PubMed · 12900120
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Juha Hernesniemi, Jaakko Rinne. 2003. Multiple aneurysms.. https://doi.org/10.1016/s0090-3019(03)00208-8
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There is a growing body of evidence that the ventromedial prefrontal cortex (VMPFC) is implicated in the new learning of visual items. Little is known, however, as to the involvement of that portion of the prefrontal cortex in the learning of temporal and spatial relationship of those items. The aim of the present study, therefore, was to investigate the role of the VMPFC in memory for temporal and spatial order. Patients who had undergone surgery of the anterior communicating artery aneurysm, and normal control subjects (C), participated in the study. The patients were subdivided into three groups: with resection of the left (LGR+) or right (RGR+) gyrus rectus, and without such a resection (GR-). Subjects were presented with two memory tests: a temporal order (TO) test and a spatial order (SO) test. In the TO test, the LGR+ and RGR+ groups performed worse than the C group, while the GR- group did not differ significantly from the C group. In the SO test, the LGR+ and RGR+ groups did not differ significantly from the C and GR- groups. However, the trend appears to be the same for both tests, although only the TO test provides statistically significant group differences. Our results thus suggest that the VMPFC is involved in memory for contextual information. Together with previous findings, the data suggest that the learning of the relationship between items as well as the learning of those items are mediated by overlapping areas of the VMPFC.
BACKGROUND AND PURPOSE: The management of aneurysms is controversial because little is known about the impact of clipping on long-term outcome. This study was designed to evaluate long-term survival of patients with aneurysms undergoing clipping in a statewide population. METHODS: We used a retrospective design using an administrative database to identify patients hospitalized with aneurysms (1987 to 2001). Time-to-event analysis was used to determine the risk of death from all causes and from neurological causes. RESULTS: 4619 patients (mean age 54.7+/-15.3, 66.3% female) were hospitalized with cerebral aneurysms. Survival among patients with ruptures was significantly lower compared with patients with unruptured aneurysm (P<0.001) with adjusted hazard ratio (HR) of death after clipping 40% higher (HR: 1.4; 95% CI: 1.2, 1.7) in patients with rupture compared with those that were unruptured. Survival estimates for unruptured patients who underwent clipping were significantly higher than among those unruptured patients who did not undergo clipping (P<0.001), with adjusted HR of death 30% higher in patients with unruptured aneurysm that were not clipped compared with unruptured patients who were clipped (HR: 1.3; 95% CI: 1.1, 1.6). Patients with unruptured aneurysm who underwent clipping and survived beyond the 30-day postoperative period were less likely to die from neurologically related causes (5.6 versus 2.3%, P<0.001). Patients with ruptures and aneurysms who underwent clipping have a higher rate of death compared with the general population in the long-term. CONCLUSIONS: Short-term and long-term mortality after clipping of cerebral aneurysms is higher than previously reported. Patients with unruptured aneurysms who undergo clipping have improved survival compared with those who do not undergo clipping. This study supports the use of early intervention in the management of patients with unruptured aneurysms.
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