TB preventive therapy preferences among children and adolescents

BACKGROUND: TB preventive therapy (TPT) is critical for ending TB, yet implementation remains poor. With new global guidelines expanding TPT eligibility and regimens, we aimed to understand TPT preferences among children, adolescents and caregivers.METHODS: We undertook a discrete choice experiment among 131 children, 170 adolescents and 173 caregivers, and conducted 17 in-depth interviews in 25 clinics in Cape Town, South Africa. The design included attributes for location, waiting time, treatment duration, dosing frequency, formulation/size, side effects, packaging and taste. Mixed-effects logistic regression models were used for analysis.RESULTS: Among children and caregivers, the number and size of pills, taste and side effects were important drivers of preferences. Among adolescents and caregivers, clinic waiting times and side effects were significant drivers of preferences. Adolescents expressed concerns about being stigmatised, and preferred services from local clinics to services delivered in the community. Dosing frequency and treatment duration were only significant drivers of choice among adolescents, and only if linked to fewer clinic visits.CONCLUSIONS: Introducing shorter TPT regimens in isolation without consideration of preferences and health services may not have the desired effect on uptake and completion. Developing TPT delivery models and formulations that align with preferences must be prioritised.

The Omicron (B.1.1.529) variant of SARS-CoV-2 binds to the hACE2 receptor more strongly and escapes the antibody response: Insights from structural and simulation data

As SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) continues to inflict chaos globally, a new variant officially known as B.1.1.529 was reported in South Africa and was found to harbor 30 mutations in the spike protein. It is too early to speculate on transmission and hospitalizations. Hence, more analyses are required, particularly to connect the genomic patterns to the phenotypic attributes to reveal the binding differences and antibody response for this variant, which can then be used for therapeutic interventions. Given the urgency of the required analysis and data on the B.1.1.529 variant, we have performed a detailed investigation to provide an understanding of the impact of these novel mutations on the structure, function, and binding of RBD to hACE2 and mAb to the NTD of the spike protein. The differences in the binding pattern between the wild type and B.1.1.529 variant complexes revealed that the key substitutions Asn417, Ser446, Arg493, and Arg498 in the B.1.1.529 RBD caused additional interactions with hACE2 and the loss of key residues in the B.1.1.529 NTD resulted in decreased interactions with three CDR regions (1-3) in the mAb. Further investigation revealed that B.1.1.529 displayed a stable dynamic that follows a global stability trend. In addition, the dissociation constant (K_D), hydrogen bonding analysis, and binding free energy calculations further validated the findings. Hydrogen bonding analysis demonstrated that significant hydrogen bonding reprogramming took place, which revealed key differences in the binding. The total binding free energy using MM/GBSA and MM/PBSA further validated the docking results and demonstrated significant variations in the binding. This study is the first to provide a basis for the higher infectivity of the new SARS-CoV-2 variants and provides a strong impetus for the development of novel drugs against them.

A randomized clinical study evaluating effects of high-intensity interval training on myocardial microvascular dysfunction

Background

Myocardial microvascular function assessed with the Index of Microcirculatory Resistance (IMR) after heart transplantation (HTx) predicts the development of cardiac allograft vasculopathy (CAV) and adverse long-term outcome. This study aimed to evaluate the otherwise beneficial effects of high-intensity interval training (HIT) on microvascular dysfunction development.

Methods

Eighty-one de novo HTx patients were randomized to nine consecutive months of HIT or standard care rehabilitation. Coronary physiology assessment with a pressure wire was performed in the left anterior descending coronary artery. IMR was calculated by multiplying the mean distal coronary pressure by the mean hyperemic transit time. Results obtained at three and twelve months after HTx were compared to assess the treatment effect of HIT.

Results

Results were available for 60 patients. 71% were men, and the mean age was 48±13. IMR in the HIT group (n=26) decreased from 14.8±9.5 to 13.8±8.0, change = 1.2, 95% CI [−2.6 to 4.9] and increased in the standard care group (n=34) from 13.8±5.8 to 16.8±12.0, change = −3.5, 95% CI [−7.1 to 0.1]. The mean difference between groups was 4.7, 95% CI [−9.7 to 0.4], p=0.07.

