Faculty Profiles - KUNISADA Toshiyuki

A case of synovial sarcoma with brain metastasis treated with surgical resection and stereotactic radiosurgery Reviewed

Yoshihiro Otani, Tomotsugu Ichikawa, Kazuhiko Kurozumi, Hiroyuki Yanai, Toshiyuki Kunisada, Toshifumi Ozaki, Isao Date

Neurological Surgery 41 ( 3 ) 255 - 262 2013.3

Language：Japanese Publishing type：Research paper (scientific journal)

Synovial sarcomas compromise between 5 to 10% of all soft tissue sarcomas in adults. Synovial sarcoma commonly occurs in the vicinity of the large joints and cranial metastasis is rare. Here, we describe a case with intracranial metastases of a synovial sarcoma A 41-year-old woman was admitted to our department with sensory aphasia. She had a history of a left inguinal synovial sarcoma and underwent surgery and chemotherapy for primary and metastatic lesions Head MRI revealed three gadolinium-enhancing lesions in the left frontal, parietal and parietotemporal lobe Gross total resection was achieved in the left parietotemporal lesion and pathological diagnosis was synovial sarcoma. Two weeks after surgery, she received cyber-knife radiosurgery and her neurological deficit was almost completely resolved Intracranial metastatic synovial sarcoma is rare. Surgical resection and stereotaxic radiosurgery was very effective in the present case.

Scopus

Total Hip Arthroplasty for Hip Ankylosis due to Juvenile Idiopathic Arthritis : A Case Report

Harada Ryozo, Fujiwara Kazuo, Misawa Haruo, Miyake Yoshiaki, Okada Yoshiki, Ozaki Toshifumi, Endo Hirosuke

The Journal of the Chugoku-Shikoku Orthopaedic Association 25 ( 1 ) 13 - 17 2013

Language：Japanese Publisher：The Chugoku-Shikoku Orthopaedic Association

In patients with variable changes in pelvic inclination, total hip arthroplasty (THA) is required for accurate cup installation to prevent dislocation. Here we reported the use of THA for hip ankylosis due to juvenile idiopathic arthritis (JIA) and variable pelvic inclination with changes in posture. The patient was a 55-year-old woman, who had received medical treatment for JIA until the age of 14 year. She had been examined two years previously for bilateral leg pain and gait disturbance. Clinically, the lumbar spine had degenerative changes and the left hip joint was ankylosed at a 50-degree -flexed position, causing severe lordosis of the pelvis and lumbar spine and more severe lordosis during changes in posture. We treated the lumbar spine by laminectomy, and then THA was performed under a navigation system. Postoperatively, the patient was relieved of her symptoms and her ambulatory ability was improved. Anteversion of the pelvis with changes in posture remains, but the large femoral head has ensured that no dislocation has occurred up to the present.<br>In cases of variable pelvic inclination due to changes in posture, use of a navigation system is useful intraoperatively for accurate cup installation, and a large femoral head matches any postoperative changes in pelvic inclination.

DOI： 10.11360/jcsoa.25.13

Other Link： http://search.jamas.or.jp/link/ui/2013299772

A simple detection system for adenovirus receptor expression using a telomerase-specific replication-competent adenovirus.

Sasaki T, Tazawa H, Hasei J, Osaki S, Kunisada T, Yoshida A, Hashimoto Y, Yano S, Yoshida R, Kagawa S, Uno F, Urata Y, Ozaki T, Fujiwara T

Gene Ther 2013

外科的摘出および定位放射線治療が有用であった転移性滑膜肉腫の1例

大谷理浩, 市川智継, 黒住和彦, 柳井広之, 国定俊之, 尾崎敏文, 伊達勲

Neurological Surgery 41 ( 3 ) 255 - 262 2013

Surgical Treatment for Congenital Kyphosis Correction Using Both Spinal Navigation and a 3-dimensional Model Reviewed

Yoshihisa Sugimoto, Masato Tanaka, Ryuichi Nakahara, Haruo Misawa, Toshiyuki Kunisada, Toshifumi Ozaki

