Faculty Profiles - OZAKI Toshifumi

Effect of dose intensity of methotrexate, doxorubicin, and ifosfamide on the prognosis of patients with osteosarcoma Reviewed

Yoichiro Uchida, Toshifumi Ozaki, Akira Kawai, Toshiyuki Kunisada, Tomoyuki Dan'ura, Noriko Naito, Hajime Inoue

International Journal of Clinical Oncology 4 ( 1 ) 36 - 40 1999.2

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

Background. The prognosis of patients with osteosarcoma has improved due to the introduction of systemic chemotherapy. The current study tried to identify the effect of each anti-tumor drug on the prognosis of patients with osteosarcoma. Methods. The records of 29 patients with osteosarcoma who received systemic chemotherapy were retrospectively analyzed. All tumors were classified as stage IIB (Enneking's surgical stage) and were located around the knee joint or more distal areas. The histologic response to preoperative chemotherapy was determined in 20 patients: 9 patients had grade 1, 4 grade 2, 5 grade 3, and 2 grade 4. The mean follow-up period was 102 months. Results. The 5-year overall survival and relapse-free survival (RFS) in the 29 patients was 47.7% and 41.4%, respectively. The 5-year RFS for the 7 good responders (grade 3 and 4) was 85.7%, and that for the 13 poor responders (grade 1 and 2) was 23.1% (P = 0.008). The mean preoperative dose intensity (DI) of methotrexate (MTX) for good responders was significantly higher than that for poor responders (P = 0.028). In 23 patients who received MTX and doxorubicin (ADR) but not ifosfamide (IFOS), the DI of MTX significantly influenced the RFS (P = 0.0128). In the 13 poor responders, 6 of whom received IFOS, the DI of IFOS and ADR significantly influenced RFS (P = 0.0112, 0.0395). Conclusion. The preoperative DI of MTX was related to the histologic response rate. The DI of MTX was significantly associated with the patients' RFS. In poor responders, the DI of IFOS and ADR influenced the patients' RFS.

DOI： 10.1007/s101470050021

Implantation of antibiotic impregnated PMMA beads for infection after implantation of endoprosthesis.

Insertion of the patella tendon after prosthetic replacement of the proximal tibia Reviewed

Toshifumi Ozaki, Toshiyuki Kunisada, Akira Kawai, Yasuyuki Takahara, Hajime Inoue

Acta Orthopaedica Scandinavica 70 ( 5 ) 527 - 529 1999

TAKADA Itsuro

The Central Japan Journal of Orthopaedic Surgery & Traumatology 42 ( 5 ) 1183 - 1184 1999

Limb-salvage for soft tissue sarcomas which involve the sciatic nerve.

KATOH Hisayoshi

The Central Japan Journal of Orthopaedic Surgery & Traumatology 42 ( 4 ) 833 - 834 1999

Prognostic factors for patients with osteosarcoma of the extremities.

KAWAI Akira

The Central Japan Journal of Orthopaedic Surgery & Traumatology 42 ( 4 ) 797 - 798 1999

悪性軟部腫ように対するＭＡＩＤ療法の検討

内藤訓子, 川井章, 尾崎敏文, 檀浦智幸, 井上一

中部日本整形外科災害外科学会雑誌 42 ( 6 ) 1415 - 1416 1999

Treatment of congenital kyphosis

OZAKI Toshifumi

The Central Japan Journal of Orthopaedic Surgery & Traumatology 42 ( 6 ) 1367 - 1368 1999

Results of hydroxyapatite grafting for treatment of benign bone tumors

NAITO Noriko

The Central Japan Journal of Orthopaedic Surgery & Traumatology 42 ( 3 ) 543 - 544 1999

Treatment of Extra-abdominal Desmoid Tumor.

SHIOTA Naofumi, OZAKI Tosifumi, DAN-URA Tomoyuki, NAITOH Noriko, INOUE Hajime

The Journal of the Chugoku-Shikoku Orthopaedic Association 11 ( 2 ) 305 - 309 1999

Language：Japanese Publisher：The Chugoku-Shikoku Orthopaedic Association

Extra-abdominal desmoid tumors are benign lesions but difficult to cure because of their infiltrative nature and tendency to recur. Fifteen patients were treated at our department between 1966 and 1998. Six of them were men, and 9 women. Eleven underwent their first operation at-our department and 4 had recurrent tumors after surgery at other hospitals. Local recurrence was observed in one patient with intralesional resection (100%), and one of 8 with wide resection (12.5%). However, 2 patients with marginal resection did not have a second operation. Resection with inadequate margin at that first operation led to poor clinical results.

