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Biomedical subjects

M R Veen

Publications and source records attributed to M R Veen.

10 recordsLinked to original sources
PubMed1999

A comparative study of blood and bone marrow cultures in cadaveric bone donation.

The results of blood cultures taken from cadaveric bone donors were compared with bone marrow and also swab cultures of the procured grafts. In eight of the 95 donors evaluated, pathogenic micro-organisms were detected in the blood sample. In two, identical micro-organisms were cultured from the blood and bone marrow sample whilst the swab cultures were negative. Considering the low sensitivity of the swab culture, the organisms detected in the blood culture were likely to have spread haematogenously and considered to be present in the explanted grafts. Bacteriological screening of bone donors is extremely important since the transmission of micro-organisms via an allograft can lead to serious complications in the recipient. Positive blood cultures provide important information on the presence of pathogenic micro-organisms in grafts obtained from cadaveric bone donors and are therefore essential in deciding whether a graft is bacteriologically acceptable for transplantation.

Blood↗
PubMed1999

Recording and classification of complications in a surgical practice.

OBJECTIVE: To document the incidence and outcome of complications in the department of surgery. DESIGN: Retrospective study. SETTING: District hospital, The Netherlands. SUBJECTS: 7455 patients operated on between 1 January 1993 and 31 December 1995. MAIN OUTCOME MEASURES: Documentation and outcome of complications (defined as "every unwanted development in the illness of the patient or in the treatment of the patient's illness that occurs in the clinic"). RESULTS: 1078 complications were recorded after 8130 operations (13%), 337 (33%) of which had no long term effects. 175/1078 (16%) required reoperation, and in 134 of these (77%) an error in management or surgical technique was responsible for the complication. 6 patients were irreversibly harmed and of the 141 patients who died, 11 had evidence of some sort of error. CONCLUSIONS: Audit of complications is necessary to improve practice in a surgical department, and weekly morbidity and mortality meetings are a good opportunity for learning about them.

Humans↗
PubMed1997

Contamination of bone allografts: analysis of incidence and predisposing factors.

We analysed the bacterial contamination of 1999 bone allografts retrieved from 200 cadaver donors under sterile operating conditions. The effect of various factors on the relative risk of contamination was estimated using a multiple logistic regression model. Organisms of low pathogenicity were cultured from 50% of the grafts and of high pathogenicity from 3%. The risk of contamination with low pathogenic organisms (mainly skin commensals) increased by a factor of 1.6 for each member added to the procurement team. The risk of contamination with high pathogenic organisms (mainly contaminants from the gastrointestinal tract) was 3.4 times higher in donors with a traumatic cause of death and 5.2 times higher in those with a positive blood culture. Preceding organ procurement did not significantly influence the risk of contamination. Rinsing the graft with an antibiotic solution was not an effective decontamination method. The major source of contamination is exogenous and is strongly influenced by the procurement team. Contamination from endogenous sources can be controlled by donor selection. We discuss methods that can be used to decrease contamination and the rate of discarding of bone allografts.

Anti-Bacterial Agents↗
PubMed1995

[5-year experience with a central bone bank].

Since December 1988 the Leiden Bone Bank Foundation, in cooperation with the BIS Foundation, makes allogeneic bone and related soft tissue available for transplantation. Bone banking has become a scientifically high level medical activity in which international standards are established in order to provide safe and effective allografts. Careful donor selection and extensive laboratory testing are the cornerstones for the prevention of disease transmission. In the first 5 years of the existence of the Leiden Bone Bank 450 deep frozen massive bone allografts, of which 221 osteoarticular and intercalary allografts, were shipped to different clinics inside and outside the Netherlands. Furthermore, 322 deep frozen soft tissues, 1877 units of freeze dried bone grafts and 5629 units of demineralized grafts were distributed. The number of transplants with allogeneic bone and related soft tissue from the Leiden Bone Bank increased each year by at least 30% Bone and related soft tissue allografts were used in orthopaedic surgery, neurosurgery and maxillofacial surgery. There are no known cases of transmission of infectious diseases by grafts distributed by the Leiden Bone Bank.

Bone Transplantation↗
PubMed1994

Sensitivity and negative predictive value of swab cultures in musculoskeletal allograft procurement.

Seventy-five fibular specimens were obtained from postmortem donors using aseptic surgical techniques. All specimens were swabbed following the same technique as routinely used for retrieved musculoskeletal grafts. After swabbing, the specimens were placed in BHI-culture medium. Three different protocols were subsequently followed: (1) culture of the entire bone specimen in BHI-culture medium, (2) culture of the swab incubated on blood agar and chocolate plates, and (3) culture of the swab in BHI-culture medium. A control group included 20 sterilized bone specimens that were cultured entirely in BHI-culture medium according to Protocol 1. The sensitivity and negative predictive value were found to be 10% and 9% in Protocol 2 and 13% in Protocol 3. These findings imply that swab cultures are inadequate to detect bacterial contamination of musculoskeletal allografts in all cases. However, the instances of infection after transplantation of allografts bacteriologically screened according to Protocols 1 and 2 do not exceed those reported in other similar series. This suggests an acceptable bioburden.

Bacteria↗
PubMed1991

[The use of allogeneic bone and tendon tissue from a central bone bank].

During the period January 1989 to December 1990 the use of bone and related soft tissue allografts from our bone bank was reviewed retrospectively. Data were complete for 278 patients, who received 403 allografts in total. Forty-nine patients were transplanted with a massive deep frozen bone allograft, 41 patients received a deep frozen soft tissue allograft, while 313 units of freeze dried bone allografts were transplanted into 188 patients. Massive deep-frozen bone allografts were used mainly in patients with bone tumours, fibrous dysplasia of the neck of the femur and for revision arthroplasty. Soft tissues were used mainly for reconstruction of ruptured cruciate ligaments. Freeze dried bone allografts such as cancellous chips as well as cortical cancellous chips were used for spinal fusion, arthroplasty, treatment of pseudarthrosis, fractures, tumours and fibrous dysplasia, and in maxillofacial defects. Cancellous blocks were used specifically for spinal fusion. Demineralized cortical dust was used mainly in maxillofacial surgery.

Bone Diseases↗