Just a phase? Causal probing reveals spurious phasic dependence of sustained attention.

For over a decade, electrophysiological studies have reported correlations between attention / perception and the phase of spontaneous brain oscillations. To date, these findings have been interpreted as evidence that the brain uses neural oscillations to sample and predict upcoming stimuli. Yet, evidence from simulations have shown that analysis artefacts could also lead to spurious pre-stimulus oscillations that appear to predict future brain responses. To address this discrepancy, we conducted an experiment in which visual stimuli were presented in time to specific phases of spontaneous alpha and theta oscillations. This allowed us to causally probe the role of ongoing neural activity in visual processing independent of the stimulus-evoked dynamics. Our findings did not support a causal link between spontaneous alpha / theta rhythms and behaviour. However, spurious correlations between theta phase and behaviour emerged offline using gold-standard time-frequency analyses. These findings are a reminder that care should be taken when inferring causal relationships between neural activity and behaviour using acausal analysis methods.

Breastfeeding media coverage and beliefs during the COVID-19 pandemic in Mexico: implications for breastfeeding equity.

BACKGROUND: Because breastfeeding offers short- and long- term health benefits to mothers and children, breastfeeding promotion and support is a public health priority. Evidence shows that SARS-CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are thought to be contained in breastmilk of mothers with history of COVID-19 infection or vaccination. WHO recommends direct breastfeeding as the preferred infant feeding option during the COVID-19 pandemic, even among women with COVID-19; but conflicting practices have been adopted, which could widen existing inequities in breastfeeding. This study aims to describe how information about breastfeeding was communicated in Mexican media during the pandemic and assess Mexican adults' beliefs regarding breastfeeding among mothers infected with COVID-19. METHODS: We conducted a retrospective content analysis of media coverage on breastfeeding in Mexico between March 1 and September 24, 2020, excluding advertisements. For the content analysis, we performed both a sentiment analysis and an analysis based on strengths, weaknesses, opportunities, and threats (SWOT) for breastfeeding promotion. Additionally, we conducted a descriptive analysis of nationally representative data on adults' beliefs about breastfeeding from the July 2020 round of the ENCOVID-19 survey in Mexico and stratified the results by gender, age, and socioeconomic status. RESULTS: A total of 1014 publications on breastfeeding were identified on the internet and television and in newspapers and magazines. Most information was published during World Breastfeeding Week, celebrated in August. The sentiment analysis showed that 57.2% of all information was classified as positive. The SWOT analysis indicated that most information focused on current actions, messages, policies, or programs that enable breastfeeding (i.e., strengths) or those not currently in place but that may enable breastfeeding (i.e., opportunities) for breastfeeding promotion. However, ENCOVID-19 survey results showed that 67.3% of adults living in households with children under 3 years of age believe that mothers with COVID-19 should not breastfeed, and 19.8% do not know whether these mothers should breastfeed. These beliefs showed differences both by gender and by socioeconomic status. CONCLUSIONS: While the Mexican government endorsed the recommendation on breastfeeding during the COVID-19 pandemic, communication was sporadic, inconstant and unequal across types of media. There was a widespread notion that mothers with COVID-19 should not breastfeed and due to differences on beliefs by socioeconomic status, health inequities could be exacerbated by increasing the risk of poorer breastfeeding practices and preventing vulnerable groups from reaping the short and long-term benefits of breastfeeding.

Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression.

BACKGROUND: Clinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. PROCEDURES: Thirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England were asked to submit details of between 20 and 100 eligible service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. FINDINGS: Data from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care plan recorded in the notes, but a review date was documented in only two-thirds, and almost half of individuals had not received a copy. CONCLUSIONS: There was considerable variation between English mental health services across many variables, and much scope for improvement. Clinicians should ensure that care plans are developed collaboratively with service users/patients and identified carers should be provided with information about support services. Health services should investigate the reasons for low referral rates for psychological therapies. Clinicians should ensure all service users have jointly developed crisis plans in place at discharge. Service managers should agree outcome measures to evaluate the treatment provided and clinicians should use these measures at initial assessment and review appointments. The implementation of such changes provides an opportunity for collaborative research into mental health service delivery and quality.