DOI： 10.11360/jcsoa1989.11.305

CiNii Article

Expression of CD44 variants in osteosarcoma

M. Kuryu, T. Ozaki, K. Nishida, M. Shibahara, A. Kawai, H. Inoue

Journal of Cancer Research and Clinical Oncology 125 ( 11 ) 646 - 652 1999

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

The standard form of CD44 (CD44H) is a transmembranous glycoprotein, widely distributed on a variety of human lymphoid cells, epithelial cells and tumours. CD44 has many variant forms, which are generated by alternative splicing. In recent years, CD44 has been reported to be related to the degree of tumour differentiation, tumour cell invasion, and metastasis. We investigated 44 tumour specimens in 39 patients with osteosarcoma immunochemically to analyze the expression of CD44 standard (CD44H) and variant exon-encoded gene products (CD44v3, v4, v5, v6, v7, v9, and v10). Furthermore, the relationship between CD44 expression and the clinical outcome of patients with osteosarcoma was analyzed. Membrane accentuation and exclusive cytoplasmic reactivity were analyzed as separate staining patterns. Tumour cells and some multinucleated giant cells were markedly stained. CD44H, v3, v4, v5, v6, v7, v9, and v10 were expressed in 85%, 49%, 54%, 59%, 46%, 5%, 28%, and 10% of the specimens respectively. The cumulative 5-year metastasis-free survival was 58% in CD44v6-negative cases and 24% in CD44v6-positive cases (P = 0.046). However, the cumulative 5-year metastasis-free survival was not significantly different between cases positive and negative for other variants of CD44. Multivariate analysis (Cox proportional-hazard model) with CD44v6 expression (positive or negative), chemotherapy (intensive or non-intensive), tumour site (proximal or distal), and age (at least 30 years or less than 30 years) showed that expression of CD44v6 and chemotherapy were important prognostic factors in patients with osteosarcoma. Overexpression of CD44 isoforms containing variant v6 is correlated with poor prognosis in patients with osteosarcoma.

DOI： 10.1007/s004320050329

High complication rate of reconstruction using Ilizarov bone transport method in patients with bone sarcomas Reviewed

T Ozaki, Y Nakatsuka, T Kunisada, A Kawai, T Dan'ura, N Naito, H Inoue

ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY 118 ( 3 ) 136 - 139 1998.12

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

We performed five reconstructions by bone transport in patients with bone sarcoma: three osteosarcomas, one Ewing's sarcoma and one chondrosarcoma. Four sacromas were in the distal femur and one in the shaft of the tibia. Four patients received multidrug chemotherapy. The average length of the skeletal defect after tumour resection was 17 (range 10-25) cm. All patients underwent double elongation from both proximal and distal sites: of the bone defect. The average follow-up period was 48 (range 40-66) months, and the average duration of external fixation was 32 months (range 579-1340 days). In one case, bone formation was satisfactory, but in the other cases, it was poor and slow. The average treatment index was 95 (range 53-191) days per 1 cm of elongation. In one case, the bone fragment disappeared during the bone transport. In one case, the end of the bone protruded from the skin, and osteomyelitis set in. This patient underwent above-knee amputation due to failure of infection control. Three patients suffered talipes equinus. One patient died of pulmonary metastasis. Two patients had fair and three had poor function. This method is not recommended for patients with bone sarcoma who may have a poor prognosis, as it has an unacceptably high complication rate.

Web of Science

Treatment outcome of osteofibrous dysplasia

T. Ozaki, M. Hamada, S. Sugihara, T. Kunisada, S. Mitani, H. Inoue

Journal of Pediatric Orthopaedics Part B 7 ( 3 ) 199 - 202 1998.7

Publishing type：Research paper (scientific journal)

The disease course of six tibial lesions in five patients with osteofibrous dysplasia who were followed longer than 10 years (average: 16.8 years) was analyzed retrospectively. Three patients had a lesion of the unilateral tibia; one patient had lesions of the unilateral tibia and fibula; and one patient had lesions of the bilateral tibiae and ulnae. Curettage and autogeneic bone graft were performed on two lesions, which then healed. Of four lesions on which curettage and xenogeneic bone grafts were performed, three lesions healed, and one developed local recurrence. Curettage and xenogeneic bone graft were performed on the recurrent lesion, which finally healed and the deformity stopped. Three lesions healed without surgical treatment. During the long-term follow-up, this disease showed a clear tendency of healing. Surgical treatment should be considered in patients with disease uncontrollable by conservative treatment or those who have a high possibility of impending fracture and progressing deformity.

DOI： 10.1097/01202412-199807000-00004

Hyperparathyroid Crisis in a Patient with a Giant Brown Tumor of the Iliac Bone: A Case Report

Satoshi Ishikawa, Toshifumi Ozaki, Akira Kawai, Hajime Inoue, Hiroyoshi Doihara

Hiroshima Journal of Medical Sciences 47 ( 1 ) 27 - 30 1998.3

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

We observed a patient with a giant brown tumor of the iliac bone due to hyperparathyroidism. There was a risk of pathologic fracture due to huge cysts produced by bone absorption. In hyperparathyroid crisis, control of severe hypercalcemia is difficult without resection of the parathyroid gland.

Reconstruction of bone defect using the bone transport technique for a case of osteosarcoma of the femur Reviewed

T Ozaki, Y Nakatsuka, A Kawai, H Akazawa, T Kunisada, H Inoue

ACTA MEDICA OKAYAMA 52 ( 1 ) 67 - 70 1998.2

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

There are few reports on skeletal reconstruction using the bone transport technique to repair bone defects caused by resections of tumors associated with osteosarcoma. We attempted to reconstruct a 23 cm bone defect after resection of an osteosarcoma of the left femur, and succeeded in gaining 17 cm by bone transport. Five years after surgery, this patient remains alive without metastasis or local recurrence.