ACTA MEDICA OKAYAMA 66 ( 6 ) 499 - 502 2012.12

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

An 11 year-old girl had 66 degrees of kyphosis in the thoracolumbar junction. For the purpose of planning for kyphosis correction, we created a 3-D, full-scale model of the spine and consulted spinal navigation. Three-dimensional models are generally used as tactile guides to verify the surgical approach and portray the anatomic relations specific to a given patient. We performed posterior fusion from Th10 to L3, and vertebral column resection of Th12 and L1. Screw entry points, directions, lengths and diameters were determined by reference to navigation. Both tools were useful in the bone resection. We could easily detect the posterior element to be resected using the 3D model. During the anterior bony resection, navigation helped us to check the disc level and anterior wall of the vertebrae, which were otherwise difficult to detect due to their depth in the surgical field. Thus, the combination of navigation and 3D models helped us to safely perform surgery for a patient with complex spinal deformity.

DOI： 10.18926/AMO/49047

クラウドを利用した遠隔カスタムメイドインプラント作成システム

井上円加, 中原龍一, 島村安則, 野田知之, 国定俊之, 尾崎敏文

骨折 34 ( 4 ) 959 - 963 2012.12

Language：Japanese Publisher：(一社)日本骨折治療学会

【目的】当科では鎖骨骨幹部骨折に対し、CT画像を元にプレベンディングしたプレートを用いたMIPO法を行い、良好な結果を得ている。遠隔地の小規模施設でも同様の手術を行うため、クラウドサーバー経由でのCTの編集画像を転送し、作成したプレートを当該施設に輸送して手術を行うシステムを構築した。【方法】健側鎖骨のCT画像からプレベンディング用の画像データを作成する。手術を行う施設で画像処理を行い、クラウドサーバーに匿名化した編集画像を転送する。データを元に当院でプレートをプレベンディングし、当該施設に輸送し、手術を行った。【結果】当該施設でのデータ編集は30分で可能であった。編集後の画像データ量は大幅に削減でき、ネットワーク上での転送に支障はなかった。【結論】当科と手術を行う病院でクラウドサーバーを構築し、低コストでカスタムメイドインプラント作成ネットワークを作り、大学病院の手術方法を他院で実現できた。(著者抄録)

Tc-99m DMSA (V) scintigraphy for evaluation in patients with cartilaginous bone tumor

T. Shinya, S. Sato, A. Alafate, H. Gobara, K. Kato, T. Kunisada, T. Ozaki, S. Kanazawa

EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 39 S473 - S474 2012.10

MicroRNA-21 correlates with tumorigenesis in malignant peripheral nerve sheath tumor (MPNST) via programmed cell death protein 4 (PDCD4) Reviewed

Satoru Itani, Toshiyuki Kunisada, Yuki Morimoto, Aki Yoshida, Tsuyoshi Sasaki, Sachio Ito, Mamoru Ouchida, Shinsuke Sugihara, Kenji Shimizu, Toshifumi Ozaki

JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY 138 ( 9 ) 1501 - 1509 2012.9

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

We investigated the miRNA profile in peripheral nerve tumors and clarified the involvement of miRNA in the development and progression of MPNST in comparison with neurofibroma (NF). In addition, we attempted to seek associations between the miRNA and their potential targets in MPNST.
Global miRNA expression profiling was investigated for clinical samples of 6 MPNSTs and 6 NFs. As detected by profiling analysis, the expressions of miR-21 in clinical samples of 12 MPNSTs, 11 NFs, and 5 normal nerves, and 3 MPNST cell lines were compared using quantitative real-time reverse transcription PCR. MPNST cell line (YST-1) was transfected with miR-21 inhibitor to study its effects on cell proliferation, caspase activity, and the expression of miR-21 targets.
Analysis of miRNA expression profiles in MPNST and NF revealed significantly altered expression levels of nine miRNAs, one of those, miR-21, and its putative target, programmed cell death protein 4 (PDCD4), were selected for further studies. miR-21 expression level in MPNST was significantly higher than that in NF (P < 0.05). In MPNST cells, transfection of miR-21 inhibitor significantly increased caspase activity (P < 0.01), significantly suppressed cell growth (P < 0.05), and upregulated protein level of PDCD4, indicating that miR-21 inhibitor could induce cell apoptosis of MPNST cells.
These results suggest that miR-21 plays an important role in MPNST tumorigenesis and progression through its target, PDCD4. MiR-21 and PDCD4 may be candidate novel therapeutic targets against the development or progression of MPNSTs.

