Disseminated hemangiosarcoma in the horse: 35 cases

Thirty-five cases of disseminated hemangiosarcoma (21 clinical cases and 14 previously reported cases) were reviewed to describe the disease in horses. Hemangiosarcoma occurred in mature, particularly middle-aged horses, with no apparent sex predilection. Thoroughbreds seemed to be overrepresented (13 cases) but a true breed predilection could not be established. The respiratory and musculoskeletal systems were most commonly affected and presenting complaints included dyspnea (26%), subcutaneous or muscular swelling (24%), epistaxis (17%), and lameness (12%). Heart and respiratory rates were usually increased and mucous membrane color was frequently pale or icteric. Capillary refill time and rectal temperature were often normal. Anemia (88%), neutrophilic leukocytosis (62%), and thrombocytopenia (48%) were common. Examination of tissue samples collected by fine-needle aspirate or biopsy established an antemortem diagnosis in 4 horses. The diagnosis was made during postmortem examination in the remaining 31 horses. The lung and pleura (77%), skeletal muscle (46%), and spleen (43%) were most commonly affected. A primary site of tumor involvement could be identified in 22 horses. Hemangiosarcoma should be included as a differential diagnosis for horses with evidence of hemorrhage into body cavities, skeletal muscle, or subcutaneous locations.

Differences in fat, carbohydrate, and protein metabolism between lean and obese subjects undergoing total starvation

Despite extensive experimental studies on total starvation, many of the findings relating to protein, fat (plus ketone body), and carbohydrate metabolism remain confusing, although they become more consistent when considered in relation to the degree of initial obesity. During prolonged starvation, protein loss and percent energy derived from protein oxidation are 2- to 3-fold less in the obese than in the lean; percent urine N excreted as urea is 2-fold less in the obese; and the contribution of protein to net glucose production is only about half in the obese compared to lean subjects. During short-term starvation (first few days) the following differences are reported: hyperketonaemia is typically 2-fold greater in lean subjects, but associated with a 2-fold lower uptake of ketone bodies by forearm muscle; glucose tolerance becomes impaired more in lean subjects; and both protein turnover and leucine oxidation increase in the lean, but may show no significant change in the obese. It is no longer acceptable to describe the metabolic response to starvation as a single typical response. The differences between lean and obese subjects have important physiological implications, some of which are of obvious relevance to survival.

Physical activity levels in a sample of Oxford school children aged 10-13 years

OBJECTIVE

To determine physical activity levels (PAL) in children aged between 10 and 13 y.

DESIGN

Cross-sectional study of physical activity levels on school days, with and without physical education (PE) lessons and at weekend. Data were collected using self-reported activity diaries.

SETTING

The children were recruited from a middle school in Oxford. Basal metabolic rate (BMR) and anthropometry were measured in the school.

SUBJECTS

Thirty-eight children (12 boys and 26 girls), aged 10-13 y, returned completed activity diaries. PAL values were calculated by applying physical activity ratios (PAR) to the time spent on each activity. BMR and anthropometry were measured within 20 d of activity diary completion.

RESULTS

The mean +/-s.d. (range) PAL values for all children were 1.52+/-0.08 (1.34-1.71), 1. 50+/-0.05 (1.44-1.57) for boys and 1.53+/-0.10 (1.34-1.71) for girls. The lowest PAL value (1.48+/-0.13, mean +/-s.d.) was observed in girls on school days without PE lessons. The lowest PAL value in boys (1.46+/-0.13, mean +/-s.d.) was observed at the weekend. PE lessons made a significant difference to the PAL values for boys (1. 58+/-0.09) and girls (1.60+/-0.12). A wide range of PAL values (1. 20-1.87) was recorded in these children. The total energy expenditure for the boys was slightly lower than the estimated average requirements (EAR) predicted by the Department of Health (8. 71+/-0.96 MJ compared with 8.86 MJ/d) for this age group. The girls had a higher average energy expenditure than the predicted EAR (8. 47+/-1.00 MJ/d compared with 7.885).

CONCLUSIONS

The children in this study may be classified as light to moderately active with PAL values ranging from 1.20 to 1.87. The promotion of physical activity in childhood will have beneficial effects for the child and their future wellbeing. Programmes aimed at preventing obesity in children should encourage physical activity as well as promoting appropriate dietary changes.