Web of Science

Value of thallium-201 scintigraphy in bone and soft tissue tumors Reviewed

Osamu Sato, Akira Kawai, Toshifumi Ozaki, Toshiyuki Kunisada, Tomoyuki Danura, Hajime Inoue

Journal of Orthopaedic Science 3 ( 6 ) 297 - 303 1998

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

The potential role of thallium-201 (201Tl) scintigraphy in the imaging of various musculoskeletal tumors was investigated in 80 patients. Uptake of 201Tl was observed in 17 (100%) malignant bone tumors, 6 (100%) giant cell tumors, and 2 of 8 (25%) benign bone tumors. Nineteen of 30 malignant soft tissue tumors (63%) were positive for 201Tl scintigraphy, while 2 of 14 benign soft tissue tumors (14%) yielded positive results. None of 6 liposarcomas were visualized by 201Tl scintigraphy. There was no 201Tl uptake in the tissues of 5 non-tumorous conditions. Ten patients with osteosarcoma were evaluated by 201Tl scintigraphy both pre- and post- chemotherapy. There was a significant correlation between changes in tumor- to-normal count ratio and percent necrosis of the resected tumor. The mean decrease in tumor-to-normal count ratio was 71% for patients with ≥90% tumor necrosis and 26% for those with &lt
90% tumor necrosis. Serial 201Tl scintigraphy, with quantitative analysis of alterations in 201Tl uptake, may provide a quantitative and objective measure of the effect of preoperative chemotherapy in patients with malignant bone tumors.

DOI： 10.1007/s007760050056

Vancomycin-impregnated polymethylmethacrylate beads for methicillin- resistant Staphylococcus aureus (MRSA) infection: Report of two cases Reviewed

Toshifumi Ozaki, Teruhito Yoshitaka, Toshiyuki Kunisada, Tomoyuki Dan'ura, Noriko Naito, Hajime Inoue

Journal of Orthopaedic Science 3 ( 3 ) 163 - 168 1998

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

Two patients with methicillin-resistant Staphylococcus aureus (MRSA) infection were treated with vancomycin (VCM)-impregnated polymethylmethacrylate (PMMA) beads. One patient, who had a history of polycystic kidney and diabetes mellitus, who was receiving hemodialysis due because of non-functional kidney, underwent resection of an intermediate grade chondrosarcoma in the pelvis. MRSA infection developed and curettage of the lesion was performed, but MRSA infection recurred. During the second revision surgery, VCM-impregnated PMMA beads were implanted. MRSA infection has not recurred for 16 months since the implantation of the VCM beads. The second patient had a history of total hip arthroplasty (THA) performed because of coxarthrosis. After the initial surgery, MRSA infection developed, recurring after the second revision surgery for THA. After curettage following removal of the prosthesis, VCM beads were implanted with a spacer composed of VCM-PMMA and a Luque rod. Infection did not recur and THA revision was performed 3 months after the VCM beads implantation. Fifteen months after the last revision surgery, infection has not recurred.

DOI： 10.1007/s007760050037

Chronic Inflammation of Hip Joint Resembling Bone Tumor. A Report of Two Cases.

HIROOKA Hirokimi, OZAKI Toshifumi, KAWAI Akira, INOUE Hajime

The Journal of the Chugoku-Shikoku Orthopaedic Association 10 ( 1 ) 117 - 122 1998

Language：Japanese Publisher：The Chugoku-Shikoku Orthopaedic Association

We observed 2 patients with an inflammatory disease that occurred in the femoral neck. An evident inflammatory sign was not observed. Osteomyelitis or bone tumors such as osteoid osteoma was suspected by the radiological findings. These patients underwent curettage and resection of the lesion. Histological findings showed a diagnosis of chronic osteomyelitis in both patients.

DOI： 10.11360/jcsoa1989.10.117

CiNii Article

Surgical Treatment of Metastatic Bone Tumor Affecting Lower Extremity.

KUNISADA Toshiyuki, OZAKI Toshifumi, DOI Takeshi, DAN'URA Tomoyuki, INOUE Hajime

The Journal of the Chugoku-Shikoku Orthopaedic Association 10 ( 2 ) 285 - 288 1998

Language：Japanese Publisher：The Chugoku-Shikoku Orthopaedic Association

We evaluated the results of surgical treatment of 15 metastatic lesions affecting long bones in 14 patients. Pathological fractures occured in 7 patients preoperatively. Pain due to bone metastasis subsided after the operation in 12 of 14 lesions with pain preoperatively. Since after surgery pain subsided in patients who had not suffered a pathological fracture preoperatively, we considered that prophylactic surgical treatment would be effective to control pain due to bone metastasis in a long bone. In this series, the results of surgical treatment were excellent in 4 patients, good in 6, and fair in 2. Intramedullary fixation would be a useful treatment on bone metastasis affecting long bones. Wide resection should be attempted in patients who may have a good prognosis.

DOI： 10.11360/jcsoa1989.10.285

CiNii Article