DOI： 10.1007/s00432-012-1223-1

Segmental Pedicle Screw Fixation for a Scoliosis Patient with Post-laminectomy and Post-irradiation Thoracic Kyphoscoliosis of Spinal Astrocytoma Reviewed

Masato Tanaka, Yoshihiro Sugimoto, Haruo Misawa, Tomoyuki Takigawa, Toshiyuki Kunisada, Toshifumi Ozaki

ACTA MEDICA OKAYAMA 66 ( 4 ) 363 - 368 2012.8

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

Spinal deformity is an important clinical manifestation after surgery for spinal cord tumors. One-third of patients who receive laminectomies and irradiation of the spinal column develop scoliosis, kyphosis, or kyphoscoliosis. Recent reports indicate good results after scoliosis surgery using segmental pedicle screws and a navigation system, but these reported studies have not included surgery for post-laminectomy kyphosis. Hooks and wires are ineffective in such patients who undergo laminectomy, and there are also high perioperative risks with insertion of pedicle screws because landmarks have been lost. Here, we report on the 5-year follow-up of a 13-year-old male patient with post-laminectomy and post-irradiation thoracic kyphoscoliosis after surgical treatment of spinal astrocytoma. Posterior segmental pedicle screw fixation was performed safely using a computer-assisted technique. The authors present the first case report for treatment of this condition using a navigation system.

DOI： 10.18926/AMO/48692

Statistical Analysis of Prognostic Factors for Survival in Patients with Spinal Metastasis Reviewed

Masaki Kataoka, Toshiyuki Kunisada, Masato Tanaka, Ken Takeda, Satoru Itani, Yoshihisa Sugimoto, Haruo Misawa, Masuo Senda, Shinnosuke Nakahara, Toshifumi Ozaki

ACTA MEDICA OKAYAMA 66 ( 3 ) 213 - 219 2012.6

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

There are a variety of treatment options for patients with spinal metastasis, and predicting prognosis is essential for selecting the proper treatment. The purpose of the present study was to identify the significant prognostic factors for the survival of patients with spinal metastasis. We retrospectively reviewed 143 patients with spinal metastasis. The median age was 61 years. Eleven factors reported previously were analyzed using the Cox proportional hazards model: gender, age, performance status, neurological deficits, pain, type of primary tumor, metastasis to major organs, previous chemotherapy, disease-free interval before spinal metastasis, multiple spinal metastases, and extra-spinal bone metastasis. The average survival of study patients after the first visit to our clinic was 22 months. Multivariate survival analysis demonstrated that type of primary tumor (hazard ratio [HR] = 6.80, p < 0.001), metastasis to major organs (HR = 2.01, p = 0.005), disease-free interval before spinal metastasis (HR = 1.77, p = 0.028), and extra-spinal bone metastasis (HR = 1.75, p = 0.017) were significant prognostic factors. Type of primary tumor was the most powerful prognostic factor. Other prognostic factors may differ among the types of primary tumor and may also be closely associated with primary disease activity. Further analysis of factors predicting prognosis should be conducted with respect to each type of primary tumor to help accurately predict prognosis.