Species composition, monitoring, and feeding injury of stink bugs (Heteroptera: Pentatomidae) in blackberry.

Blackberry (Rubus spp.) production in Florida has increased > 100% within the past two decades. and several insect pests, including stink bugs (Heteroptera: Pentatomidae), have been observed feeding on this crop. The objectives for this study were to determine the stink bug species present in blackberry; to develop monitoring tools for stink bugs in blackberry; and to describe feeding injury to blackberries by Euschistus quadrator Rolston, a relatively new stink bug pest to Florida, that has spread throughout the state. In a field survey, E. quadrator was the most abundant stink bug species, followed by Euschistus servus Say, Euschistus obscurus (Palisot de Beauvois), Thyanta custator (F.), Proxys punctulatus (Palisot de Beauvois), and Podisus maculiventris Say. Yellow pyramid traps caught more stink bugs than tube traps with or without the addition of Euschistus spp. pheromone lures. There were no statistical differences between traps baited with a Trécé Pherocon Centrum lure, a Suterra Scenturion lure, and an unbaited trap. These results were supported by Y-tube olfactometer assays with E. quadrator where there were no differences between pheromone baited lures and a control. Injury to berries caused by E. quadrator adults and third instars was similar, and both adults and third instars fed more on green berries compared with turning berries. In addition, adults fed more on green berries compared with ripe fruit. The most common injury to green berries was discoloration. In contrast, misshapen drupelets were commonly seen on turning and ripe berries. The potential for managing stink bugs in blackberries to prevent them from reaching damaging levels is discussed.

Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus.

AIMS: To estimate remaining life expectancy (RLE), quality-adjusted life expectancy (QALE), causes of death and lifetime cumulative incidence of microvascular/macrovascular complications of diabetes for youths diagnosed with Type 2 diabetes. METHODS: A Markov-like computer model simulated the life course for a hypothetical cohort of adolescents/young adults in the USA, aged 15-24 years, newly diagnosed with Type 2 diabetes following either conventional or intensive treatment based on the UK Prospective Diabetes Study. Outcomes included RLE, discounted QALE in quality-adjusted life years (QALYs), cumulative incidence of microvascular/macrovascular complications and causes of death. RESULTS: Compared with a mean RLE of 58.6 years for a 20-year-old in the USA without diabetes, conventional treatment produced an average RLE of 43.09 years and 22.44 discounted QALYs. Intensive treatment afforded an incremental 0.98 years and 0.44 discounted QALYs. Intensive treatment led to lower lifetime cumulative incidence of all microvascular complications and lower mortality from microvascular complications (e.g. end-stage renal disease (ESRD) death 19.4% vs. 25.2%). Approximately 5% with both treatments had ESRD within 25 years. Lifetime cumulative incidence of coronary heart disease (CHD) increased with longer RLE and greater severity of CHD risk factors. Incorporating disutility (loss in health-related quality of life) of intensive treatment resulted in net loss of QALYs. CONCLUSIONS: Adolescents/young adults with Type 2 diabetes lose approximately 15 years from average RLE and may experience severe, chronic complications of Type 2 diabetes by their 40s. The net clinical benefit of intensive treatment may be sensitive to preferences for treatment. A comprehensive management plan that includes early and aggressive control of cardiovascular risk factors is likely needed to reduce lifetime risk of CHD.

Neanderthal exploitation of marine mammals in Gibraltar.

Two coastal sites in Gibraltar, Vanguard and Gorham's Caves, located at Governor's Beach on the eastern side of the Rock, are especially relevant to the study of Neanderthals. Vanguard Cave provides evidence of marine food supply (mollusks, seal, dolphin, and fish). Further evidence of marine mammal remains was also found in the occupation levels at Gorham's Cave associated with Upper Paleolithic and Mousterian technologies [Finlayson C, et al. (2006) Nature 443:850-853]. The stratigraphic sequence of Gibraltar sites allows us to compare behaviors and subsistence strategies of Neanderthals during the Middle Paleolithic observed at Vanguard and Gorham's Cave sites. This evidence suggests that such use of marine resources was not a rare behavior and represents focused visits to the coast and estuaries.

