Scintigraphy,Ultrasound and CT Scanning of the Liver ,

Isotope examination of the liver depends on the functional activity of the liver phagocytes, while ultrasound and CT scanning display the anatomical structure. Cold areas on an isotope scan may be due to impaired function or space-occupying lesions. The method is nonspecific and does not differentiate between cysts, abscesses and metastases. Both ultrasound and CT scanning can differentiate space-occupying lesions with a high degree of accuracy so that both techniques can be used to improve the accuracy and specificity of the radioisotope examination. CT scanning of the liver is limited by relatively slow data acquisition and the small differences in X-ray absorption within soft tissues unless contrast agents are used. In comparison, ultrasonic data are rapidly collected and displayed and liver consistency is imaged without contrast media or ionizing radiation. Diffuse abnormalities of the liver, such as cirrhosis, cannot be detected by CT scanning but are apparent on ultrasound examination. In addition, equipment purchase and maintenance costs for ultrasound are a fraction of those for CT scanning. Experience to date at Yale indicates that ultrasound and CT scanning are complementary and supplementary to isotope examination of the liver but that ultrasound in most patients produces better resolution and enhanced tissue differentiation at considerably less cost.     

History of the Department of Cell Biology at Yale School of Medicine, 1813-2010

The Department of Cell Biology at the Yale University School of Medicine was established in 1983. It was preceded by the Section of Cell Biology, which was formed in 1973 when George E. Palade and collaborators came to Yale from the Rockefeller University. Cell Biology at Yale had its origins in the Department of Anatomy that existed from the beginning of classes at the Medical Institution of Yale College in 1813. This article reviews the history of the Department of Anatomy at Yale and its evolution into Cell Biology that began with the introduction of histology into the curriculum in the 1860s. The formation and development of the Section and Department of Cell Biology in the second half of the 20th century to the present time are described. Biographies and research activities of the chairs and key faculty in anatomy and cell biology are provided.     

"C.-E.A. Winslow and the early years of public health at Yale, 1915-1925"

C.-E.A. Winslow was the first chairman of the Department of Public Health at the Yale University School of Medicine. This paper considers the development and changing agenda of his department, the structure of Yale University, and the maturation of public health as a discipline. Winslow's successes and failures are discussed as they relate to Yale and external societal influences.     

Abraham Flexner and the development of the Yale School of Medicine. 1999

Abraham Flexner first toured the Yale University School of Medicine in preparation for his report of 1910, but it was just the beginning of his relationship with the school. While his review of Yale in his report was generally favorable, he mentioned several shortfalls that needed to be improved to make the school acceptable. Throughout the next twenty-five years, Flexner worked with Deans George Blumer and Milton C. Winternitz to improve the school's finances, infrastructure, and quality of education through his work with the Carnegie Foundation and General Education Board. Flexner has been given great accolades for his work on medical education for the country, but little mention is made of him at Yale, even though he was one of the most influential figures in the development of Yale in the last century.     

Abraham Flexner and the development of the Yale School of Medicine

Abraham Flexner first toured the Yale University School of Medicine in preparation for his report of 1910, but it was just the beginning of his relationship with the school. While his review of Yale in his report was generally favorable, he mentioned several shortfalls that needed to be improved to make the school acceptable. Throughout the next twenty-five years, Flexner worked with Deans George Blumer and Milton C. Winternitz to improve the school's finances, infrastructure, and quality of education through his work with the Carnegie Foundation and General Education Board Flexner has been given great accolades for his work on medical education for the country, but little mention is made of him at Yale, even though he was one of the most influential figures in the development of Yale in the last century.     

Putting together the pieces of polio: how Dorothy Horstmann helped solve the puzzle

Dr. Dorothy Horstmann, epidemiologist, virologist, clinician, and educator, was the first woman appointed as a professor at the Yale School of Medicine. Horstmann made significant contributions to the fields of public health and virology, her most notable being the demonstration that poliovirus reached the central nervous system via the bloodstream, upsetting conventional wisdom and paving the way for polio vaccines. In 1961, she was appointed a professor at Yale School of Medicine, and in 1969, she became the first woman at Yale to receive an endowed chair, which was named in honor of her mentor, Dr. John Rodman Paul. In this review, the major scientific contributions of Dr. Dorothy Horstmann will be highlighted from her more than 50-year tenure at Yale School of Medicine.     

