrine in untreated diabetics, during fasting a... more 1. Christensen NJ. Plasma norepinephrine and epinephrine in untreated diabetics, during fasting and after insulin administration. Diabetes 1974; 23: 1-8. 2. Christensen NJ, Gundersen HJG, Hegedüs L, Jacobsen F, Mogensen CE, Østerby R, Vittinghus E Acute effects of insulin on plasma noradrenaline and the cardiovascular system. Metabolism 1980; 29 (suppl 1): 1138-45. 3. MacKay JD, Hayakawa H, Watkins PJ. Cardiovascular effects of insulin: plasma volume changes in diabetics. Diabetologia 1978; 15: 453-57. 4. Mathias CJ, Frankel HL, Turner RC, Christensen NJ. Physiological responses to insulin hypoglycaemia in spinal man.
Proceedings of the Royal Society of Medicine, 1968
... Five days after the institution of Arvin the penis was completely flaccid, normal in external... more ... Five days after the institution of Arvin the penis was completely flaccid, normal in external appearance ... not due to erosion but were associated with a deformity and the moulding action of ligaments ... Limy Bile Michael Cooke FRCS (for Ian Burn FRCS) (St Charles' Hospital, London ...
Advances in Experimental Medicine and Biology, 1974
ABSTRACT
British Medical Journal - BMJ, 1990
Rheumatology, 1995
The objective of the study was to ascertain the occurrence and inter-relationships of locomotor s... more The objective of the study was to ascertain the occurrence and inter-relationships of locomotor symptoms, joint hypermobility and skin involvement in patients with the Marfan syndrome. A single clinical evaluation, using a standardized protocol, of randomly selected out-patients was made. Joint hypermobility was measured by two scales in wide clinical use (Beighton and Contompasis), skin hyperextensibility was assessed on the dorsum of the hand, and skin thickness and light transmissibility was measured at the same site with a modified Harpenden caliper. The setting was an out-patient medical genetics clinic at an urban teaching hospital in Baltimore, Maryland, USA. The subjects comprised 27 children and 48 adults who met strict diagnostic criteria for the Marfan syndrome. In patients less than 18 yr old, 70% had experienced at least one locomotor syndrome, and 40% had had multiple symptoms, of which arthralgia, myalgia and ligamentous injury were the most frequent. Symptoms were absent in children younger than 5 yr. Thereafter, the number of symptoms increased with age. Considerable joint hyperextensibility (> 3/9 of Beighton's criteria) was present in 85%. While one-third had received orthopaedic attention, there had been little if any rheumatological input. In adult patients, locomotor symptoms had occurred in 96%, with 88% having experienced more than one complaint. Spinal pain, arthralgia, ligament injury and fracture were the most common. Most (81%) of the adults had some (> 1/9), and 56% had considerable (> 2/9) evidence of joint hypermobility. Only 20% had received specialist attention for their locomotor symptoms. Skin changes are documented in the Marfan syndrome for the first time in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Rheumatology, 1975
ALTHOUGH there is considerable evidence that therapeutic ultrasound can stimulate tissue repair, ... more ALTHOUGH there is considerable evidence that therapeutic ultrasound can stimulate tissue repair, little is known of the mechanisms by which this stimulation occurs. Shortly after injury the fibroblast population of damaged tissue increases, and the protein synthesized by these ...
Rheumatology, 1979
In this paper we report the use of the technetium-99m diphosphonate bone scan in the diagnosis an... more In this paper we report the use of the technetium-99m diphosphonate bone scan in the diagnosis and management of traumatic bone lesions in the ballet dancer's foot. Nine illustrative case histories are given. We conclude that this is a useful technique particularly in the recognition of stress lesions not identified by conventional radiography.
