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Lecturer (IAEA Expert Mission)

3-7 July 2000




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.


Lecture topic: Historical background

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.


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:


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



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.


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

Cancer treatment:

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 and Plastic Surgery

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

Overview on Plastic Surgery

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


suture material



Post operative care


subsequent support of the wound


Keloids and Hypertrophic scars

Free skin grafts

whole skin grafts

split skin grafts


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


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


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




Management control



Behavioral Science

Social system


Motivational features

Job satisfaction

Benefits of job satisfaction studies

Types of recovery

Climate and organizational behavior

Elements of a favorable climate

Measuring climate


Employee participation

Benefits of participation

Progress for participation

Quality of work life

Employee communication

Stress and counseling

Causes of stress

Maladjusted workers

Personnel management


importance of personnel policies

specific procedures and programs of personnel management