Acetaminophen for osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is the most common form of arthritis. Published guidelines and expert opinion are divided over the relative role of acetaminophen (also called paracetamol or Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) as first-line pharmacologic therapy. The comparative safety of acetaminophen and NSAIDs is important to consider as NSAIDs have the potential for serious gastrointestinal, renal, and cardiovascular toxicities, and acetaminophen in high dosages (greater than or equal to 2 grams per day), may also have the potential for serious upper gastrointestinal toxicity. OBJECTIVES: To assess the efficacy and safety of acetaminophen versus placebo and versus NSAIDs (ibuprofen, arthrotec, celecoxib,naproxen, rofecoxib) for treating OA. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (Issue 3, 2002), MEDLINE (up to July 2002), and Current Contents (up to March 2002). Reference lists of identified RCTs and pertinent review articles were also hand searched. SELECTION CRITERIA: Published randomized controlled trials (RCTs) evaluating the efficacy and safety of acetaminophen alone in OA were considered for inclusion. DATA COLLECTION AND ANALYSIS: Pain, physical function and global assessment outcomes were reported. Results for continuous outcome measures were expressed as standardized mean differences. Dichotomous outcome measures were pooled using relative risk and the number needed to treat was calculated. MAIN RESULTS: Six RCTs and 1689 participants were included in the review. One study compared acetaminophen to placebo, and five compared acetaminophen to NSAIDs. In the placebo-controlled RCT, acetaminophen was shown to be clearly superior to placebo with a similar safety profile. The number needed to treat to achieve an improvement in pain was three. In the comparator-controlled RCTs, acetaminophen was less effective overall than NSAIDs in terms of pain reduction and global assessments but both drugs had similar efficacy in terms of improvements in functional status. No significant difference was found between the safety of acetaminophen and NSAIDs, although patients taking NSAIDS were more likely to withdraw due to GI events. REVIEWER'S CONCLUSIONS: The evidence to date suggests that NSAIDs are superior to acetaminophen for improving knee and hip pain in people with OA but have not been shown to be superior in improving function. The size of the treatment effect was modest, and the mean trial duration was only six weeks, therefore, additional considerations need to be factored in when making the decision between using acetaminophen or NSAIDs. In OA subjects with moderate-to-severe levels of pain, NSAIDs appear to be more effective than acetaminophen.

Highly aggressive extraocular sebaceous carcinoma.

Extraocular sebaceous carcinoma is an uncommon neoplasm usually localized on the head and neck. We report a case of sebaceous carcinoma of the axillary skin with a highly aggressive behavior. The patient was a 43-year-old black man who developed multiple cutaneous and lymph node metastases shortly after the excision of primary sebaceous carcinoma of the axillary skin. Many neoplastic aggregations were identified within the lumina of the dermal lymphatic vessels in the excised specimen of the primary neoplasm. Although extraocular sebaceous carcinoma has been traditionally considered a less aggressive neoplasm than its ocular counterpart, a review of the literature and this case demonstrate that extraocular sebaceous carcinoma may also lead to disseminated metastatic disease.

Tubular apocrine carcinoma arising in a nevus sebaceus of Jadassohn.

We present an example of tubular carcinoma that developed within a nevus sebaceus of Jadassohn on the scalp of a 53-year-old woman. The neoplasm showed features of sebaceous and apocrine differentiation. We review the literature about the malignant neoplasms arising in the nevus sebaceus of Jadassohn.

Recovery of kiwifruit vines from transient waterlogging of the root system.

The extent to which kiwifruit vines (Actinidia deliciosa var. deliciosa) recovered from transient waterlogging of the root system was determined under controlled conditions. Vines were waterlogged for periods varying from 1 to 7 days. The effects of decreasing concentrations of oxygen in the root zone on growth of the vine were rapid with substantial reductions occurring after being exposed to oxygen concentrations in the surrounding water of less than 0.125 mmol l1 for as little as 1 day. There was no evidence of recovery of growth once aeration was restored to the roots, except for the appearance of new roots at the base of the stems of vines that had been waterlogged for less than 5 days. The quantity of new roots grown was inversely related to the time of waterlogging. Although new roots were also found on the control vines, the quantities involved were very much less than for the vines stressed for up to 4 days. No new roots were found for vines waterlogged for more than 4 days. The substantial loss of dry weight of roots of vines waterlogged for more than 3 days was due in part to a lack of growth and to a physical loss of root tissue. The loss of tissue resulted from the detachment of the cortex from the central stele through the dissolution of an entire layer of cortical cells which, in the control vines, were filled with starch. A microscopic examination of the cells of the root from waterlogged vines showed the cortical cells to be generally distorted with much of the intercellular material missing. The closure of the stomata within 2-3 h of the roots being waterlogged and the rapid desiccation of the leaves that followed the closure, was consistent with earlier findings with kiwifruit vines. Some recovery of stomata activity occurred for vines that had been waterlogged for less than 4 days once the oxygen supply to the root was restored. For vines that had their roots submerged for only 1 day, stomatal activity was fully restored 3 days after the vines were removed from the water. In contrast, there was no recovery of stomatal activity for vines that had been waterlogged for more than 3 days. A feature of stomatal behaviour that was not related to the effects of oxygen stress was the cyclic pattern which developed. Each cycle repeated itself every 4-6 days and consisted of a period of high stomatal conductance followed by a sharp decline to a much lower level. A highly significant negative relationship was found between the level of photosynthetically active radiation and stomatal behaviour. It was concluded that the speed with which the roots die and the associated damage to the leaves under anoxic conditions greatly limits the ability of kiwifruit vines to resume growth once oxygen supply to the root has been restored.