[The effects of energy drinks on cognitive performance]. / De effecten van energiedranken op de cognitieve prestaties.

BACKGROUND: Energy drinks have become more and more popular since the late nineties. The manufactures claim that these drinks improve physical endurance, reaction speed and concentration. The main ingredients of energy drinks are caffeine, sugar, taurine and glucuronolactone. According to the manufacturers, the stimulating effects of these drinks are due to interaction between the various ingredients. AIM: To investigate whether energy drinks do indeed improve cognitive performance and to find out which ingredients are responsible for this effect and other benefits. METHOD: We searched the literature for the period from 1997 to 2006 on the basis of Medline, by using the search term 'energy drink or energy drinks' and restricting the search to 'humans'. results Not only did focused and sustained attention improve significantly but so did reaction speed in all sorts of reaction-time tasks. Memory improved too, but not to the same degree. CONCLUSION: The findings suggest that most of the effects of energy drinks on cognitive performance are related mainly to the presence of caffeine. Further investigation is needed into the effects of the lesser known ingredients of energy drinks (taurine, glucuronolactone) if we are to obtain a better understanding of the possible interactions.

[The syndrome of Cotard: an overview]. / Het syndroom van Cotard. Een overzicht.

BACKGROUND: There is increasing controversy about whether psychiatric illnesses should be divided into categories. One of the reasons is that such a categorial system, by its very nature, cannot provide a detailed description of specific psychopathological symptoms. A patient with Cotard's syndrome, for instance, is characterised by a nihilistic delusion relating to his own body and the syndrome does not fit into any one category. We report on a case of Cotard's syndrome encountered at our clinic. AIM: To provide an overview of the characteristics of Cotard's syndrome, including its history, phenomenology, pathogenesis and treatment. METHOD: A Medline search was conducted for the period 1980-2006 using the search term 'Cotard$'. This resulted in 68 publications, of which 18 were not used. Cross-references were used as well. RESULTS: Cotard's syndrome cannot be fitted unambiguously into any one category of the current classification system. Current evidence regarding Cotard's syndrome is based mainly on case studies and therefore no clarity can be obtained about the various aspects of the syndrome, such as prevalence, pathogenesis, treatment.

Sternotomy approach for the modified Blalock-Taussig shunt.

BACKGROUND: Since 1990, sternotomy has been the preferred approach for construction of a modified Blalock-Taussig shunt (MBTS) at Children's Hospital, Boston, Mass. In retrospect, we sought to test the hypothesis that this approach yields less mortality and morbidity than the traditional thoracotomy approach. METHODS AND RESULTS: One hundred four primary MBTSs with polytetrafluoroethylene grafts were constructed in patients from January 1988 through December 1992. Fifty-two shunts were constructed by thoracotomy approach and 52 by sternotomy approach. Fifteen of the thoracotomy patients were less than one month of age (8 less than 7 days), while 36 of the sternotomy patients were less than 1 month of age (20 less than 7 days). There were 10 shunt failures and 3 hospital deaths in the thoracotomy group and 4 shunt failures with 6 hospital deaths in the sternotomy group. The overall hospital mortality rate for the group was 8.7% (9 of 104). The operative route was not a significant predictor of hospital mortality (P = .30). However, there was a significant difference between the two operative approaches in shunt failure, with shunts that were created by thoracotomy four times more likely to fail than those created by the sternotomy route (odds ratio, OR, 3.88; 95% CI, 1.01 to 15.03; P = .049). The side of the shunt was also a significant predictor of failure with left-side MBTSs foru times more prone to failure (OR, 4.02; 95% CI, 1.19 to 15.25; P = .025). CONCLUSIONS: The sternotomy route is technically less challenging and is associated with fewer shunt failures than the classic thoracotomy approach. The potential theoretical disadvantages of this method for future sternal reentry for subsequent procedures was not apparent but requires prospective analysis.