Objectives To assess the incidence of and risks for congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities among adult survivors of childhood and adolescent cancers.Design Retrospective cohort study. Setting 26 institutions that participated in the Childhood Cancer Survivor Study.Participants 14 358 five year survivors of cancer diagnosed under the age of 21 with leukaemia, brain cancer, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, kidney cancer, neuroblastoma, soft tissue sarcoma, or bone cancer between 1970 and 1986. Comparison group included 3899 siblings of cancer survivors.Main outcome measures Participants or their parents (in participants aged less than 18 years) completed a questionnaire collecting information on demographic characteristics, height, weight, health habits, medical conditions, and surgical procedures occurring since diagnosis. The main outcome measures were the incidence of and risk factors for congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities in survivors of cancer compared with siblings. Results Survivors of cancer were significantly more likely than siblings to report congestive heart failure (hazard ratio (HR) 5.9, 95% confidence interval 3.4 to 9.6; P<0.001), myocardial infarction (HR 5.0, 95% CI 2.3 to 10.4; P<0.001), pericardial disease (HR 6.3, 95% CI 3.3 to 11.9; P<0.001), or valvular abnormalities (HR 4.8, 95% CI 3.0 to 7.6; P<0.001). Exposure to 250 mg/m2 or more of anthracyclines increased the relative hazard of congestive heart failure, pericardial disease, and valvular abnormalities by two to five times compared with survivors who had not been exposed to anthracyclines. Cardiac radiation exposure of 1500 centigray or more increased the relative hazard of congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities by twofold to sixfold compared to non-irradiated survivors. The cumulative incidence of adverse cardiac outcomes in cancer survivors continued to increase up to 30 years after diagnosis.Conclusion Survivors of childhood and adolescent cancer are at substantial risk for cardiovascular disease. Healthcare professionals must be aware of these risks when caring for this growing population.

The results of this study will facilitate counseling current survivors about their future risk of premature menopause and aid in designing new regimens that seek to diminish late ovarian toxicity.

AOF develops in a small subset of survivors, especially those treated with at least 1000-cGy ovarian radiation. These results will facilitate patient counseling and selection of candidates for newer fertility preservation techniques.

In previous work in our laboratories and in the ocean, we have investigated the formation and dissociation of composite CO2 particles made of CO2 hydrate, liquid CO2, and water. The composite is formed by partially converting liquid CO2 into hydrate at mid‐ocean depth (1000–1200 m) conditions. Partial conversion of CO2 into hydrate enables injection of CO2 in seawater in the form of a dense composite material that will drive CO2 to ocean depths well below the injection point. Thermodynamic conditions allowing the formation of negatively buoyant composite particles have been established for a laboratory‐scale, continuous‐jet hydrate reactor (CJHR). An investigation has been performed to explore the issues related to the scale‐up of the CJHR. Hydrate was formed using two CJHR geometries; the first sprayed water in CO2, and the second sprayed CO2 in water. Using a plot of Ohnesorge vs. Reynolds numbers allowed flow rates to be selected that would yield a spray regime and maximize hydrate formation. The effect of varying pressure and liquid flow rates on hydrate behavior was observed. Depending on these parameters, hydrate particles were observed to sink, float, or be neutrally buoyant. A two‐order‐of‐magnitude scale‐up in the flow rates of the two fluids has been achieved with the larger CJHR geometries without losing the important characteristics of the hydrate particles (i.e., density and cohesiveness). Temperature changes as a result of hydrate formation were also monitored. A mathematical model has been developed to predict the fate of sinking CO2 hydrate particles after release in the seawater. These results can guide further field and laboratory investigations related to the scale‐up of ocean CO2 sequestration. © 2007 American Institute of Chemical Engineers AIChE J, 2007

Although cancer survivors treated with GH appear to have an increased risk of developing SN compared with survivors not so treated, the elevation of risk due to GH use appears to diminish with increasing length of follow-up. Continued surveillance is essential.

Childhood cancer survivors appear to be at increased risk for secondary sarcomas compared with general population rates.

Survivors of childhood HD are at increased risk of stroke. Mantle radiation exposure is strongly associated with subsequent stroke. Potential mechanisms may include carotid artery disease or cardiac valvular disease.

Limb-sparing surgeries have been performed more frequently than amputation based on the belief that limb-sparing surgeries provide improved function and quality-of-life (QOL). However, this has not been extensively studied in the paediatric population, which has unique characteristics that have implications for function and QOL. Using the Childhood Cancer Survivor Study, 528 adult long-term survivors of pediatric lower extremity bone tumours, diagnosed between 1970 and 1986, were contacted and completed questionnaries assessing function and QOL. Survivors were an average of 21 years from diagnosis with an average age of 35 years. Overall they reported excellent function and QOL. Compared to those who had a limb-sparing procedure, amputees were not more likely to have lower function and QOL scores and self-perception of disability included general health status, lower educational attainment, older age and female gender. Findings from this study suggest that, over time, amputees do as well as those who underwent limb-sparing surgeries between 1970 and 1986. However, female gender, lower educational attainment and older current age appear to influence function, QOL and disability.