The cutest little baby face: a hormonal link to sensitivity to cuteness in infant faces.

We used computer image manipulation to develop a test of perception of subtle gradations in cuteness between infant faces. We found that young women (19-26 years old) were more sensitive to differences in infant cuteness than were men (19-26 and 53-60 years old). Women aged 45 to 51 years performed at the level of the young women, whereas cuteness sensitivity in women aged 53 to 60 years was not different from that of men (19-26 and 53-60 years old). Because average age at menopause is 51 years in Britain, these findings suggest the possible involvement of reproductive hormones in cuteness sensitivity. Therefore, we compared cuteness discrimination in pre- and postmenopausal women matched for age and in women taking and not taking oral contraceptives (progestogen and estrogen). Premenopausal women and young women taking oral contraceptives (which raise hormone levels artificially) were more sensitive to variations of cuteness than their respective comparison groups. We suggest that cuteness sensitivity is modulated by female reproductive hormones.

A telephone intervention to achieve differentiation in dietary intake: a randomized trial in paediatric primary care.

BACKGROUND: Telehealth offers opportunities to extend clinical and research interventions for paediatric obesity. OBJECTIVES: To assess utility of a telephone intervention, implemented through a national primary care paediatric research network, for promoting differentiation in dietary intake, consistent with either a low-glycemic load (Low GL) or Low Fat prescription, among overweight/obese school-age children. METHODS: Five-week telephone dietary counselling intervention for parents of overweight/obese school-age children recruited through the Slone Center Office-based Research Network. Parent-child dyads were randomized to Low GL or Low Fat diet. Primary outcomes were dietary GL and dietary fat, adjusted for energy intake and assessed by 24-h dietary recall. RESULTS: Subjects were randomized to Low GL (n = 11, 8.1 ± 1.7 years, 45.5% male) or Low Fat (n = 11, 8.2 ± 2.0 years, 36.4% male), with no baseline differences. Overall, 86% of subjects attended at least four of five counselling sessions, and study completion rate was 91% (based on completion of the final dietary recalls). Reported satisfaction was high. In adjusted analyses limited to 'recall completers,' reduction in dietary GL (g/1000 kcal) achieved within the Low GL group was significant (p = 0.01) and greater than the change in dietary GL in the Low Fat group (mean ± SE; -12.9 ± 4.4 vs. 5.1 ± 4.9, p = 0.03). Similarly, reduction in dietary fat (% of total energy) within the Low Fat group was significant (-5.6 ± 2.5, p = 0.046) but with no difference between groups (p = 0.25). CONCLUSION: A telephone-based dietary intervention for overweight/obese children, implemented through a national paediatric research network, fostered prescribed dietary changes. ClinicalTrials.gov registration: NCT00620152.

Changes of oxygen tension in experimental tumors after a single dose of X-ray irradiation.

Electron paramagnetic resonance oximetry was used to measure the partial pressure of oxygen (pO2) in two types of tumor in vivo in C3H/HeJ mice. The pO2 in MTG-B (high hypoxic fraction) and RIF-1 (low hypoxic fraction) tumors was monitored prior to and at several time points after a single dose of X-ray irradiation (up to 7 days after treatment). Initial values of pO2 in RIF-1 (8.7 +/- 1.1 mm Hg; n = 14) were higher than that of pO2 in MTG-B (3.3 +/- 0.5 mm Hg; n = 19). The pO2 in both types of unirradiated tumors decreased slowly with tumor growth. Irradiation of tumors had a two-phase effect on pO2: an initial sharp decrease in pO2, followed by slow reoxygenation. After a 20-Gy radiation dose, the pO2 was 2.2 +/- 0.5 mm Hg at 6 h [significantly lower (P < 0.0001) than in control] and 3.2 +/- 0.5 mm Hg at 48 h [significantly higher (P < 0.02) than in control] in MTG-B, and 5.4 +/- 1.2 mm Hg at 24 h and 8.2 +/- 1.0 mm Hg at 72 h in RIF-1. The time course for these changes in pO2 was found to be independent of the doses in use in this study (10, 20, and 40 Gy). The occurrence of radiation-induced changes in pO2 and the different time courses of these changes suggest that repeated monitoring of pO2 in tumors during treatment could be used to enhance the efficacy of clinical treatments.

