Childhood to adult transition and long-term follow-up after blood and marrow transplantation.

The use of hematopoietic stem cell transplantation or blood and marrow transplantation (BMT) is on the increase worldwide. With BMT's increasing utilization and increasing success, the number of BMT survivors in the United States alone is expected to surpass 500 000 by the year 2030. BMT survivors are susceptible to a host of long-term side effects and complications. The pediatric and adolescent and young adult (AYA) populations comprise an increasing proportion of BMT survivors. Though these populations are both at risk of a specific set of sequelae and faced with the additional challenge of transitioning to adult care, no previous literature has addressed their specific challenges. In this review, we illustrate with clinical vignettes the need for focused and specific survivorship clinics for pediatric/AYA BMT survivors. We then focus on the following areas pertaining to pediatric BMT survivorship and care: (1) psychological health, (2) neurocognition, (3) endocrine health, (4) infertility resources, (5) issues in transition from pediatric to adult clinicians, (6) preventative services and (7) cost of care issues.

Assessment and management of risks arising from exposure to cadmium in fertilisers--II.

A preliminary, illustrative human health risk assessment of exposure to cadmium in phosphate fertilisers was performed using typical UK data and a protocol previously developed for application by individual Member States in the European Union. The risk assessment indicated that the for the most pessimistic population exposures characterised by both extreme (97th percentile) cereal and potato consumption and high susceptibility to cadmium uptake, the estimated dose was under the WHO Provisional Tolerable Weekly Intake (PTWI) for fertiliser cadmium concentrations ranging from 15 to 100 mg Cd/kg P2O5 applied over 100 years. However, the low margin of safety for high risk groups and the uncertainties inherent in the overall risk assessment suggested that a prudent risk management strategy would involve maintenance of low levels of cadmium in fertilisers and/or conditions that permitted low accumulation of cadmium in soils. On this basis, two main risk reduction measures were developed and assessed: (a) imposition of limits on cadmium concentration in fertilisers; and (b) imposition of charges on levels of cadmium in phosphate fertilisers. An assessment of the economic impact of these risk reduction measures indicated that, at all price elasticities, the most significant impact in terms of changes in demand and changes in consumer expenditure on phosphate fertilisers will be seen with cadmium charges where no thresholds are defined. The impact on the consumer (i.e. farmer) will be an increase in spending of approximately US $4000 per year, which is considered significant, accompanied by a decrease in demand above 20%. If a threshold is set at 60 mg Cd/kg P2O5, the impact is significantly reduced, but stays relatively high compared to the other options. The analysis also indicates that the use of low-cadmium rock is the low cost option. At a likely rock price increase of approximately 5% and assuming a likely price elasticity of -0.2, the yearly costs to farmers will be approximately US $82 which is considered a minimal impact. In the worst case scenario (elasticity of -0.6 and a 10% increase in rock prices), the increase in spending by farmers will be of 3.9% or US $221 which is also considered to represent a minimal impact. At similar price elasticities, the use of decadmation technologies is predicted to be more costly than the use of low-cadmium rock but this option can still be considered as having a minimal impact on the consumer (increase in expenditure of 1.9-13.3% or US $106-748).

Acid-base balance in continuous ambulatory peritoneal dialysis.

Metabolic acidosis was demonstrated in a group of anuric CAPD patients. Dialysate HCO3- loss was the major determinant of a negative base balance of 26.4 +/- 23.5 mMol/day. Bicarbonate supplementation corrected the acidosis. A primary respiratory alkalosis was also present in several patients.