The birth of chemotherapy at Yale. Bicentennial lecture series: Surgery Grand Round

Chemotherapy, one of the mainstays of cancer treatment today, was pioneered at Yale during World War II. Last year, two Yale surgeons, Drs. John Fenn and Robert Udelsman, sought to unearth the mystery surrounding the discovery of chemotherapy and its first use at Yale. The first chemotherapy patient is known only as JD in the literature, and without a name, date of birth, or medical record number, a search for his record seemed futile. However, persistence coupled with sheer fortune led them to JD's chart, where they found information that differed from previous accounts. The riveting personal story of JD, an immigrant patient with lymphosarcoma, was revealed for the first time by Drs. Fenn and Udelsman on January 19, 2011, at a special Surgical Grand Rounds celebrating the bicentennial of Yale School of Medicine.     

The early years of coeducation at the Yale University School of Medicine.

The Yale School of Medicine began accepting women as candidates for the degree of medicine in the fall of 1916. This decision was consistent with the trend in medical education at the time. While Yale was not the first prestigious Eastern medical school to admit women, joining Johns Hopkins (1893) and the University of Pennsylvania (1914), it was not one of the last. Columbia University College of Physicians and Surgeons admitted women a year later, but Harvard Medical School held out until 1945. The years 1916--1920 saw the number of women enrolled in medical school almost double. Yale''s decision to admit women seems to have been made with little resistance from the faculty. The final decision was made through the encouragement and financial help of Henry Farnam, a professor of economics at Yale, who agreed to pay for the women''s bathrooms. His daughter, Louise, was in the first class of women. At graduation she was awarded the highest scholastic honors, the Campbell Gold Prize. From Yale she travelled to the Yale-sponsored medical school in Changsha, China, where she became the first female faculty member, a position she held for twelve years. The impressions of Ella Clay Wakeman Calhoun, the only woman to graduate in the second class of women, are presented here. Since 1916 the Yale School of Medicine has undergone extensive physical and philosophical changes, developments in which women have participated.     

Early detection of ovarian cancer: preliminary results of the Yale Early Detection Program.

Eighty-four women at high risk for ovarian cancer by having first-degree relatives with epithelial ovarian cancer participated in a newly established, early ovarian cancer detection program at Yale University. Participants were to be evaluated with physical examinations and circulating tumor markers at entry and every six months thereafter. Endovaginal ultrasound and color Doppler flow studies were to be performed at three and nine months following entry into the program. In addition, women were encouraged to follow American Cancer Society guidelines for mammography. Stool was checked for occult blood. Endometrial sampling was offered to post-menopausal women. No participant has developed an ovarian cancer since entering the program. One woman has been diagnosed to have breast cancer. False-positive levels of circulating tumor markers (CA 125, 4/84 [4.8 percent]; lipid-associated sialic acid in plasma, 13/84 [15.5 percent]; NB/70K, 4/84 [4.8 percent]; and urinary gonadotropin fragment, 1/65 [1.5 percent]) were observed on entry into the program. Low resistive indices (less than 0.5) were documented in 8/91 (8.8 percent) ovaries studied by the color Doppler flow technique. One participant underwent a laparotomy based on a false-positive endovaginal ultrasound examination. Tests now being employed in community practice have a high likelihood of being associated with false-positive results. Therapeutic interventions based on isolated abnormal tumor markers or ultrasound studies obtained from women with family histories of ovarian cancer may lead to inappropriate surgery. It is necessary for cancer centers to develop expertise in ovarian cancer detection techniques to advise physicians in their geographic areas appropriately about the significance of the abnormal screening test.     

A Short, Informal History of the Biological Sciences at Yale University

In May 2012, Yale University’s Graduate School of Arts and Sciences held a reunion for all who have received doctorates from Yale in the biological sciences. The proceedings began with two presentations on the history of biological research at Yale: one focused on the Medical School, and the other centered on the rest of the University. This essay is a lightly edited version of my account of the history of the biological sciences outside the Medical School.     

In vitro fertilization and embryo transfer: a brief overview

The in vitro fertilization process breaks down into three essential components: induction of ovulation, fertilization of the oocyte, and development of embryos that are transferred into the uterus. Problems may arise resulting in failure at any one of these junctions. In 1984, the World Congress on In Vitro Fertilization was held, looking at 9,641 laparoscopies yielding 1,101 clinical pregnancies, with an overall pregnancy rate of 11 percent--clearly indicating that in vitro fertilization/embryo transfer (IVF/ET) was an idea whose time had come. Ovulation induction is monitored by both the use of ultrasound and daily estradiol levels, ultrasound indicating the number of oocytes that will be available for capture, and estradiol indicating in an indirect way the quality of those oocytes. It is a major aim in each patient to obtain at least four embryos, since this optimizes success rates. Ovulation induction at Yale is carried out with a high-dose human menopausal gonadotropin (HMG)/human chorionic gonadotropin (HCG) regimen. This regimen has insured us a success rate of 17 percent clinical pregnancies per laparoscopy. In the future, modification will occur in the process with cryopreservation of oocytes and embryos, and gamete manipulation. The modifications will be effected primarily to increase pregnancy rates. Research will continue mainly to delineate better biochemical markers for oocyte quality, but also to further explain the mystery of implantation.     

