Tissue Doppler imaging and conventional echocardiography after anthracycline treatment in adults: early and late alterations of left ventricular function during a prospective study.

AIM OF THE STUDY: To evaluate the short and long-term effects of anthracycline chemotherapy in adults using conventional echocardiography and pulsed tissue Doppler imaging (TDI). METHODS AND RESULTS: Twenty patients were included of which 16 had a complete follow up. They underwent an echocardiography before chemotherapy, 1-3 months and 3.5+/-0.6 years after the treatment. We recorded pulsed TDI at the mitral annulus, the basal segments of the left ventricular (LV) lateral and posterior walls; peak velocities in systole (Sm), early (Em) and late diastole and the isovolumic relaxation time (IVRT) were measured. The cumulative dose of doxorubicin was 211+/-82 g/m2. Early after anthracycline therapy, we observed changes in the diastolic LV function with a decrease of the mitral E peak velocity and TDI Em. At the late control, diastolic changes were more pronounced and associated with an alteration of the systolic function (LV ejection fraction and Sm). Four patients had a LV ejection fraction <50%; in these patients we observed a mitral annulus IVRT <80 ms at the early control; this could be of interest to predict later impairment of the LV ejection fraction. CONCLUSION: We found early changes in LV diastolic function and observed that late impairment of the LV ejection fraction occurred frequently after anthracycline therapy, despite normal systolic LV function during the first months of follow-up.

[Screening and treatment of malnutrition: European Council Resolution and its potential application in Switzerland]. / Dépistage et traitement de la dénutrition: Résolution du Conseil de l'Europe et potentiel d'application en Suisse.

The deleterious consequences of hospital malnutrition are progressively being recognized by the public. The Committee of the Ministers of the European Council has released a resolution for food and nutrition and ask the state members to apply national recommendations in their hospitals. The evaluated domains and actions to be undertaken are based on 4 elements: Access to a healthy and varied food supply is a fundamental human right; a high number of patients hospitalized in Europe are malnourished (30-60%); the demonstration that malnutrition of hospitalized patients increases length of hospital stay and medical costs; the demonstrated beneficial effects of a hospital food service and of optimal nutritional care on morbidity, healing and quality of life. The resolution indicates clearly the options to be followed to optimize the actions and decisions at three levels: patient care, support services, and administration. All caregivers must be involved in the implementation of the recommendations in a way to adapt them to the local needs and restrictions. This review summarizes the actions to be taken by medical and other caregivers in order to sensitize them to the above-mentioned problems and to initiate practical options to treat malnourished patients or patients at risk of becoming malnourished.