Introduction:

During the masters degree program at Bangkok Biomaterial Center, BBC arranged the expert visit of Dr. Rab Khan to give lectures on tissue banking related topics and evaluate the progress of IAEA fellows.

During his expert mission, he delivered lectures on historical background, rules and regulation, fundamentals of tumor treatment, overview on plastic surgery, radiation sterilization and tissue preservation. Evaluate the fellows.

03/07/2000

First attempt of repair of noses lost in battle or mutilated for punishment crimes was done by Sushruta almost 2500 years ago.

Early Peruvian medicine

Repaired the frontal bone defects in a Neolithic Peruvian Chieftain using a hammered gold plate.

Early Arab medicine

Evidence from Mohammed Al Gafequi of Cordoba (1265) for spinal fusion using fish bones.

Aztec medicine

The Aztec of central America 500 years ago gave advice for the treatment of a broken using intra-medullary graft of wood.

First documented xenograft was reported from Job van Meekeren (1668) by using a piece of bone from a dog skull and grafting it to a cranial defect of a human. The modern era was started from Bolongnese surgeon Gaspare Taggliacozzi (1545-1599). He described the use of forearm flaps for severing nose. He rejected the idea of using allograft because of Force and power. Salmon (1697) explained the use of great bone fragments for restoration of gun shot wounds.

Duhamel (1742) explained that the “bone grew as wood did, layer upon layer”. The osteogenis function of the periosteum was his discovery. But von Haller (1763) disagreed this idea and he believed that osteogenesis was due to exudation of arteries. John Hunter was the first to use the word “transplant” as akin to those in the plant kingdom. Thiersch (1886) improved the grafting method by using split thickness grafts. The first use of allograft bone was done by Willium MacEvan (1881). John Hunter re-implanted teeth lost through trauma and grafted teeth as allogarft to which he gave the name “scion teeth”. Merrem (1810) obtained successful healing of bone plates in the skull of animals after skull trephining. Subsequently Von (1821) applied the technique to human as “re-implantation”. Syme (1842) said that periosteum form new bone. But his student Goodsir (1845) concluded that periosteum is simply a limiting membrane. Ollier (1867) concluded that periosteum was the chief bone producing tissue because of osteoblast in the deepest layer of the periosteum. The first recorded human bone autogarft done by Nussabaum (1875). Barth (1893) stated that “ all the elements of bone die after transplantation.

Reverdin (1871) is attributed with the initial discovery of split thickness skin providing a perfectly satisfactory garft without injuring the donor site.

Lecture topic: Rules and Regulation

To define Ethical considerations:

Tissue banking is a non-profit activity and that tissues are not commercial goods.

To know the difference between viable and non-viable tissues.

Importance of consent.

Confidentiality

Recognize the needy patients

Religious Consideration:

Religious constraints regarding the tissue donation and transplantation

Burial procedure.

Legal Consideration:

Law of the country

Legal procedure for procurement

Medical Consideration:

Diagnose the brain death

EATB ethical code:

	Finance
	Tissue donation
	Tissue processing and storage
	Distribution and recipient

General Standards of Tissue Banking:

	General policies
	General organizational requirements
	Acquisition of tissues
	Processing, preservation and storage
	Labelling
	Distribution
	Hospital tissue storage and distribution facilities

Lecture topic: Fundamentals of tumor treatment:

Cancer epidemiology

Definition: Scientific study of factors influencing the frequency and distribution of disease in human populations. Cancer Epidemiology is the study of these factors in relation to malignancies.

incidence rate: Is the number of new cases in a given population during a specified time period.

prevalence rate: Measures existing disease in a population during a specified period of time.

mortality rate: Measures the number of deaths from a disease in a population during a specified period.

Survival: measures the number of people with cancer who are alive 5 years after diagnosis.

Morbidity: is the state or condition of having a disease.

Agent: is a factor that must be present in order for disease to occur.

Host: is a person who is susceptible to disease.

Environment: includes the factors to which the host is exposed.

Epidemiologic purpose and process

Goals: To discover the cause of disease, detect and quantify risk factors, increase the understanding of carcinogenesis.

Methods

Descriptive studies: describe disease-related data in population in order to identify clues to etiology.

Analytical studies: designed to test hypothesis about relationships between cause and outcome.

Current cancer epidemiologic studies

	cancer prevention studies
	surveillance, epidemiology and end results (SEER)
	National Cancer Data Base

Current Cancer Statistics

Incidence: The American Cancer Society estimates that there will be 168 million new cancer cases diagnosed in 2000.

Mortality: Lung cancer is the leading cause of cancer mortality among men and women of all ethnic groups in the US.

Survival: Survival rates have increased among all gender and ethnic groups.

Implications for patient care

surgical therapy

History: Earliest description of surgery for cancer were of the excision of tumor recorded on Egyptian Paprus 1600 BC.

Definition: Surgical therapy remains the primary method of treatment of most solid malignancies and in some the only chance for cure.

Rationale for use: Resect all tumors, maximize preservation of body function and appearance.

Biology of therapy: Slow growing tumors lend themselves best to surgical treatment because more likely to be confined locally, smaller tumors are less likely to have spread. Cancer cells remaining after treatment constitute a risk of recurrence or metastasis and reduce the risk of leaving residual tumor cells.