Addressing noncommunicable diseases in primary care: the case of type 2 diabetes.

The rapid growth of noncommunicable diseases represents a formidable global health challenge. Here we use type 2 diabetes as a case study to illustrate the rise of noncommunicable diseases and call attention to the important role of primary care systems in addressing these diseases in low- and middle-income countries. Comprehensive screening for diabetes should be implemented through primary care systems to increase early detection of prediabetes and undiagnosed diabetes - a first step to diabetes prevention and management. In addition, primary care systems should strengthen and expand capacity to link patients to appropriate interventions based on their diabetes status and provide care coordination (e.g. leveraging task-shifting and technology), and integrate clinic and community resources for diabetes prevention and control. Additional strategies should include continuous quality improvement, health systems strengthening, workforce development, and affordable and sustainable financing. Together, these actions could elevate the role of primary care in addressing diabetes in low- and middle-income countries and help advance global progress towards reducing diabetes complications, and also preventing or delaying diabetes among those at risk.

Outcomes from an orientation model to reduce attrition in paediatric weight management.

We aimed to reduce attrition of newly referred patients in a paediatric weight management programme by implementing an orientation to address families' expectations and screen for and support behavioural and mental health problems and psychosocial stressors at programme outset. Orientation impact was monitored with run charts with percentages of scheduled encounters completed. Long-term impact was assessed by comparing patients in the initial 6 months of the orientation to a baseline group of referred patients during the same 6-month time interval in the prior year (Pre-Orientation Group). The outcome measure was programme attrition within 15 months. Groups were compared using Kaplan-Meier survival analysis and Cox proportional hazards regression modelling. Patients in the Orientation Group had a 23% increased odds of attrition compared to patients in the Pre-Orientation group (adjusted Hazard ratio, aHR 1.23; 95% confidence interval, CI: 1.01, 1.51) and shorter median duration of follow-up (2.0 vs. 2.9 months, P = 0.004). An increase in body mass index z-score of 1 unit resulted in a nearly fivefold increased odds of attrition (aHR 5.24; 95% CI: 2.95, 9.3). An orientation for new patients did not reduce attrition within 15 months. We suggest that ongoing retention strategies should be embedded into the treatment phase of the programme.

A serum-free culture method for myeloma progenitors in vitro: proliferative and immunophenotypic characteristics.

Methods for forming multiple myeloma (MM) colonies are difficult because nonproliferative, but viable, plasma cells can survive for several weeks in culture and because MM cells tend to clump readily, forming pseudo-colonies. The present study describes a method for growing pure myeloma colonies in serum-free conditions in which genuine myeloma growth is unequivocally demonstrated. Growth was observed in 17 of 32 MM bone marrow samples. After a delay of 3-5 weeks, during which most cells died, Ig light-chain-restricted colonies emerged, expanded for approximately 3 weeks, and then showed no evidence of further proliferation. Cell doubling time was 8-10 days, and a significant number of cells in all cultures expressed Ki-67, having earlier lacked this nuclear proliferation antigen. In addition, colony formation was abrogated by irradiation, and two of eight cultures were successfully replated in 0.8% methylcellulose. Phenotypic analysis revealed a mixed population of plasma cells (RFD6+) and B-lymphocytes (CD19+, CAL-LA-), and cells were consistently Epstein-Barr virus negative. Culture of myeloma bone marrow by this serum-free method will allow appraisal of the role of various recombinant growth factors.

Bone marrow endogenous colony stimulating factor(s): relation to granulopoiesis in vivo.