Conclusion

These results suggest that early initiation of HIT improves microvascular function.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Stiftelsen Dam

Incidence of Acute Endophthalmitis After Intravitreal Bevacizumab Injection at a Tertiary Care Hospital in Lahore

OBJECTIVE

We aimed to assess the incidence, management, and visual outcome of acute endophthalmitis in patients following intravitreal bevacizumab injection in a tertiary care setup. It was a prospective and single-center database study.

PATIENTS AND METHODS

Patients receiving intravitreal bevacizumab injections for various retinal vascular diseases from January 2019 to September 2020. The study was carried out at the Institute of Ophthalmology, Mayo Hospital, Lahore over a period of 21 months. Preformed bevacizumab injections were administered intravitreally on patients of various retinal vascular diseases under strict aseptic measures and by following the standard guidelines. The patients were put on follow-ups for a duration of four weeks to see any signs of acute endophthalmitis.

RESULTS

A total of 3051 injections were administered in 1104 eyes of 743 patients during the above-mentioned study period. The incidence of endophthalmitis was found to be 0.0328% (1/3051). The patient, who developed endophthalmitis, was treated with topical and intravitreal antibiotics followed by vitrectomy that resulted in clinically significant improvement in vision.

CONCLUSION

Incidence of acute endophthalmitis following intravitreal bevacizumab injection was low and could be prevented by taking strict aseptic measures during administration.

Classification of heart rate signals of healthy and pathological subjects using threshold based symbolic entropy

The dynamical fluctuations of biological signals provide a unique window to construe the underlying mechanism of the biological systems in health and disease. Recent research evidences suggest that a wide class of diseases appear to degrade the biological complexity and adaptive capacity of the system. Heart rate signals are one of the most important biological signals that have widely been investigated during the last two and half decades. Recent studies suggested that heart rate signals fluctuate in a complex manner. Various entropy based complexity analysis measures have been developed for quantifying the valuable information that may be helpful for clinical monitoring and for early intervention. This study is focused on determining HRV dynamics to distinguish healthy subjects from patients with certain cardiac problems using symbolic time series analysis technique. For that purpose, we have employed recently developed threshold based symbolic entropy to cardiac inter-beat interval time series of healthy, congestive heart failure and atrial fibrillation subjects. Normalized Corrected Shannon Entropy (NCSE) was used to quantify the dynamics of heart rate signals by continuously varying threshold values. A rule based classifier was implemented for classification of different groups by selecting threshold values for the optimal separation. The findings indicated that there is reduction in the complexity of pathological subjects as compared to healthy ones at wide range of threshold values. The results also demonstrated that complexity decreased with disease severity.

Radiological hazards due to naturally occurring radionuclides in the selected building materials used for the construction of dwellings in four districts of the Punjab Province, Pakistan

This paper presents the finding of a study undertaken to determine the naturally occurring radionuclides present in commonly used building materials for dwellings and workplaces in four districts of the Punjab Province, Pakistan. The concentrations of (226)Ra, (232)Th and (40)K were measured by using gamma-ray spectroscopy. A total of 80 samples of building materials were collected from various manufacturers and suppliers of the studied area. The specific activities of (226)Ra, (232)Th and (40)K were measured in building samples, and results ranged from minimum values of 9 ± 1, 9 ± 2 and 27 ± 8 Bq kg(-1) to maximum values of 106 ± 5, 133 ± 5 and 914 ± 21 Bq kg(-1) with mean values of 42 ± 3, 48 ± 3 and 376 ± 16 Bq kg(-1), respectively. From the measured activity concentrations, equivalent radium (Ra(eq)), terrestrial absorbed dose rate, annual effective dose as well as external and internal hazard indices were calculated and found to range from 52 ± 7 to 274 ± 15 Bq kg(-1), 23 ± 3 to 130 6 nGy h(-1), 0.15 ± 0.02 to 0.80 ± 0.03 mSv, 0.14 ± 0.02 to 0.75 ± 0.04 and 0.2 ± 0.02 to 0.98 ± 0.05, respectively. These results were comparable to the results of similar studies undertaken locally and in other countries. The samples considered were safe for use in construction of dwellings in the study area and do not pose any significant source of radiation hazard.

