Three years ago a junior Fellow of tile Royal College of Surgeons asked me if actinomycosis ever affected bone, for (said he) lIe had been taught that it never did gain a foothold in that structure. I was surprised at tile question and still more disturbed at the erroneous teaciling, because from tile earliest years of our knowledge of actinomycosis it llas been well known that bone is Ilot exempt from its ravages. THE JOURNAL OF BONE AND JOINT SURGERY combination of caries and sclerosis in differing proportion gives rise to many clinical types. Sequestration is very uncommon. THE JOURNAL OF BONE AND JOINT SURGERY 11G. 3 ACTINOMYCOSIS OF BONE WITH SPECIAL REFERENCE TO INFECTION OF VERTEBRAL COLUMN

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BackgroundInformation is scarce regarding effects of antihypertensive medication on blood pressure variability (BPV) and associated clinical outcomes. We examined whether antihypertensive treatment changes BPV over time and whether such change (decline or increase) has any association with long‐term mortality in an elderly hypertensive population.Methods and ResultsWe used data from a subset of participants in the Second Australian National Blood Pressure study (n=496) aged ≥65 years who had 24‐hour ambulatory blood pressure recordings at study entry (baseline) and then after a median of 2 years while on treatment (follow‐up). Weighted day‐night systolic BPV was calculated for both baseline and follow‐up as a weighted mean of daytime and nighttime blood pressure standard deviations. The annual rate of change in BPV over time was calculated from these BPV estimates. Furthermore, we classified both BPV estimates as high and low based on the baseline median BPV value and then classified BPV changes into stable: low BPV, stable: high BPV, decline: high to low, and increase: low to high. We observed an annual decline (mean±SD: −0.37±1.95; 95% CI, −0.54 to −0.19; P<0.001) in weighted day‐night systolic BPV between baseline and follow‐up. Having constant stable: high BPV was associated with an increase in all‐cause mortality (hazard ratio: 3.03; 95% CI, 1.67–5.52) and cardiovascular mortality (hazard ratio: 3.70; 95% CI, 1.62–8.47) in relation to the stable: low BPV group over a median 8.6 years after the follow‐up ambulatory blood pressure monitoring. Similarly, higher risk was observed in the decline: high to low group.ConclusionsOur results demonstrate that in elderly hypertensive patients, average BPV declined over 2 years of follow‐up after initiation of antihypertensive therapy, and having higher BPV (regardless of any change) was associated with increased long‐term mortality.

Three paraganglionomas in the neck investigated by angiography are presented. The value of angiography in these tumours is stressed, and one case showed distinctive radiological features hitherto undescribed which probably constitute a basis for the definitive preoperative diagnosis of malignant lesions.