Granulocyte-macrophage colony stimulating factors (CSF) are produced both in peripheral tissues and within the bone marrow. Stimulators from either source might regulate granulocyte and monocyte production in vivo. The purpose of this study was to devise an assay for bone marrow endogenous CSF so that its role in regulation of granulopoiesis might be assessed. There was a significant positive correlation between the endogenous CSF level and the subsequent trend in peripheral blood neutrophil count in both normal and infected patients, suggestive of a regulatory role. In addition, granulopoietic recovery after neutropenia was associated with increased endogenous CSF levels. There are two candidate regulators of endogenous CSF production, a stimulatory humoral factor and a neutrophil derived inhibitor which inhibits endogenous CSF production in vitro. Our results suggest that the marrow neutrophil level had a much more significant inhibitory effect than the neutrophil level in the culture.

Peanut agglutinin in combination with CD19 monoclonal antibody has potential as a purging agent in myeloma.

Administration of high-dose chemotherapy to patients with myeloma, followed by rescue with autologous bone marrow transplantation (ABMT), sometimes induces complete disease remission but relapse is usual. We have attempted to reduce the risk of relapse by selective in vitro removal of myeloma cells from the autologous graft. A combination of the (gal-galNac)-binding lectin peanut agglutinin (PNA), which binds all plasma cells, and the pan-B monoclonal antibody CD19 was assessed for purging marrow of myeloma cells and their putative precursors using a magnetic bead method. Preliminary experiments performed on peripheral blood mononuclear cells spiked with fluorescent-labeled PNA+ Kirk tumor cells showed that a magnetic bead: target cell ratio of 40:1 resulted in a greater than 3-log reduction in PNA+ cells. This technique was then applied to 17 samples of myeloma bone marrow and to 18 samples of normal bone marrow spiked with PNA+ Kirk cells and CD19+ hairy cell leukemia cells. In each case all detectable plasma cells and CD19+ lymphocytes were effectively removed, and normal hemopoietic progenitor cell recovery was greater than 55%. This purging system deserves further study as a means of reducing relapse rates in myeloma patients treated by a combination of high-dose chemotherapy and ABMT.

Disappearance of antibodies to Factor VIII in a patient with acquired haemophilia and carcinoma of the pancreas during cytotoxic therapy with fluorouracil and CCNU.

An inhibitor to clotting factor VIII (anti-VIII:C) developed in a 70 year old woman with carcinoma of the pancreas three months after palliative by-pass surgery. A life-threatening sublingual haemorrhage was controlled by infusion of human factor VIII concentrate in high dosage. With the objective of reducing pancreatic tumour size, combination cytotoxic therapy with fluorouracil and CCNU was given. Reduction in the size of the tumour was associated with disappearance of anti-VIII:C, reappearance of normal quantities of clotting factor VIII (VIII:C) in the plasma and resolution of the bleeding tendency. The anti-VIII:C was characterised as being predominantly of the IgG4 sub-class with k light chains. In vitro and in vivo studies showed the inactivation of VIII:C by anti-VIII:C was markedly non-linear. Normal quantities of factor VIII coagulant antigen (VIII:CAg) were detected in the patient's plasma when VIII:C levels were negligible.

A method for clinical purging of myeloma bone marrow using peanut agglutinin as an anti-plasma cell agent, in combination with CD19 monoclonal antibody.

Previous studies have shown that the lectin peanut agglutinin (PNA) binds bone marrow plasma cells in the majority of patients with myeloma and does not bind to normal haemopoietic progenitors. This lectin has been used in combination with anti-CD19 monoclonal antibody (moAb) in a system for purging myeloma bone marrow. This has now been scaled up for application to ex vivo treatment of large volumes of bone marrow suitable for autologous bone marrow transplantation. Four bone marrow harvests from patients with myeloma containing 9.5 +/- 4.9% plasma cells were depleted of erythrocytes and mature granulocytes by Ficoll separation using the Haemonetics V50 cell separator. The mononuclear fraction was then purged with magnetic beads coated with PNA and anti-CD19 moAb. The system proved highly efficient with removal of all detectable plasma cells and CD19+ cells. Average mononuclear cell recovery following purging was 71% of the concentrated marrow with 78% yield of CFU-GM. Normal progenitor recovery related to patients' weight is predicted to be adequate for haemopoietic reconstitution following ablative chemoradiotherapy. This system is therefore feasible for large-scale clinical purging.