Exposure of population from residential radon: a case study for district Hattian, Azad Kashmir, Sub-Himalayas, Pakistan

Indoor air quality has acquired considerable importance in recent years. Tighter buildings with poorer ventilation systems have led towards higher levels of indoor air pollution. Radon is considered to be most significant perilous gas among the various air contaminants found in the residential environment. To determine the risk posed by residential radon exposure, a survey was carried out in the Hattian district of the state of Azad Jammu and Kashmir, Pakistan. In this context, 160 houses were carefully selected for the installation of CR-39-based National Radiological Protection Board-type detectors installation. After exposing the CR-39 detectors for a period of 90 d, they were etched in 6 M chemical solution of sodium hydroxide at a temperature of 80°C for a period of 16 h. The detectors were read under an optical microscope and observed track densities were converted into the indoor radon concentration using a calibration factor of 2.7 tracks cm(-2) h(-1) per kBqm(-3). For the current study, observed radon concentrations ranged from 35 to 175 Bqm(-3), whereas the mean annual effective radon doses received by the inhabitants of the area ranged from 0.88 ± 0.12 to 4.41 ± 0.20 mSv with an average value of 2.62 ± 0.12 mSv. These reported values are less than the limits (standards) recommended by the different world organisations.

Malaria burden in human population of Quetta, Pakistan

Malaria is a serious global health challenge, which is responsible for more than one million deaths a year. Malarial infection is more prevalent in developing countries including Pakistan. Significant efforts have been made to control malaria; however, due to socio-environmental factors, it remains a frequent problem in Quetta. The present study was undertaken to determine the malarial incidence, species prevalence, and its demographic evaluation in human population of Quetta, Pakistan. A total of 1831 subjects, comprising 1072 male and 759 female presenting symptoms of malaria, were included in this study. Blood samples from clinically suspected individuals were subjected to the standard immunochromatographic and malaria parasite smear analysis for malaria diagnosis. Out of 1831 subjects, 338 (18.45%) patients were positive for malarial parasite while the species prevalence was found as 276 (81.66%) and 62 (18.34%) for Plasmodium vivax, and Plasmodium falciparum, respectively. Furthermore, seasonal variations gradual increase in the prevalence rate. The age group of 21-30 years (30.47%) was found more prone to malaria. The suspected malaria cases were found more frequent in rural (72.1%) as compared to urban (27.9%). In addition, the malaria burden was high in urban area (22.89%) population as compared to the rural area (16.74%) population. It was observed that the highest disease occurrence was caused by P. vivax, which reflects a serious threat for public health. The current findings will be helpful to plan effective strategies to prevent and control malaria in this area.

Biomass fuel burning and its implications: deforestation and greenhouse gases emissions in Pakistan

Pakistan is facing problem of deforestation. Pakistan lost 14.7% of its forest habitat between 1990 and 2005 interval. This paper assesses the present forest wood consumption rate by 6000 brick kilns established in the country and its implications in terms of deforestation and emission of greenhouse gases. Information regarding consumption of forest wood by the brick kilns was collected during a manual survey of 180 brick kiln units conducted in eighteen provincial divisions of country. Considering annual emission contributions of three primary GHGs i.e., CO(2), CH(4) and N(2)O, due to burning of forest wood in brick kiln units in Pakistan and using IPCC recommended GWP indices, the combined CO(2)-equivalent has been estimated to be 533019 t y(-1).

Life-threatening hyperkalaemia developing following excessive ingestion of orange juice in a patient with baseline normal renal function

Hyperkalaemia is a less-recognised life-threatening cause of paralysis. We describe a 51-year-old African-American man, who suffered from muscle weakness progressing to ascending symmetric paralysis, and inability to masticate. Physical examination revealed flaccid paralysis with areflexia of the four limbs. Computed tomography of the brain and cervical spine did not demonstrate any organic lesions. Laboratory investigations revealed serum potassium 9.0 mEq/L (not haemolysed), blood urea nitrogen 34 mg/dL, and serum creatinine 2.0 mg/dL. Electrocardiography showed typical features of hyperkalaemia. After emergent treatment for hyperkalaemia was initiated, serum potassium was rapidly-normalised to 5 mEq/L and all neuromuscular symptoms reversed within one hour. Upon reviewing his food and medication history, he admitted drinking 2.5 litres of orange juice (which contains about 450 mg of potassium in 1,000 ml) per day for the past three weeks to quench his thirst. Hyperkalaemia should be borne in mind in the differential diagnosis of acute paralysis. Hidden sources of potassium intake, such as orange juice, should not be overlooked, even in patients with baseline normal renal function.