Roles of surgery: Curative, salvage, adjuvant, palliative

Radiation therapy:

History: Late 1890 X-Ray and gamma rays were discovered by Roentgen and Curie. Early 1900 ionizing radiation being used to treat variety of neoplasms.

Definition: Causes damage or changes to the cells. RT is a major cancer tretament that can be used alone or in combination with other therapies to cure, control or palliate disease.

Rationale for use: Cancer cells are killed or left unable to reproduce while the surrounding healthy cells are minimally effected and repair radiation damage.

Biology of therapy: Radiation causes damage or changes to cells that are penetrated and DNA is directly or indirectly damaged.

Lecture topic: Chemotherapy

History: Use began in 1940 with discovery that mustard gas causes myelo-suppression.

Definition: Use of various chemical agents that interfere with the replication and other normal functions of cancer cells.

Rationale for use: Because malignant cells tend to divide more rapidly than normal cells. It provides systemic approach to the treatment of cancer.

Biology of therapy: Cells are more sensitive to chemotherapeutic agents while they are actively dividing.

Types of chemotherapy drugs: Alkylating agents, antimetabolites, antitumor antibiotics, plant alkaloids, hormones and hormone antagonists.

Nursing issue: Administration by several routes depending on the drug being administered, as well as on the tumor type and location.

Overview on burns : Thermal injury and its sequelae are often the cause of personnel and family tragedies. The wide use of electric energy and ionizing radiation in scoence and technology has contributed to the frequency of burns. Many survivors become invalids with permanent loss of working ability.

The treatment of burns: Prevention is the best form of attacking the problems of burns. First aid is the first line of defense.

A perspective on burns in Asia: It can be safely stated, without fear of contraction that the majority of women spend most of their working hours in the kitchen. The commonest form of burn is that due to droplets of hot oil from a frying pan; next come scalds due to hot water, milk or steam from pressure cooker.

The pathophysiological basis of first aid in burns: All the skin that is burnt is not uniformly burnt. Since heat reaches the deeper layer of skin by conduction. Partially damaged skin heals spontaneously. Full thickness skin damage requires resurfacing with skin graft. Rapid cooling not only prevents further damages but helps to revive moribound cells. Water is a good conductor of heat. The application of cold water at the burned area is very effective and safe method of rem.

Plan of action

Wound care

Placing the scar

	use of natural lines
	placing the scar where it will not visible
	use of Z-plasty

Preparation of the wound

Stitchraft

	suture material
	needle
	instrument

Post operative care

	dressing
	subsequent support of the wound

Haematoma

Keloids and Hypertrophic scars

Free skin grafts

whole skin grafts

split skin grafts

Flaps

General surgery

	Traumatic skin loss
	Infective skin loss
	Postsurgical skin loss

A group of doctors including Dr. Panan (maxillofacial surgeon) participated for this lecture and discussed with the expert and Prof. Yongyudh Vajaradul on their problems on using tissue allografts.

Visited Ramathibodi hospital with the expert to see a plastic surgery on pinna reconstruction using rib cartilage.

Surgery details:

Patient was under supine position. Cleaned the incision site and defected ear lobe with alcohol and povidone iodine. The surgeon cleaned the cartilage and cut into required size and shape. A model of exact size of allograft was prepared using a piece of cardboard. Using this model, drew the incision line. Local anesthesia was injected along the incision line. Incision was done alone the line and placed the two pieces of cartilage in the correct position. Then sutured along the incision line.

The surgeon explained that after three months second operation is to be done to lift up the ear lobe.

Lecture topic: Radiation sterilization and tissue preservation

	need for sterilization
	sterilization as a concept
	comparison of sterilization methods
	radiation sterilization
	electromagnetic radiation
	particulate radiation
	dosimetry
	advantages of radiation sterilization
	effect of radiation on microbes
	radiobiological damage
	measuring the effect of radiation on microbes
	D10 value
	Bioburden estimation
	Sterility test
	Sterility Assurance Level
	Inactivation of HIV by radiation

Tissue preservation

	donor screening
	proper processing
	cryopreservation
	freeze drying and its principals

Presentation by BBC staff

	tumor and treatment – Ms. Rthathai
	Co60 Gamma cell – Ms. Jirapa
	Hydroxyapetite implant – Mr. Sahachart
	Giant Cell Tumor – Ms. Tanyawan
	ISO standards – Mr. Pisit

Examination conducted by the expert

discussion on answers for the exam.

Presentation of mini research proposals by fellows.

Final discussion with the expert, and Prof. Vajaradul on problems in tissue banking.

Lecture from Mr. Reyas on Management Principles

	definition for management
	management process
	need for principles of management
	advantage of planing
	decision making
	organization and delegation
	co-ordination
	communication
	centralization
	Management control
	Committees
	Leadership

Behavioral Science

	Social system
	Motivation
	Motivational features
	Job satisfaction
	Benefits of job satisfaction studies
	Types of recovery
	Climate and organizational behavior
	Elements of a favorable climate
	Measuring climate
	Leadership
	Employee participation
	Benefits of participation
	Progress for participation
	Quality of work life
	Employee communication
	Stress and counseling
	Causes of stress
	Maladjusted workers

Personnel management

	definition
	importance of personnel policies
	specific procedures and programs of personnel management

 

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