DOI： 10.18926/AMO/48560

関節内骨折の克服治療成績の向上を目指して関節内骨折の克服治療成績の向上を目指して足関節内骨折

野田知之, 島村安則, 中原龍一, 齋藤太一, 金澤智子, 長谷井嬢, 井上円加, 山川泰明, 国定俊之, 尾崎敏文, 木浪陽

骨折 34 ( Suppl. ) S9 - S9 2012.6

鎖骨骨幹部骨折に対するMIPO法による治療成績(第2報)

島村安則, 中原龍一, 斉藤太一, 金澤智子, 小澤正嗣, 井上円加, 山川泰明, 原田遼三, 中道亮, 島村好信, 国定俊之, 野田知之, 尾崎敏文

骨折 34 ( Suppl. ) S120 - S120 2012.6

後内側剪断骨片を有する脛骨近位部関節内骨折に対する固定方法の検討

小澤正嗣, 野田知之, 山川泰明, 金澤智子, 長谷井嬢, 齋藤太一, 中原龍一, 木浪陽, 島村安則, 国定俊之, 尾崎敏文

骨折 34 ( Suppl. ) S170 - S170 2012.6

p53-mediated apoptotic signaling overcomes the resistance to oncolytic adenovirus in human osteosarcoma cells

Joe Hasel, Tsuyoshi Sasaki, Hiroshi Tazawa, Yuuri Hashimoto, Toshiyuki Kunisada, Yasuo Urata, Toshifumi Ozaki, Toshiyoshi Fujiwara

CANCER RESEARCH 72 2012.4

Treatment of Histiocytic Sarcoma in the Right Lower Leg : A Case Report

Morimoto Yuki, Itani Satoru, Ozaki Toshifumi, Kunisada Toshiyuki

The Journal of the Chugoku-Shikoku Orthopaedic Association 24 ( 1 ) 5 - 9 2012

Language：Japanese Publisher：The Chugoku-Shikoku Orthopaedic Association

Histiocytic sarcoma is a rare hematopoietic malignancy with a poor prognosis. We report a 31-year-old woman who developed histiocytic sarcoma in the lower extremity. An open biopsy was required because a definitive diagnosis could not be made on the basis of a core-needle biopsy specimen. The diagnosis of histiocytic sarcoma was established using immunohistochemistry. No metastatic lesion was detected by PET-CT, and wide resection based on the procedure for a malignant soft tissue tumor was performed without neo-adjuvant chemotherapy. However, adjuvant radiotherapy was performed because there are few reports of histiocytic sarcoma being treated using surgery alone. During 35 months of follow-up, neither local recurrence nor distant metastasis has been observed. Our experience suggests that if a solitary lesion of histiocytic sarcoma can be resected with a sufficient margin, chemotherapy may be unnecessary.

DOI： 10.11360/jcsoa.24.5

Outcome of Treatment for Metastatic Spine Tumors with High-grade Malignancy

Mazaki Tetsuro, Tanaka Masato, Sugimoto Yoshihisa, Takigawa Tomoyuki, Tetsunaga Tomoko, Shiozaki Yasuyuki, Osaki Shuhei, Ozaki Toshifumi, Kunisada Toshiyuki, Misawa Haruo, Kataoka Masaki

The Journal of the Chugoku-Shikoku Orthopaedic Association 24 ( 2 ) 273 - 277 2012

Language：Japanese Publisher：The Chugoku-Shikoku Orthopaedic Association

We report the outcome of patients with metastatic spine tumors showing high-grade malignancy using the Tokuhashi scoring system. A retrospectively compared 21 patients with such tumors (group H) and 29 patients with spinal metastases showing low-grade malignancy (group L). There were 18 men and 3 women in group H, and 16 men and 13 women in group L, and the average patient ages were 55 years and 65 years, respectively. All of the patients were scored with the Tokuhashi scoring system and evaluated for neurological symptoms with the ASIA Impairment Scale (AIS).<br>Results : The rates of improvement in the AIS score and gait ability were almost the same in both groups. Among patients who we were able to follow postoperatively for 6 months or more, 7 in group H and 4 in group L died within 6 months. The mean survival period was 12 months in group H and 17 months in group L.<br>Conclusions : The outcome after treatment in group H was almost the same as that in group L. This may have been due to progress in the treatment of malignancy. Further studies to determine the indications for surgery in such patients are warranted.