Pelvic spleen with uterovaginal prolapse

A case of wandering (pelvic) spleen associated with third degree uterovaginal prolapse and ascaris in the biliary and intestinal tract is being presented here. On laparotomy; congested splenomegaly was found in the pelvis. Splenectomy, total abdominal hysterectomy and bilateral salpingo-ophrectomy was performed.

Case report: intra-renal paraganglioma masquerading as a renal cyst

A case is reported in which a 46-year-old normotensive male patient presented with large right-sided painless abdominal mass. On sonography there was a large cyst in the lower pole of right kidney. Intravenous urography showed distortion of pelvicollecting system and medial shift of upper right ureter. Exploration revealed a cystic mass (18 x 15 cm) located in lower pole of right kidney. It contained brownish fluid and because of suspicion of malignancy radical nephrectomy was carried out. Histological examination showed the cystic mass to be adrenal tissue infiltrated by neoplastic cells. Characteristic organoid nests of malignant cells ("Zellaballen" were present. Cells stained positively for chromogranin, neurone specific enolase (NSE), neurofilament, and synaptophysin. Sustentacular cells showed positive reaction to S-100 protein. No further treatment was offered. Patient remains well at 30 months follow-up. On medline search there is record of three cases of intra-renal paraganglioma in English literature and the present case appears to be the fourth one.

Genitourinary fistulas of obstetric origin

OBJECTIVE

To review the results of management of 42 cases of genitourinary fistulas of obstetric origin.

SETTINGS

Department of urology, Nishtar Hospital, Multan, Pakistan.

METHODS

Forty two cases of genitourinary fistulas (36 vesicovaginal, 2 vesicouterine, one ureterovaginal and 3 urethrovaginal) were repaired from 1st December, 1999 to 31st May, 2002). All fistulas were repaired three months or more after formation. Trans-abdominal and vaginal repair of vesicovaginal fistulas was undertaken in 29 and 7 patients respectively. Two patients had trans-abdominal closure of vesicouterine fistulas. Ureteroneocystostomy with antireflux mechanism was performed for uretereovaginal fistula. For three urethrovaginal fistulas transvaginal layered repair was carried out.

RESULTS

Overall success rate for all types of fistula was 85.7% (36 pts).

CONCLUSION

The surgical treatment of genitourinary fistulas will depend upon the type, size and location of fistula. Acceptable results can be achieved by adhering to the surgical principles of fistula repair i.e. optimal tissue conditions, adequate exposure and tension free closure.

An unusual cause of vesical stone: a migrant intrauterine device

Intrauterine contraceptives devices have been in use for many years. Although perforation of the uterus by an intrauterine device is not uncommon, intravesical migration with secondary stone formation is a rare complication. We report on a 32-year-old woman in whom an intrauterine contraceptive device (Copper T) migrated from her uterus into the bladder. She had lower urinary tract symptoms for nearly 2 years but sought no treatment. The onset of hematuria and fear of cancer prompted her to seek treatment. On investigation, a vesical stone was discovered that had formed on a copper T contraceptive device. It was removed via suprapubic cystostomy. In any woman in whom an intrauterine device is fitted and who presents with lower urinary tract symptoms, the possibility of intravesical migration of the device should be included in the differential diagnosis.

Vesical calculus: a complication of intravesical migration of intrauterine contraceptive device

Intravesical migration of an intra-uterine contraceptive device (IUCD) in a 28-year-old woman resulted in recurrent urinary tract infections. She received antibiotic treatment from her general practitioner but had no investigations done. Later on she became pregnant and investigations revealed that the thread of IUCD was missing and there was a vesical calculus. After she had delivered the baby, a pelvic X-ray was taken and showed a vesical calculus on the IUCD. Both calculus and IUCD were removed cystoscopically.

Chemical composition of upper renal tract calculi in Multan

OBJECTIVE

To study the chemical composition of upper renal tract (renal and ureteric) calculi in Multan.

SETTING

Department of Urology, Nishtar Hospital, Multan.

STUDY PERIOD

September 1992 to February 1999.

MATERIAL AND METHODS

A total of 700 renal and ureteric calculi were analyzed by chemical method of Hodgkinson.