Rheumatology, 1996
The aim of the project was to explore the possibility of conferring, on the practice nurse (PN), ... more The aim of the project was to explore the possibility of conferring, on the practice nurse (PN), the skills and knowledge of the rheumatology nurse practitioner (RNP), hitherto, exclusively, a member of the hospital team. A trained and experienced RNP paid a series of regular visits to participating general practices in SE London. The subjects were 11 PNs and 30 patients with chronic rheumatic diseases. Interactive sessions involving the RNP, PN and patients were set up with a view to (1) instructing the PNs in the role of the RNP in the education and care of patients, and educating patients about their disease and its treatment. Practice nurse and patient questionnaires were used to assess PN and patient knowledge before and after the instructional sessions. Only eight out of the 392 (2%) practices approached participated in the project and, even with these, difficulties were encountered, arising from the PNs' workload and pattern of work, and the reluctance of the general practitioners to enter a new project in the present climate of change in the NHS, unless clear and immediate financial advantages were in prospect. Statistically significant results were obtained in before/after comparisons of patient and nurse knowledge scores (P < 0.00001 and P = 0.001, respectively) following the RPN visits. The basic instructional format is sound and workable. A PN, if allocated protected time and appropriate patients, can acquire the knowledge and skills needed to manage patients with chronic rheumatic diseases in primary care. Both the instruments of measurement used can register changes over time, leading in a small number of patients (30) and PNs (11) to a statistically highly significant result.
Rheumatology, 1975
In this study the value of undertaking routine blood and urine estimations was assessed in relati... more In this study the value of undertaking routine blood and urine estimations was assessed in relation to achieving maximum efficacy and safety in chrysotherapy. It was found that a favourable response to gold was forthcoming in approximately two-thirds of patients and occurred irrespective of the patients&amp;#39; disease duration or severity, or the mean serum gold level or the mean urinary gold excretion, estimated immediately before the next gold injection was due. The presence of rheumatoid nodules and the patients&amp;#39; advancing age were associated with a less favourable clinical response to gold. Those patients who derived a marked benefit from chrysotherapy did so significantly earlier in their course than those who derived only moderate benefit. A frequent correlation was seen in individual patients between serum gold levels and urinary gold excretion. This was most marked in those patients showing a favourable response to gold.
Rheumatology, 1992
We carried out a segregation analysis comparing the inheritance of collagen gene markers and join... more We carried out a segregation analysis comparing the inheritance of collagen gene markers and joint hypermobility syndrome in two extended families. Our results exclude the genes encoding type III (COL3A1), type V alpha 2 chain (COL5A2) and type VI alpha 3 chain (COL6A3) unambiguously in both families. The simultaneous exclusion of both the type 1 alpha 1 and alpha 2 chain genes in the same family was not possible: COL1A1, but not COL1A2 was excluded in one and COL1A2, but not COL1A1 was excluded in the second. There was no suggestion of strong linkage to either of these loci. These data do not support the hypothesis that JHS in these families is caused by mutations in these collagen genes.
Rheumatology, 1982
ABSTRACT
Annals of The Rheumatic Diseases, 1998
OBJECTIVEEhlers Danlos syndrome (EDS) is an inherited disorder of connective tissue characterised... more OBJECTIVEEhlers Danlos syndrome (EDS) is an inherited disorder of connective tissue characterised by hyperextensible skin, joint laxity, and easy bruising. There are phenotypic similarities with osteogenesis imperfecta, but in EDS a tendency to fracture or altered bone mass has not previously been considered to be a cardinal feature.METHODThis case-control design study investigates whether 23 patients with EDS had differences in
Annals of The Rheumatic Diseases, 1970
Annals of The Rheumatic Diseases, 1971
Revue du Rhumatisme, 2000
... Pain 1990 ; Suppl 5 : S500S500. 38 Williams Ac de C, Nicholas MK, Richardson PH, Pither C Jus... more ... Pain 1990 ; Suppl 5 : S500S500. 38 Williams Ac de C, Nicholas MK, Richardson PH, Pither C Justins DM, Chamberlain JH, et al. ... 12. M Acasuso-Diaz and E Collantes-Estevez , Joint hypermobility in patients with fibromyalgia syndrome. Arthritis Care Res 11 (1998), pp. 3942. ...
Spine, 1993
Epidural corticosteroid injection is a relatively effective treatment for low back pain and sciat... more Epidural corticosteroid injection is a relatively effective treatment for low back pain and sciatica with a low incidence of side effects, although the patient's perspective in terms of outcome and satisfaction has not been studied well. The assessment of outcome in low back pain patients is complex. Three types of measure were compared: 1) a clinical score, 2) patient ratings of pain and disability, and 3) patient satisfaction ratings. There were significant discrepancies among the results. Consequently, clinical trials using different outcome measures may reach different conclusions. It therefore is vital to have planned the study carefully in advance, considering the questions to be asked, especially in this area, where patient-derived measures (e.g., "patient satisfaction") are so important. This study of 35 patients showed a fall in clinical signs/symptoms, disability, and pain 1 week after the injection, with maintenance of the reduction in disability at 3 months...