Yale-China association exchange programs in medical sciences: past,present, and future.

There has been a close association between Yale University and educational institutions in China for almost 80 years. Although this relationship was interrupted during the early years of the People''s Republic of China, collaboration between Yale and medical institutions in China is in the process of being resumed. The history of this collaboration and the opening phases of its resumption are described.     

Progress in complementary and alternative medicine research: Yale Research Symposium on Complementary and Integrative Medicine

Integrative Medicine at Yale and the Yale Center for Continuing Medical Education (CME) sponsored the Yale Research Symposium on Complementary and Integrative Medicine in March 2010 at the university's School of Medicine. Delivering the keynote address, Dr. Josephine P. Briggs, Director of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH), highlighted recent progress made in the field of complementary and alternative medicine (CAM).     

The Yale Plan of Medical Education: the early years

This paper considers the early years of the Yale Plan of Medical Education, which has come to be called the Yale System. It chronicles and analyzes the incremental development of the System and considers evaluations of the plan and modifications introduced over time. Also considered are external factors which influenced design and implementation. The paper covers the period of medical education at Yale from the 1920s to the early 1950s.     

Reflections of a member of the bicentennial class on the Bicentennial Symposium

This perspective piece explores what it means to be a first-year medical student at Yale School of Medicine during its bicentennial year. At first, it seemed like a hefty burden to bear. However, upon listening to Dr. Eric Kandel speak at the Bicentennial Symposium at Yale on April 28, 2011, it became clear what it means to be a part of the future of science and medicine at Yale.     

Merit and Blessing in Mainland Southeast Asia in Comparative Perspective

Merit and Blessing in Mainland Southeast Asia in Comparative Perspective. Cornelia Ann Kammerer and Nicola Tannenbaum. eds. Yale Southeast Asia Studies, 45. New Haven, CT: Yale University Southeast Asia Studies, 1996. 263 pp.     

Focus: 50 Years of DNA Repair: The Yale Symposium Reports: Early Days of DNA Repair: Discovery of Nucleotide Excision Repair and Homology-Dependent Recombinational Repair

The discovery of nucleotide excision repair in 1964 showed that DNA could be repaired by a mechanism that removed the damaged section of a strand and replaced it accurately by using the remaining intact strand as the template. This result showed that DNA could be actively metabolized in a process that had no precedent. In 1968, experiments describing postreplication repair, a process dependent on homologous recombination, were reported. The authors of these papers were either at Yale University or had prior Yale connections. Here we recount some of the events leading to these discoveries and consider the impact on further research at Yale and elsewhere.     

C.-E.A. Winslow and the later years of public health at Yale, 1940-1945

This paper is one of a series of papers in which I consider contemporary Yale medical education in general and the Yale Department of Epidemiology and Public Health in particular. It tells of the retirement in 1945 of C.-E.A. Winslow, Professor and Chairman of the Yale Department of Public Health since its inception in 1915; of the committees established by the dean of the School of Medicine and the president of the University, charged with determining the future direction of the department; and of the outcome, which, in 1945, proved favorable to Winslow's public health philosophy in contrast to the medical school's clinical needs and desires.     

Systems biology: new institute and applications

The Yale Systems Biology Institute (YSBI) sponsored its first symposium at the university's West Campus in October 2010. The symposium served to provide Yale's scientific community with a glimpse into the wide range of research at the forefront of this interdisciplinary field. YSBI was conceived less than a year ago, and the event was the perfect forum for its debut, both at Yale and in the U.S. scientific community. This article includes a brief overview of the different topics presented at the symposium, followed by a discussion of the advantages and challenges of practical application of systems biology.     

Harvey Cushing's ghosts: death and hauntings in modern medicine

The passing of Yale School of Medicine's 2010 Bicentennial occasions a moment of reflecting on the past, present, and future of medical education and research at Yale and beyond. Last June, a ribbon-cutting ceremony inaugurated the opening of the Cushing Center in the Cushing-Whitney Medical Library. Named after Harvey Cushing, an early 20th-century neurosurgeon and former Yale College alum, the dual education/exhibition space now houses hundreds of gross brain specimens constituting the Cushing Tumor Registry. Originally a personal collection, Cushing donated his numerous medical specimens, photographs, and other medical relics from his deathbed, relinquishing the brains to Yale only under the condition that a suitable space be erected to preserve the many specimens. Some 70 years later and after nearly being destroyed, Cushing's wish is fully realized: The once desiccated, hidden brains have been painstakingly restored and are now on view in the Cushing Center. The brains express Cushing's singular and spectral worldview as a surgeon, artist, athlete, soldier, book collector, and historian.