Autologous bone marrow transplantation for myeloma patients using PNA- and CD19-purged marrow rescue.

A new method of in vitro bone marrow purging using a lectin and monoclonal antibody in combination has been used for the first time in vivo. Two patients with advanced myeloma were treated with high-dose melphalan and total body irradiation and then rescued with autologous bone marrow which had been purged in vitro to remove malignant cells by using a combination of a plasma cell-binding lectin (peanut agglutinin, PNA) and the anti-B lymphocyte monoclonal antibody anti-CD19, bound to magnetised microspheres. Both patients showed rapid engraftment of the purged bone marrow and remain well 36 and 46 months later with normal bone marrow morphology, although one patient still has a low level of circulating paraprotein. This is a promising form of therapy for what has been an invariably fatal condition.

Effect of perception of mechanical loading on human respiratory pattern regulation.

We applied external flow resistive (R) and elastic (E) mechanical loads over the entire respiratory cycle to five normal subjects by using a pseudorandom loading protocol. Loads ranged in magnitude from imperceptible (R0/E0) through just perceptible (R1/E1) to large (R2/E2) and resulted in respiratory pattern responses that were due to reflex responses alone (R0/E0) or to a combination of reflex responses and behavioral reactions to the perception of impeded breathing (R1/E1 and R2/E2). Pattern regulation dynamics were estimated from the computed impulse responses of tidal volume and inspiratory and expiratory durations. We anticipated that emergence of behavioral contributions would be marked by increased variability in response strategies and by increased nonlinearity in the observed responses. Regarding the immediate pattern response to loading, there was a tendency for increased qualitative variation across subjects as the load size increased, but the within-subject variability (coefficient of variation) was unaffected. We found no evidence for increased nonlinearity as loads became perceptible. The emergence of behavioral control in some instances seemed to be marked by reduction of complexity of the impulse response to one dominated by the zeroth-order lag, leading to dynamically simpler responses compared to control.

Submaximal exercise responses of tetraplegics and paraplegics.

This study describes responses of 21 wheelchair users to a continuous, increasing work rate test to exhaustion on a wheelchair ergometer. Heart rate, ventilation, O2 uptake, respiratory exchange ratio, ventilation equivalent for O2, and O2 pulse were determined for each minute. Subjects were divided into tetraplegic (n = 8), high-lesion paraplegic (n = 6), and low-lesion paraplegic (n = 7) groups. Linear regression analyses, with O2 uptake as the independent variable, were used to determine the strength of relationships within each group and differences between groups in slopes and intercepts of regression equations. All variables were significantly (P less than 0.05) related to O2 uptake (r = 0.42-0.94). The only significant difference between the high- and low-lesion paraplegic groups was for heart rate intercept, as the heart rate for the low-lesion group tended to be lower at any given O2 uptake. Tetraplegics had a higher intercept and/or slope for ventilation equivalent, ventilation, and respiratory exchange ratio and lower intercepts for heart rate and O2 pulse. These differences in responses to a progressive exercise task are logically related to the differences in maximal O2 uptake, functional muscle mass, and vasomotor and cardiac control of the groups.

Aneurysms of extracranial carotid arteries.

Twenty-three extracranial carotid artery aneurysms were encountered in 19 patients. Arteriosclerosis was evident in 16 aneurysms. Severe arterial hypertension affected all patients with arteriosclerotic lesions. Trauma, penetrating neck injury once, and blunt neck injury three times caused four aneurysms. Three aneurysms resulted from earlier carotid artery operations. All 19 patients were symptomatic. Neurologic symptoms affected 13 individuals. Local symptoms referable to the aneurysmal mass troubled 15 patients. Twenty-one aneurysms were treated operatively. There was no operative mortality. Aneurysmectomy with arterial reconstruction was performed 16 times. Aneurysmorrhaphy was undertaken on four occasions and carotid ligation once. Two strokes and multiple cranial nerve injury accounted for three operative complications. No neurologic complications occurred during follow-up totaling 360 man-months. These lesions may be successfully treated by a carefully performed, properly selected operation.