Pharmatherapeutica, 1984
A double-blind, placebo-controlled, crossover trial was carried out to assess the efficacy and to... more A double-blind, placebo-controlled, crossover trial was carried out to assess the efficacy and tolerance of nabumetone in patients with osteoarthrosis of the hip or knee. Patients were allocated at random to receive either 1 g nabumetone twice daily or matching placebo for 2 weeks and then crossed over to the alternative treatment for a further 2 weeks. Clinical assessments of pain and function were made before and at the end of each treatment period. Seventeen of 18 patients completed the trial and the results showed that most clinical parameters assessed were improved during active treatment, with significantly more patients preferring nabumetone (p less than 0.001) to placebo. Only 1 patient reported what was considered to be a drug-related adverse event (irritation of the scalp) during nabumetone treatment.
Annals of the Royal College of Surgeons of England, 1984
A series of 104 patients 'cured' by one, or at most two, manipulations in reviewed. A cli... more A series of 104 patients 'cured' by one, or at most two, manipulations in reviewed. A clinical syndrome emerges--recent and/or sudden onset of back pain and leg pain, no neurological symptoms or signs, a mechanical pattern of back movements with extension more limited than flexion, straight leg raising (SLR) more than 60 degrees and no neurological signs.
Lancet, Jan 5, 1982
1. Christensen NJ. Plasma norepinephrine and epinephrine in untreated diabetics, during fasting a... more 1. Christensen NJ. Plasma norepinephrine and epinephrine in untreated diabetics, during fasting and after insulin administration. Diabetes 1974; 23: 1-8. 2. Christensen NJ, Gundersen HJG, Hegedüs L, Jacobsen F, Mogensen CE, Østerby R, Vittinghus E Acute effects of insulin on plasma noradrenaline and the cardiovascular system. Metabolism 1980; 29 (suppl 1): 1138-45. 3. MacKay JD, Hayakawa H, Watkins PJ. Cardiovascular effects of insulin: plasma volume changes in diabetics. Diabetologia 1978; 15: 453-57. 4. Mathias CJ, Frankel HL, Turner RC, Christensen NJ. Physiological responses to insulin hypoglycaemia in spinal man.
Proceedings of the Royal Society of Medicine, 1968
... Five days after the institution of Arvin the penis was completely flaccid, normal in external... more ... Five days after the institution of Arvin the penis was completely flaccid, normal in external appearance ... not due to erosion but were associated with a deformity and the moulding action of ligaments ... Limy Bile Michael Cooke FRCS (for Ian Burn FRCS) (St Charles' Hospital, London ...
Advances in Experimental Medicine and Biology, 1974
ABSTRACT
British Medical Journal - BMJ, 1990
Rheumatology, 1995
The objective of the study was to ascertain the occurrence and inter-relationships of locomotor s... more The objective of the study was to ascertain the occurrence and inter-relationships of locomotor symptoms, joint hypermobility and skin involvement in patients with the Marfan syndrome. A single clinical evaluation, using a standardized protocol, of randomly selected out-patients was made. Joint hypermobility was measured by two scales in wide clinical use (Beighton and Contompasis), skin hyperextensibility was assessed on the dorsum of the hand, and skin thickness and light transmissibility was measured at the same site with a modified Harpenden caliper. The setting was an out-patient medical genetics clinic at an urban teaching hospital in Baltimore, Maryland, USA. The subjects comprised 27 children and 48 adults who met strict diagnostic criteria for the Marfan syndrome. In patients less than 18 yr old, 70% had experienced at least one locomotor syndrome, and 40% had had multiple symptoms, of which arthralgia, myalgia and ligamentous injury were the most frequent. Symptoms were absent in children younger than 5 yr. Thereafter, the number of symptoms increased with age. Considerable joint hyperextensibility (> 3/9 of Beighton's criteria) was present in 85%. While one-third had received orthopaedic attention, there had been little if any rheumatological input. In adult patients, locomotor symptoms had occurred in 96%, with 88% having experienced more than one complaint. Spinal pain, arthralgia, ligament injury and fracture were the most common. Most (81%) of the adults had some (> 1/9), and 56% had considerable (> 2/9) evidence of joint hypermobility. Only 20% had received specialist attention for their locomotor symptoms. Skin changes are documented in the Marfan syndrome for the first time in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Rheumatology, 1975
ALTHOUGH there is considerable evidence that therapeutic ultrasound can stimulate tissue repair, ... more ALTHOUGH there is considerable evidence that therapeutic ultrasound can stimulate tissue repair, little is known of the mechanisms by which this stimulation occurs. Shortly after injury the fibroblast population of damaged tissue increases, and the protein synthesized by these ...