Primary renal tumours in cats: 19 cases (1992-1998)

A search from databases of four veterinary colleges and one private referral practice between January 1992 and April 1998 provided 20 cases diagnosed with primary renal neoplasia. Review of these cases revealed 19 primary renal tumours, excluding lymphoma. Of the 20 histologically reviewed cases, the diagnosis was amended in eight. There were 13 renal carcinomas (11 tubular and two tubulopapillary), three transitional cell carcinomas, one malignant nephroblastoma, one haemangiosarcoma and one adenoma. The haemangiosarcoma is, to our knowledge, the first reported case of this tumour type as a primary renal tumour in the cat. Most cats were presented for non-specific clinical signs such as anorexia and weight loss. One cat presented with tumour-associated polycythaemia which has not, to our knowledge, been reported previously. The metastatic rate for cats with complete staging was 64%, and 100% for transitional cell carcinomas.

Milk cytokines and subclinical breast inflammation in Tanzanian women: effects of dietary red palm oil or sunflower oil supplementation

Previously, we have found that subclinical breast inflammation, as indicated by raised breastmilk concentrations of sodium and the inflammatory cytokine, interleukin-8 (IL-8), was highly prevalent in Bangladesh and associated with poor infant growth. In order to investigate further the prevalence of subclinical breast inflammation and to assess the impact of dietary intervention, we studied rural Tanzanian women taking part in a study of dietary sunflower or red palm oil supplementation during late pregnancy and lactation. We measured breastmilk concentrations of IL-8, the anti-inflammatory cytokine, transforming growth factor-beta2 (TGF-beta) and the ratio of sodium to potassium. We also estimated systemic inflammation by plasma concentrations of the acute phase proteins, alpha1-acid glycoprotein and C-reactive protein. There were highly significant intercorrelations among milk Na/K ratio and concentrations of IL-8 and TGF-beta, the last only after treatment with bile salts which also improved TGF-beta recovery in the enzyme-linked immunosorbent assay (ELISA). Plasma acute phase protein concentrations tended to correlate with milk Na/K ratio and IL-8, suggesting that subclinical breast inflammation was related to systemic inflammation. Dietary supplementation with vitamin E-rich sunflower oil but not provitamin A-containing red palm oil decreased milk Na/K, IL-8 and TGF-beta at 3 months postpartum; however, the effect was significant only for Na/K ratio. The results suggest that milk Na/K ratio, IL-8, and TGF-beta all measure the same phenomenon of subclinical breast inflammation but that Na/K ratio, having the lowest assay variability, is the most useful. Subclinical breast inflammation may result in part from systemic inflammation and may be improved by increased dietary intake of vitamin E-rich sunflower oil.

Mitoxantrone and cyclophosphamide combination chemotherapy for the treatment of various canine malignancies

Thirteen dogs with histopathologically confirmed malignancies were treated with mitoxantrone and cyclophosphamide combination therapy. One to four doses were administered at 21-day intervals. Recombinant human granulocyte colony-stimulating factor was administered to ameliorate myelosuppression in dogs with neutrophil nadirs less than 1,000/microl. While the protocol appears to be safe for use in tumor-bearing dogs, an advantage over mitoxantrone single-agent protocols in terms of tumor response was not demonstrated in this initial pilot study.

Systemic and tissue chamber fluid platinum concentrations released from cis-diamminedichloroplatinum II-impregnated polymethylmethacrylate in healthy dogs

OBJECTIVES

To determine systemic and local platinum concentrations released from subcutaneously implanted cis-diamminedichloroplatinum (cisplatin) -impregnated polymethylmethacrylate (PMMA) and to evaluate systemic or local adverse reactions.

ANIMALS

6 healthy dogs.

PROCEDURE

Cisplatin (20 mg) was inserted into PMMA that was fashioned into cylinders and placed into subcutaneous tissue chambers overlying the thorax (treated site). An empty tissue chamber was placed over the opposite side (control site). Plasma samples were obtained for platinum determination before implantation, at 3, 6, and 12 hours after implantation on day 0, and once daily on days 1, 2, 3, 7, 14, 21, and 29. At similar times on similar days, tissue chamber fluid samples also were obtained for platinum determination. Complete blood count, serum urea nitrogen and creatinine concentration determinations, and urinalyses were performed on days 1, 2, 3, 7, 14, 21, and 29. Complete necropsy was performed at conclusion of the study.

