Disease relevance of bismuth

• BACKGROUND & AIMS: Successful treatment in nonresectable Bismuth type III and IV cholangiocarcinoma is seldom achieved [1].
• CASE AND TREATMENT: After intravenous injection of sodium porfimer we treated an adenocarcinoma of the proximal common bile duct (T2 N0 M0, Bismuth type II) in a 72-year-old man with red laser light (applied from the lumen at a dose 250 Joules/cm2), and the adjacent right and left hepatic and common bile duct at a dose of 125 Joules/cm2 [2].
• BACKGROUND: Bismuth has been used as symptomatic treatment of dyspepsia for many years [3].
• CONCLUSIONS: Bismuth carbomer foam enemas (270 mg bismuth) nightly for 3 weeks are safe but not efficacious for active chronic pouchitis [4].
• The type of treatment for Bismuth type l-II carcinomas is still a matter of discussion [5].

High impact information on bismuth

• Twenty-three consecutive patients (8 women, 15 men; 67 +/- 14 years) with nonresectable bile duct cancer (Bismuth type III n = 2, type IV n = 21) were treated with photodynamic therapy and biliary endoprosthesis [6].
• Univariate analysis indicated the type of hepatectomy, histopathologic grade, Bismuth classification, concomitant hepatic artery resection, and International Union Against Cancer stage as significant prognostic factors [7].
• There were eight men and two women, median age 72 years (range 54-94), six with cholangiocarcinoma (all Bismuth type 1) and four with carcinoma of the head of the pancreas [8].
• Effect of Octamethylcyclotetrasiloxane on Methylation of Bismuth by Methanosarcina barkeri [9].
• RESULTS: PDT group and the control group were comparable due to age, gender, performance status, bilirubin level, and BDC stage (Bismuth classification) [10].

Anatomical context of bismuth

• The purpose of the present study was to compare survival data in patients with malignant hilar obstruction, stratified according to the Bismuth classification, who had cholangiography with filling of one or both hepatic ducts and subsequently endoscopic or percutaneous drainage of one or both ducts [11].
• 2. Bismuth was present in kidney lung, spleen, liver, brain, heart and skeletal muscles, in descending order of abundance [12].
• Thus it can be said to be a curative operation not only in patients considered high risk but also in those whose hilar bile duct carcinoma is limited to the bifurcation area (Bismuth type IIIa and IIIb) and in gallbladder carcinoma up to pT2 with slight extension on the hepatic side [13].
• RESULTS: Bismuth subsalicylate and nitecapone inhibit acetaldehyde formation from 0.1% ethanol by H. pylori cytosol at drug concentrations theoretically achievable in the stomach after intake of therapeutic doses of these drugs [14].
• IOERT is a reasonable option to consider in patients who have biliary tract cancers above AJCC or Bismuth stage I disease [15].

Associations of bismuth with other chemical compounds

• Levofloxacin- vs. Ranitidine Bismuth Citrate-Containing Therapy After H. pylori Treatment Failure [16].
• Approximately 75% of the patients required nasal packing; the most common pack used was BIPP (Bismuth Iodine Paraffin Paste) [17].

Gene context of bismuth

• There were 5 Bismuth type 1 strictures; 4, type 2; 7, type 3; 5, type 4; and 1, type 5 [18].
• Five patients had Bismuth type E2 injury and the rest were higher (E3, E4, E5) [19].
• Proton pump inhibitors (4 trials generating 1,248 patients; RRR = 12%; 95% CI = -1 to 24%) and Bismuth salts (6 trials generating 311 patients; RRR = 40%; 95% CI = -3 to 65%) were superior to placebo but this was of marginal statistical significance [20].

Analytical, diagnostic and therapeutic context of bismuth

• CONCLUSIONS: This study provides clear evidence that photodynamic therapy is effective in restoring biliary drainage and improving quality of life in patients with nonresectable disseminated cholangiocarcinomas Bismuth type III and IV [1].
• Survival of patients with Bismuth type III or IV tumors or of patients who underwent right hepatectomy was significantly better [7].
• PURPOSE: To assess the usefulness of the Bismuth classification method in the preoperative localization of iatrogenic bile duct lesions with cholangiography and to correlate these cholangiographic findings with surgical findings [21].
• CONCLUSIONS: Bismuth subcitrate-based b.i.d. quadruple therapy was an excellent primary and salvage therapy and should be considered as first line therapy [22].
• CONCLUSION: There is no need to place more than one stent in Bismuth type I, II, and III hilar obstructions [23].

References