DOI： 10.11360/jcsoa.24.273

Surgical Treatment of Pedal Osteomyelitis : Report of Five Cases

Other Link： http://search.jamas.or.jp/link/ui/2013107551

Okada Yoshiki, Noda Tomoyuki, Nishiyama Takeshi, Nakahara Ryuichi, Shimamura Yasunori, Ozaki Toshifumi

The Journal of the Chugoku-Shikoku Orthopaedic Association 24 ( 2 ) 209 - 214 2012

Language：Japanese Publisher：The Chugoku-Shikoku Orthopaedic Association

Osteomyelitis after trauma or surgery can be problematic, especially pedal osteomyelitis including calcaneal osteomyelitis. Here we report the results and problems associated with surgery for pedal osteomyelitis in five patients (four men and one woman). The mean age of the patients was 37 years (range 12-51 years). Four developed infection after surgery and one after contusion. Treatment involved thorough debridement of the infected area and filling of the dead space with artificial bone or cement beads incorporating a DDS (Drug Delivery System). Until the infection had subsided, we repeated this operation every 3 to 4 weeks. Finally, we performed a subtalar arthrodesis in one patient, a desis of the cuneiform bone in one, and auto-bone graft in three. The bacteria detected were MSSA in two patients, MRSA in three patients (including one case of MRSA combined with fungus). All of the infections subsided within a mean period of 9.6 months (range 5-21 months). The mean operation time was 3.2 hours (range 1-5 hours). We used mainly a DDS that released antibiotics from cement or artificial bone. There was no complication associated with this treatment. Since the calcaneus has poor vascularization and a large proportion of cancellous bone, pedal osteomyelitis, especially in the calcaneus, is challenging to treat. Filling the dead space using a DDS is effective for control of infection.

DOI： 10.11360/jcsoa.24.209

Other Link： http://search.jamas.or.jp/link/ui/2013107539

Thallium-201 Scintigraphy Is an Effective Diagnostic Modality to Distinguish Malignant From Benign Soft-Tissue Tumors Reviewed

Naoaki Kawakami, Toshiyuki Kunisada, Shuhei Sato, Yuki Morimoto, Masato Tanaka, Tsuyoshi Sasaki, Shinsuke Sugihara, Hiroyuki Yanai, Susumu Kanazawa, Toshifumi Ozaki

CLINICAL NUCLEAR MEDICINE 36 ( 11 ) 982 - 986 2011.11

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Background: The aim of this study is to evaluate whether thallium-201 (201-Tl) scintigraphy can differentiate malignant from benign soft-tissue tumors.
Methods: Between April 1995 and December 2005, 192 patients with soft-tissue tumors (85 malignant and 107 benign) underwent 201-Tl scintigraphy before treatment. Isotope uptake was used as a proxy for tumor-to-background ratio (TBR). The accuracy of TBR on early and delayed imaging was evaluated using the Mann-Whitney U and chi(2) tests.
Results: There was a statistically significant difference in mean TBR on early and delayed imaging of malignant and benign soft-tissue tumors (124% +/- 109% vs. 22% +/- 42%, and 82% +/- 83% vs. 12% +/- 25%, P < 0.0001). A TBR cutoff of 20% indicated the probability of malignancy on early and delayed imaging (82% sensitivity and 77% specificity; 82% sensitivity and 84% specificity, P < 0.0001). Well-differentiated liposarcomas showed low isotope accumulation, while pigmented villonodular synovitis and giant cell tumors of the tendon sheath showed high isotope accumulation.
Conclusions: Thallium-201 scintigraphy can distinguish malignant from benign tumors with relatively high accuracy. With the exception of low grade liposarcomas and locally aggressive benign tumors, 201-Tl scintigraphy may be an effective diagnostic modality to differentiate malignant from benign soft-tissue tumors.

DOI： 10.1097/RLU.0b013e3182177407