RESULTS

Tissue chamber platinum concentrations at the treated site were significantly greater than plasma and control site tissue chamber concentrations on days 2, 3, 7, 10. Mean plasma platinum concentration at 3 (0.735 microg/ml), 6 (0.691 microg/ml), 12 (0.534 microg/ml), 24 (0.131 microg/ml), 48 (0.2 microg/ml), 72 (0.1 microg/ml), and 158 (0.014 microg/ml) hours was significantly greater than pretreatment values (0.0 microg/ml). Plasma platinum concentration 10 days after treatment (0.011 microg/ml) did not significantly differ from pretreatment values. Local or systemic adverse reactions were not apparent.

CONCLUSIONS

The route of cisplatin administration was safe. Greater concentration of platinum was released locally relative to plasma concentration for an extended period.

Influence of palm olein on protein utilisation in the growing rat

In view of our preliminary findings that refined palm oil (RPOL) enhanced protein utilisation, and because of the growing importance of palm oil in human diets, two separate studies were conducted. The first study aimed to investigate the effect of the palm oil source and fraction on protein utilisation, as determined by net protein utilization (NPU) in growing rats. The second study aimed to investigate the influence of the dietary concentration of one particular palm oil fraction, refined palm olein (RPO) on net protein utilisation. The fat source of each of the semi-purified diets was as follows: crude palm oil (CPO), refined palm kernel oil (RKO), refined palm olein (RPO), refined palm stearin (RPS), and refined palm oil (RPOL). A sixth control group was offered an identical diet but with olive oil (OO, control) as the fat source. Both the oil source (P < 0.01) and the oil level (P < 0.05) influenced NPU in rats. NPU values were generally higher for rats given the RPO-containing diets, particularly at the 20% dietary level (P < 0.01) compared to the diets containing ground nut oil (GNO). The results of these two experiments indicate that RPO influences protein metabolism specifically at a concentration of at least 20% in the diet. This may suggest that RPO is superior to GNO as a source of fat for the rehabilitation of malnourished children. Human trials notably during the rehabilitation of malnourished children may therefore be the next step in this line of research.

New equations to estimate basal metabolic rate in children aged 10-15 years

OBJECTIVE

To develop new equations for the estimation of basal metabolic rate in children aged 10-15 years, and to evaluate the impact of including pubertal stage into the equations.

DESIGN

Mixed longitudinal.

SETTING

The children were recruited from schools in Oxford, and the measurements were made in the schools.

SUBJECTS

195 school children, aged 10-15 years, were recruited in three cohorts. The gender distribution of the subjects was 40% boys and 60% girls.

METHODS

Basal metabolic rate (BMR) was measured, by indirect calorimetry, at 6-monthly intervals for 3 years. Anthropometric data, height, weight, body breadths and skinfold measurements (biceps, triceps, subscapular, suprailiac and medial calf) were collected on each occasion. Fat and fat-free mass was calculated from the skinfold measurements. Pubertal development was also assessed on annually by paediatricians. Pubic hair (PH) and gonad (G) development was assessed in boys and breast (B) development in girls. The girls were questioned about menarche. Stepwise multiple regression analysis was used to develop and assess new formulae for BMR that also incorporate pubertal development.

RESULTS

The mean BMR measured was 5.754 (s.d. 0.933) MJ/day (138 (s.d. 22) kJ/kg body wt/day) in the boys (n = 351) and 5.476 (s.d. 0.725) MJ/day (121 (s.d. 20) kJ/kg body wt/day) in the girls (n = 554). Weight was the most important factor in developing the regression equations for the calculation of BMR in both sexes (R2 = 0.61 and 0.52 for boys and girls, respectively). Stepwise multiple regression analyses, with independent variables such as gender, weight, height, puberty stage and skinfolds, allowed several BMR regression equations to be developed. The inclusion of the menarche status in the regression equations significantly (P < 0.05) improved BMR estimation in the pre-menarche girls. Boys, pubertal stage as assessed by Pubic Hair (PH) and Gonadal Stage (G) did not contribute to a significant improvement in BMR estimation, except for 11-year-olds.

CONCLUSIONS

The inclusion of pubertal stage afforded only minor improvements in the derivation of regression equations for the estimation of BMR of children aged between 10 and 15 years.