Rheumatology, 1979
In this paper we report the use of the technetium-99m diphosphonate bone scan in the diagnosis an... more In this paper we report the use of the technetium-99m diphosphonate bone scan in the diagnosis and management of traumatic bone lesions in the ballet dancer&amp;#39;s foot. Nine illustrative case histories are given. We conclude that this is a useful technique particularly in the recognition of stress lesions not identified by conventional radiography.
Rheumatology, 1996
The aim of the project was to explore the possibility of conferring, on the practice nurse (PN), ... more The aim of the project was to explore the possibility of conferring, on the practice nurse (PN), the skills and knowledge of the rheumatology nurse practitioner (RNP), hitherto, exclusively, a member of the hospital team. A trained and experienced RNP paid a series of regular visits to participating general practices in SE London. The subjects were 11 PNs and 30 patients with chronic rheumatic diseases. Interactive sessions involving the RNP, PN and patients were set up with a view to (1) instructing the PNs in the role of the RNP in the education and care of patients, and educating patients about their disease and its treatment. Practice nurse and patient questionnaires were used to assess PN and patient knowledge before and after the instructional sessions. Only eight out of the 392 (2%) practices approached participated in the project and, even with these, difficulties were encountered, arising from the PNs' workload and pattern of work, and the reluctance of the general practitioners to enter a new project in the present climate of change in the NHS, unless clear and immediate financial advantages were in prospect. Statistically significant results were obtained in before/after comparisons of patient and nurse knowledge scores (P < 0.00001 and P = 0.001, respectively) following the RPN visits. The basic instructional format is sound and workable. A PN, if allocated protected time and appropriate patients, can acquire the knowledge and skills needed to manage patients with chronic rheumatic diseases in primary care. Both the instruments of measurement used can register changes over time, leading in a small number of patients (30) and PNs (11) to a statistically highly significant result.
Rheumatology, 1975
In this study the value of undertaking routine blood and urine estimations was assessed in relati... more In this study the value of undertaking routine blood and urine estimations was assessed in relation to achieving maximum efficacy and safety in chrysotherapy. It was found that a favourable response to gold was forthcoming in approximately two-thirds of patients and occurred irrespective of the patients&amp;#39; disease duration or severity, or the mean serum gold level or the mean urinary gold excretion, estimated immediately before the next gold injection was due. The presence of rheumatoid nodules and the patients&amp;#39; advancing age were associated with a less favourable clinical response to gold. Those patients who derived a marked benefit from chrysotherapy did so significantly earlier in their course than those who derived only moderate benefit. A frequent correlation was seen in individual patients between serum gold levels and urinary gold excretion. This was most marked in those patients showing a favourable response to gold.
Rheumatology, 1992
We carried out a segregation analysis comparing the inheritance of collagen gene markers and join... more We carried out a segregation analysis comparing the inheritance of collagen gene markers and joint hypermobility syndrome in two extended families. Our results exclude the genes encoding type III (COL3A1), type V alpha 2 chain (COL5A2) and type VI alpha 3 chain (COL6A3) unambiguously in both families. The simultaneous exclusion of both the type 1 alpha 1 and alpha 2 chain genes in the same family was not possible: COL1A1, but not COL1A2 was excluded in one and COL1A2, but not COL1A1 was excluded in the second. There was no suggestion of strong linkage to either of these loci. These data do not support the hypothesis that JHS in these families is caused by mutations in these collagen genes.
Rheumatology, 1982
ABSTRACT