RESULTS

The commonest were uric acid (28.1%) calculi, followed in frequency by calcium oxalate calculi (26.1%), mixed calculi containing calcium oxalate and uric acid (21.8%) and calculi containing calcium oxalate and calcium phosphate (10.4%). Other variety of calculi were less common.

CONCLUSION

Uric acid, calcium oxalate and mixed uric acid and calcium oxalate calculi are the main types in Multan region (JPMA 50:145, 2000).

Extrafascial excision of the rectum for rectal cancer

BACKGROUND

The fascia propria of the rectum is an upward capsular projection from the superior fascia of the pelvic floor which surrounds the rectum and its mesorectum posteriorly and the fat, blood vessels, nerves and lymphatics in front and laterally. It is postulated that if rectal cancer is contained within the fascia propria and extrafascial excision of the rectum is performed then it would be exceptional for the cancer to recur locally.

METHODS

A total of 122 consecutive patients with rectal cancer underwent extrafascial excision of the rectum. The operation involved mobilizing the rectum outside its fascia propria and removing not only the rectum and its mesorectum posteriorly but also the fat, blood vessels, nerves and lymphatics in front and laterally. Resection was considered curative unless there were distant metastases or the tumour had involved the resection margins.

RESULTS

There was one postoperative death. The cumulative cancer-free survival rate at 5 years was 68 per cent. In 100 patients in whom the operation was considered to be curative, the cumulative cancer-free survival rate was 81 per cent. Eighty-four of these patients were available for a minimum follow-up of 24 (median 73, range 24-193) months. Three (4 per cent) developed local recurrence. In two patients this was at the anastomosis.

CONCLUSION

If the cancer is contained within the fascial tube surrounding the rectum and complete extrafascial excision has been performed, local recurrence will be minimal.

Adverse effects of intraportal chemotherapy on natural killer cell activity in colorectal cancer patients

BACKGROUND

Adjuvant intraportal chemotherapy has been used with a view to prevent the development of metachronous hepatic metastases following curative resection for colorectal cancer. To evaluate the effects of this therapy on systemic antitumor immunological activity, 35 colorectal cancer patients who underwent curative resection were investigated.

METHOD

Among them. 19 had adjuvant intraportal chemotherapy with mitomycin C and 5-fluorouracil (treated group) and 16 had no chemotherapy (untreated group). Natural killer (NK) cell activity, lymphocyte subpopulations, and immunosuppressive acidic protein (IAP) in the peripheral blood were measured serially before and after operation, and the values were compared between the two groups.

RESULTS

The NK cell activity and the percentages of CD16 positive and CD56 positive cells were markedly reduced in the treated group postoperatively. Significant difference was also observed between the two groups on the 4th postoperative day in regard to NK cell activity and CD56 positive cells.

CONCLUSIONS

Intraportal chemotherapy in our study reduced the NK cell activity and its population in the peripheral blood.

Effects of intraportal administration of chemoimmunotherapeutic agents on natural killer cell activity in the rat liver

To evaluate the effects of continuous intraportal chemotherapy on tumor immunity of the liver, natural killer (NK) cell activity was estimated in the rat liver. In an in vitro study, NK-enriched mononuclear cells collected from rat liver were incubated with 5-fluorouracil (5-FU) alone and with a 5-fluorouracil/mitomycin C (5-FU/MMC) combination at different concentrations. NK activity was measured after 24-hour incubation. In an in vivo study, the continuous intraportal administration of chemotherapeutic (5-FU/MMC) and chemoimmunotherapeutic (5-FU/MMC/lentinan) agents was carried out in rats for 5 days, and NK-enriched mononuclear cells were then collected from the liver for the measurement of NK activity. Neither 5-FU alone nor the 5-FU/MMC combination affected NK activity in vitro. In the in vivo study, however, the 5-FU/MMC combination significantly decreased NK activity, and the addition of lentinan recovered the activity to the control level. It can thus be concluded that the intraportal administration of chemotherapeutic agents reduces NK activity in the liver and the addition of an immunostimulator to such agents prevents this reduction.