Survival in dogs with nasal adenocarcinoma: 64 cases (1981-1995)

Case records of 64 dogs with nasal adenocarcinoma were reviewed. The effects of age, gender, tumor stage, presence of metastatic lesions, and treatment method on survival time were examined. Surgery groups included rhinotomy (n = 9), transnasal curettage (n = 29), and no surgery (n = 26). Chemotherapy groups included fluorouracil-cyclophosphamide combination therapy (n = 15), mitoxantrone (n = 7), and no chemotherapy (n = 42). Fifty-three dogs received fractionated cobalt 60 radiation therapy. Surgical procedure, chemotherapy group, and stage of primary tumor were not significantly associated with survival time (P > .05). Dogs that received radiation therapy had a significantly longer median survival time (424 days) than dogs that did not (126 days)(P = .0001). The presence of either regional lymph node or pulmonary metastasis was associated with significantly shorter median survival time (109 days) when compared to dogs without metastases (393 days)(P = .0125). When only dogs that had received radiation therapy were considered, neither surgical treatment nor chemotherapy group was associated with significant changes in median survival time. An alternate staging system emphasizing the presence or absence of metastases is proposed.

Cutaneous mast cell tumors in cats: 32 cases (1991-1994)

Case records of 32 cats with cutaneous mast cell tumors (CMCTs) were reviewed. Using the Patnaik system for grading canine mast cell tumors, the relationships between histopathological grade and patient survival time and tumor recurrence were examined. Tumor histopathological grade had no prognostic significance. One-, two-, and three-year tumor recurrence rates following surgical excision were 16%, 19%, and 13%, respectively. Incomplete excision was not associated with a higher rate of tumor recurrence.

Accuracy of fluorocrit in determination of blood perflubron concentration

Previous studies examining the radiosensitizing effects of perfluorochemical emulsions have based dose recommendations on a measurement known as fluorocrit. The fluorocrit is the proportion of blood volume occupied by perfluorochemicals and is measured using standard hematocrit procedures. This measurement is inherently crude and subject to error and variability between different individuals measuring the same sample. Furthermore, the fluorocrit method has not been compared to other quantitative methods to determine its reliability. The purpose of this study was to compare fluorocrit measurements to those obtained by gas chromatographic analysis. A 90% w/v perflubron emulsion was administered to six normal dogs once weekly for four weeks and peripheral blood samples were obtained at specified time points for analysis. A total of 123 blood samples were analyzed by both methods. The relationship between blood fluorocrit and plasma perflubron concentration measured by gas chromatography was examined using regression models. Based on the modest predictive value (r2 = 0.3683) of the derived statistical model, we conclude that fluorocrit measurement is an inaccurate method of estimation of blood perflubron concentration. Caution must, therefore, be exercised when extrapolating data and dose recommendations from reports of studies using flurocrit as the only estimate of blood perflubron concentration.

Nutrient losses and gains during frying: a review

Recent consumer interest in 'healthy eating' has raised awareness to limit the consumption of fat and fatty foods. What are the relative nutritional advantages and disadvantages of consuming fried foods? Are all fried foods bad for you? A review on macro- and micronutrients losses and gains during frying is presented here. Frying has little or no impact on the protein or mineral content of fried food, whereas the dietary fibre content of potatoes is increased after frying due to the formation of resistant starch. Moreover, the high temperature and short transit time of the frying process cause less loss of heat labile vitamins than other types of cooking. For example, vitamin C concentrations of French fried potatoes are as high as in raw potatoes, and thiamine is well retained in fried potato products as well as in fried pork meat. The nutritive value of the frying media is also important to take into consideration and therefore losses of nutrients from the frying oil are also discussed. Although some unsaturated fatty acids and antioxidant vitamins are lost due to oxidation, fried foods are generally a good source of vitamin E. It is true that some fat is inevitably taken up by the food being fried, contributing to an increased energy density. However, this also results in highly palatable foods with a high nutritional content. It is concluded that fried foods certainly have a place in our diets.

