The prognosis of patients with brain metastasis as the only manifestation of an undetected primar... more The prognosis of patients with brain metastasis as the only manifestation of an undetected primary tumor generally is considered to be poor. Therefore, most treatment is palliative. The authors reviewed the clinical outcomes and treatment results of patients presenting with brain metastasis from an undetected primary tumor at The University of Texas M. D. Anderson Cancer Center. Between 1977-1996, 220 patients were referred to the study department for the treatment of brain metastasis from an undetected primary tumor. The patients' records were reviewed to identify those for whom brain metastasis was the only manifestation of the primary tumor. The majority of patients were excluded from the current analysis because extracranial metastasis also were present. Thirty-nine patients qualified for this retrospective review. The level of neurosurgical excision varied, but all patients received radiotherapy. Tumor control in the brain and survival were analyzed by various tumor-related and treatment-related factors. In 31 patients, the brain metastasis were adenocarcinomas, whereas the remaining patients had tumors of various other histologies. In 12 patients, the primary tumor eventually was found, most commonly in the lung. The median survival time for all patients was 13.4 months. Overall survival rates (OS) at 1, 3, and 5 years were 56%, 19%, and 15%, respectively. Intracranial disease control was 72% at 5 years. Patients who received gross total resection (GTR) and radiotherapy had significantly better OS than patients who received radiotherapy alone. The OS of patients whose primary tumor was identified was similar to that of patients in whom the primary tumor remained occult. Brain metastasis as the only manifestation of an unknown primary tumor is a distinct clinical entity. The prognosis for patients with this presentation is better than that of patients with brain metastasis in general. Although the majority of patients die of extracranial disease, a few will achieve long term survival. Treatment to the brain is effective in controlling local disease; aggressive treatment with GTR and radiotherapy is recommended.
Preparations of apical cavities in resected root ends using rotary burs, with and without citric ... more Preparations of apical cavities in resected root ends using rotary burs, with and without citric acid rinse, and ultrasonic tips were compared based on the presence or absence of superficial debris and smear layer. Three groups of 20 extracted teeth each were prepared as follows; I, a size 010 round bur was used to prepare an apical cavity 2–3 mm down the long axis of the root; II, treatment as per group I followed by a 60-s rinse with a solution of 10:3 (10% citric acid, 3% Fe2Cl3); and III, an ultrasonic retrotip was used to prepare a 2–3 mm deep apical cavity. Roots were grooved longitudinally, split and prepared for SEM analysis at ×100 and ×780 magnification. Examiners were calibrated to a standardized grading system. Extensive statistical analyses indicated statistically significant differences within and among the groups (P<0.05). Root-end preparation with a bur created a heavy smear layer at all levels of the preparation. This layer was partially removed during ultrasonic preparation in the apical two-thirds. A greater removal of the smear layer was achieved with the citric acid rinse (P<0.05). Coronally, root-end preparations were contaminated with moderate to heavy amounts of debris with all techniques.
The prognosis of patients with brain metastasis as the only manifestation of an undetected primar... more The prognosis of patients with brain metastasis as the only manifestation of an undetected primary tumor generally is considered to be poor. Therefore, most treatment is palliative. The authors reviewed the clinical outcomes and treatment results of patients presenting with brain metastasis from an undetected primary tumor at The University of Texas M. D. Anderson Cancer Center. Between 1977-1996, 220 patients were referred to the study department for the treatment of brain metastasis from an undetected primary tumor. The patients&#39; records were reviewed to identify those for whom brain metastasis was the only manifestation of the primary tumor. The majority of patients were excluded from the current analysis because extracranial metastasis also were present. Thirty-nine patients qualified for this retrospective review. The level of neurosurgical excision varied, but all patients received radiotherapy. Tumor control in the brain and survival were analyzed by various tumor-related and treatment-related factors. In 31 patients, the brain metastasis were adenocarcinomas, whereas the remaining patients had tumors of various other histologies. In 12 patients, the primary tumor eventually was found, most commonly in the lung. The median survival time for all patients was 13.4 months. Overall survival rates (OS) at 1, 3, and 5 years were 56%, 19%, and 15%, respectively. Intracranial disease control was 72% at 5 years. Patients who received gross total resection (GTR) and radiotherapy had significantly better OS than patients who received radiotherapy alone. The OS of patients whose primary tumor was identified was similar to that of patients in whom the primary tumor remained occult. Brain metastasis as the only manifestation of an unknown primary tumor is a distinct clinical entity. The prognosis for patients with this presentation is better than that of patients with brain metastasis in general. Although the majority of patients die of extracranial disease, a few will achieve long term survival. Treatment to the brain is effective in controlling local disease; aggressive treatment with GTR and radiotherapy is recommended.
Preparations of apical cavities in resected root ends using rotary burs, with and without citric ... more Preparations of apical cavities in resected root ends using rotary burs, with and without citric acid rinse, and ultrasonic tips were compared based on the presence or absence of superficial debris and smear layer. Three groups of 20 extracted teeth each were prepared as follows; I, a size 010 round bur was used to prepare an apical cavity 2–3 mm down the long axis of the root; II, treatment as per group I followed by a 60-s rinse with a solution of 10:3 (10% citric acid, 3% Fe2Cl3); and III, an ultrasonic retrotip was used to prepare a 2–3 mm deep apical cavity. Roots were grooved longitudinally, split and prepared for SEM analysis at ×100 and ×780 magnification. Examiners were calibrated to a standardized grading system. Extensive statistical analyses indicated statistically significant differences within and among the groups (P<0.05). Root-end preparation with a bur created a heavy smear layer at all levels of the preparation. This layer was partially removed during ultrasonic preparation in the apical two-thirds. A greater removal of the smear layer was achieved with the citric acid rinse (P<0.05). Coronally, root-end preparations were contaminated with moderate to heavy amounts of debris with all techniques.
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