The influence of excess body weight on the surgical treatment of patients with gastric cancer

Sixty-two overweight gastric cancer patients were compared with 201 normal-weight patients to clarify the influences of excessive weight on the surgical treatment of gastric cancer. The frequencies of hypertension and diabetes mellitus were significantly higher in the overweight group (P < 0.01), but no pathologic differences in the resected tumor were found between the two groups. The operative times were longer (P < 0.01) and the number of lymph nodes extirpated and examined was smaller (P < 0.01) in the overweight group. The incidence of postoperative complications was not higher in the overweight group. The postoperative survival rate of patients with nodal metastasis was statistically lower in the overweight group (P < 0.05). Regarding the causes of death in patients with nodal metastasis, 61.1% of overweight patients and 43.8% of normal-weight patients died of recurrence of gastric cancer. In conclusion, surgical treatment of overweight patients with gastric cancer was found to be technically more difficult and the prognosis of such patients with nodal metastasis may thus be worse than that of their normal-weight counterparts.

Establishment of an experimental model for continuous intraportal infusion of chemo/immunotherapeutic agents in the rat

The results of adjuvant continuous intraportal chemotherapy in preventing hepatic metastasis, following curative colorectal surgery, are still equivocal. To improve the efficacy of this treatment we tried to establish an experimental model for continuous intraportal infusion in Wistar male rats. Using a drug infusion balloon catheter, which can be fixed on the back of the rat, the continuous intraportal administration of chemo/immunotherapeutic agents was carried out in 47 rats for 5 days. Of them, 23 received chemotherapeutic (Mitomycin C/5-fluorouracil) and 24 received chemoimmunotherapeutic (Mitomycin C/5-fluorouracil/Lentinan) agents. The overall success rate of complete 5-day infusion of the agents was 70.2%. The concentration of 5-fluorouracil in the peripheral blood ranged from 5ng/ml to 17ng/ml (mean 10.4ng/ml) and in the portal blood from 192ng/ml to 610ng/ml (mean 312.0ng/ml) following the perfect continuous infusion of the agents. It can thus be suggested that our established experimental model can be used for the study of continuous intraportal infusion in unrestrained rats.

Management of gastric cancer patients with synchronous hepatic metastasis: a retrospective study

BACKGROUND/AIMS

In order to improve the management of patients of gastric cancer with synchronous hepatic metastasis, their records were retrospectively studied.

MATERIALS AND METHODS

From January 1981 to July 1993, 558 gastric cancer patients were admitted in our institute. Twenty-five with synchronous hepatic metastasis were used in this study. Among these 25 patients, six had hepatic metastasis alone and nineteen had some other additional noncurative prognostic factors. For the primary lesion, 12 patients received gastrectomy (total or distal subtotal) and 13 patients did not. For the hepatic metastasis, 12 patients had regional therapy (hepatectomy or hepatic arterial chemotherapy) and 13 had not. Both gastrectomy and regional therapy for hepatic metastasis were carried out in 6 patients who had hepatic metastasis alone.

RESULTS

Five year cumulative survival rate was 9%. Survival rate of patients with hepatic metastasis alone was significantly better than the patients with additional noncurative factors (p < 0.05). The two long term survivors in this study had no other noncurative factors except hepatic metastasis.

CONCLUSIONS

Neither gastrectomy nor regional therapy for hepatic metastasis had beneficial effects on the patients with additional noncurative factors. Gastrectomy and regional therapy for hepatic metastasis should be performed in patients without additional noncurative factors.

Preoperative intraperitoneal chemotherapy for gastric cancer, with special reference to delayed peritoneal complications

Preoperative intraperitoneal (IP) chemotherapy was performed in 23 patients with gastric malignancies to inhibit peritoneal recurrence. Cis-diamminedichloroplatinum (CDDP) and mitomycin C (MMC) were administered intraperitoneally 3 days prior to surgery, at which time a very viscid peritoneum and mucinous intraperitoneal fluid were found in 100% and 83% of the patients, respectively. Inflammatory changes were microscopically observed in the subserosal layer of the resected stomachs and in the intraperitoneal fluid, but degenerative changes characteristic of cancer cells could not be seen. The 3-year survival rate of the stage III patients was 55.6%, and peritoneal recurrence was found in three of six patients with recurrence. Extensive adhesions were found in eight patients (34.8%) as a delayed peritoneal complication, and chronic bowel obstruction resulting from the adhesion developed in five patients (21.7%). Thus, we conclude that the administration of this IP chemotherapy demonstrated no definite antitumor effects or survival benefits, but was frequently associated with delayed peritoneal complications.