Relationship between tissue mobilization and storage in the rat

The amount of energy mobilized or stored as protein, expressed as a proportion of the total energy stored or mobilized (defined as the P ratio, Payne & Dugdale, 1977), was investigated in the young male (rapid growth) and adult female (slow growth) rat. Energy mobilization was induced by a 3 d fast and the changes in body content of fat and lean tissues were used to estimate the fasting P ratio (Pfast). Tissue storage was subsequently effected by 17 d of refeeding and the corresponding ratio (P(refed)) was calculated from the amounts of lean and fat tissue regained. The same experimental protocol was used for measuring Pfast and P(refed) in weanling (30 d) and adult (130 d) rats. Weight-matched individuals were assigned to three groups. All animals in group 1 were killed at the beginning of the experiment. Animals in group 2 were fasted for 3 d and then killed. Group 3 animals were first fasted for 3 d, then had free access to a stock diet for a further 17 d before being killed. During fasting, a close linear relationship was found between weight change and body energy changes (r 0.985, and r 0.92, P < 0.001 for weanlings and adult rats respectively) and between carcass N loss and urinary N loss (r 0.933, P < 0.001). These relationships were used to estimate the body energy and N content of each animal at the end of the initial fasting period. Hence, both Pfast and P(refed) values could be calculated for all individuals at both ages. When Pfast and P(refed) were calculated for adult rats, the mean values were similar (0.138 (SE 0.002) and 0.130 (SE 0.006) respectively). Individually, the Pfast and P(refed) values were correlated (r 0.54, P = 0.058). In weanling rats, the mean P(refed) value was about 2.5 times the Pfast (0.421 (SE 0.0113) v. 0.156 (SE 0.004)). Despite the differences in Pfast and p(refed), the individual values were again correlated (r 0.668, P < 0.05). These results support the suggestion made by Payne & Dugdale (1977), that particular P. ratio values are characteristic of individuals and describe the extent to which protein is mobilized or stored during fasting or refeeding. These observations are discussed in relations to the predictions made by the Payne-Dugdale model.

Gingival vascular hamartoma with associated paraneoplastic hyperglycemia in a kitten

A 4-month-old domestic shorthair cat was examined because of a maxillary gingival mass that had regrown following excisional biopsy. The kitten also had a history of persistently high blood glucose concentrations, despite 2 weeks of insulin treatment. Radiography revealed maxillary alveolar bone lysis and displacement of multiple teeth. Partial maxillectomy was performed to remove the mass, which histologically was a gingival vascular hamartoma. Hyperglycemia permanently resolved < 24 hours after mass removal. On the basis of the temporal relationship between mass removal and resolution of hyperglycemia, as well as the lack of evidence of any concurrent disease, hyperglycemia in this cat was considered to be a paraneoplastic syndrome.

Influence of palm oil and palm oil fractions on protein utilisation

The influence of dietary palm-oil fractions on protein utilisation has been investigated in the growing rat. At 30 days of age, 4-6 groups of four animals were offered one of six semi-purified diets that differed only in the palm-oil fraction. Diets contained 200g casein, 550 g carbohydrate, and 200g fat/kg. The different palm-oil fractions were: crude palm oil (CPO), refined palm-kernel oil (PKO), refined palm olein (RPO), refined palm stearin (RPS), refined palm oil (RPOL). The control groups were given Olive oil (OO) as the dietary fat source. The conversion efficiency of dietary protein was assessed as Net Protein Utilisation (NPU), using a 10-day comparative carcass technique. Weight gain and food intake were not altered by the various palm-oil fractions. However, the NPU of rats given RPO was significantly higher (p<0.05) than that of rats given all other palm-oil fractions or the OO control. It is concluded that the RPO has the potential to significantly improve NPU in the rat, compared to four other palm-oil fractions as well as olive oil.

The need for policy and risk analysis--the Department of Energy experience

Reduction of major risks to the public and workers is a top priority of all federal agencies. Given current and future budget realities, agencies cannot attempt to address all risks simultaneously nor to address certain relatively lower risk activities as rapidly as some would like. The assumptions and judgments inherent in using risk analysis in the absence of data, however, have to be clearly stated. What is needed is an integrated risk assessment and management process that meets the current and future needs of the government, as well as of stakeholders. Yet there have been many questions raised regarding risk assessment: our ability to define the risks on a specific substance or site basis and in a systematic way; methodology questions about identifying and assessing diverse hazards and risks as well as uncertainties in the estimates, data gaps, and concern over the quality of information; and the fact that "who" performs the risk assessment matters. Knowing these controversies surrounding risk and the use of risk-based approach, the Department of Energy (DOE) requested the National Academy of Sciences-National Research Council to determine whether and how risk and risk-based decisions could be incorporated into a major federal program, the DOE's Office of Environmental Management. The report identified the major obstacles, issues, and barriers to implementing a risk-based management approach. The report concluded that the use of risk-based approach could help compare outcomes, build consensus, and gain early public involvement to include cultural, socioeconomic, historical, and religious values, if its purposes and limitations are well defined. A status of the DOE's ability to implement the recommendations presented in the report on the use of risk assessment in a major federal program and the adoption of principles for using risk analysis will be given.

The relationship between arm-span measurement and height with special reference to gender and ethnicity

OBJECTIVE

The relationship between height and arm-span measurement in both sexes and different ethnic groups was studied in order to assess the use of the arm-span measurement as a suitable proxy indicator for height.

SETTING

School of Biological and Molecular Sciences, Oxford Brookes University.

SUBJECTS

Five hundred and fifty-three subjects (272 male and 281 female) aged 23.3 years (s.d. 5.5).

RESULTS

Correlation coefficients (r = 0.73-0.89) indicated a clear association between arm-span measurements and height in all groups. However, arm-span was found to be significantly different (P < 0.01) from height in two ethnic groups, the Afro-Caribbean's of both sexes and Asian males. This suggests that arm-span measurements may be an inappropriate proxy for height in certain populations.

CONCLUSION

The arm-span measurement and height relationship is significantly different in Afro-Caribbean and Asian males. This suggests that any future studies attempting to use arm-span measurement as a proxy for height must consider these ethnic differences.

Basal metabolic rate of women on the contraceptive pill

OBJECTIVE

To investigate the variability in basal metabolic rate (BMR) of women taking the contraceptive pill, through sequential measurement over the course of one menstrual cycle.

DESIGN

Randomised.

SETTING

Metabolic room, School of Biological and Molecular Sciences, Oxford Brookes University.

SUBJECTS AND MEASUREMENTS

BMR of five weight-stable women taking the contraceptive pill, was measured three to four times each week for a period of five consecutive weeks, BMR was measured using a Douglas bag.

RESULTS

The pattern of variation in BMR was random for individual subjects throughout the period of measurement. The level of intraindividual variation indicated by the coefficient of variation (CV) ranged from 2.4 to 4.87%.

CONCLUSIONS

Women taking the contraceptive pill did not exhibit the cyclicity or variation in BMR observed in some normally ovulating subjects. BMR in women taking the contraceptive pill could therefore be considered a 'biological constant'.

Urine cortisol:creatinine ratio in healthy and sick cats

Urine cortisol:creatinine ratios (UCCR) were determined from single urine samples obtained by cystocentesis in 47 cats allotted into 2 groups: 31 healthy cats and 16 sick, hospitalized cats with assorted clinical illnesses. The mean (+/- standard deviation) UCCR for healthy cats was 5.9 +/- 7.0 (median, 3.2; range, 0.6 to 27.8). Age or gonadal status had no significant effect on the magnitude of UCCR within this group. However, sick cats had significantly higher UCCR (P = .002) when compared with healthy cats. The mean UCCR for sick cats was 19.6 +/- 19.2 (median, 14.8; range, 1.7 to 75.1). This report establishes a reference range for UCCR in 31 normal cats and provides evidence that health status affects UCCR in cats.

Amputation and carboplatin for treatment of dogs with osteosarcoma: 48 cases (1991 to 1993)

Forty-eight dogs with histologically confirmed appendicular osteosarcoma (OSA) entered a prospective clinical trial evaluating treatment with amputation and up to 4 doses of carboplatin given every 21 days. The median disease-free interval (DFI) was 257 days, with 31.2% of the dogs disease-free at 1 year. The median survival time was 321 days, with 35.4% of the dogs alive at 1 year. Dogs with proximal humeral OSA had shorter DFI (P = .016) and survival (P = .037) times than dogs with OSA at other locations. Dogs with lower body weights ( < 40 kg) had longer DFI (P = .0056) and survival (P = .007) times than larger dogs. Survival times for dogs that received carboplatin were statistically longer than those previously reported for amputation alone (P < .001). DFI and survival times are similar to those previously reported for 2 to 4 doses of cisplatin. Carboplatin appears to be a well-tolerated chemotherapeutic drug that can be given safely every 21 days at a dose of 300 mg/m2. Neutropenia was the dose-limiting toxicity in this study.