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Tiny scope finds difficult cancers deep inside the body

Tue, 13 Jul 2010 00:00:00 EDT

Confocal microscopes can generate high-resolution images of hard to reach organs in real time, and spot cancer at a curable stage.

The most preventable cancer is among the most common

Mon, 28 Jun 2010 00:00:00 EDT

Before you lie in the sun without your sunscreen this summer, consider that cases of melanoma, the most serious form of skin cancer, are rising significantly.

Fifty of New York’s best doctors are here at Yale

Thu, 10 Jun 2010 00:00:00 EDT

New York magazine’s 2010 top doctors list includes 50 Yale Medical Group physicians—practicing in 36 specialties, from dermatology to medical oncology.

Tackling colitis and Crohn's disease in one highly specialized visit

Wed, 9 Jun 2010 00:00:00 EDT

A gastroenterologist and a colorectal surgeon seeing patients together eliminates long waits, and results in better and timely treatments.

Two pediatric subspecialties are among U.S. News’ best

Wed, 9 Jun 2010 00:00:00 EDT

Yale-New Haven Children's Hospital is among the best in the nation for two of its subspecialties in new rankings published by U.S. News & World Report.

HIV-infected drug users risk other health problems

Wed, 9 Jun 2010 00:00:00 EDT

(July 2010) A Yale University study of the health problems of people infected with HIV reveals that those who also have substance abuse problems are at greater risk for other serious illnesses than those who do not— primarily because the substance abuse leads to reduced access and adherence to life-prolonging antiretroviral treatment (ART).

The researchers recommend that integrated treatment options be developed to directly address drug use and underlying mental illness so that HIV treatment can be managed more effectively. Despite daunting challenges, researchers say, effective treatments are now available to successfully manage these patients if stigma is reduced and resources leveraged to provide treatment. The study will be published in The Lancet.

According to the Yale researchers, these complications are also compounded by a number of secondary conditions such as viral hepatitis, tuberculosis, bacterial infections, and renal and cardiovascular disease.

Effective treatments for substance abuse and HIV are known, but these treatments are insufficiently available. Even where they are, HIV-infected drug users are often excluded from antiretroviral treatment, the researchers say.
“The number and range of these concurrent disorders complicates diagnosis and treatment. They must be addressed all at once, preferably in an integrated approach, in order to achieve health outcomes on a par with those who do not use drugs,” says Yale Medical Group physician Frederick L. Altice, MD, lead author and director of clinical and community research for the Yale University AIDS Program. He notes that injection drug use especially poses severe challenges.

Another issue, the team writes, is that drug and alcohol dependence are associated with decreased access to and use of health care and reduced likelihood of being prescribed antiretroviral therapy.

Altice’s team recommends evidence-based treatment that can improve the psychological and physiological problems that perpetuate the “often unstable” life of HIV-infected and drug-dependent people. These include a range of interventions, such as counseling, contingency management, supervised therapy, medication-assisted therapy and integrated health services delivery, note the researchers.

The team also found that incarceration is detrimental to HIV-infected drug users because it makes them more susceptible to illnesses such as drug-resistant tuberculosis and other infections associated with contained settings.
“Once effective treatment is initiated, successful transitional programs and continuity of care after release to the community are desperately needed,” Altice said.

Gender impacts mental illness in children of alcoholics

Wed, 9 Jun 2010 00:00:00 EDT

(July 2010) A new Yale University study reveals that gender plays an important role in determining the risk of specific psychiatric illnesses in children of alcoholics. The gender of both the alcoholic parent and the child were key factors in the types of disorders that develop.

The full paper will be published in the October, 2010 issue of Alcoholism: Clinical & Experimental Research.

Parental alcoholism was associated with an overall higher prevalence of psychiatric disorders, regardless of the gender of the children. But when broken down by specific illness, gender-related differences became clear:
• Alcohol abuse: stronger association between alcoholic fathers and their daughters
• Mania, nicotine dependence, alcohol abuse and schizoid personality disorder: stronger association between alcoholic mothers and their daughters
• Mania: stronger association between alcoholic fathers and their sons
• Panic disorder: stronger association between alcoholic mothers and their sons

In addition, researchers found that in general, there was a higher prevalence of any mood or anxiety disorder such as major depression among females, while conduct disorders, pathological gambling, substance abuse and personality disorders were more common among males.

Corresponding author Peter T. Morgan, M.D., associate professor of psychiatry at Yale School of Medicine, explained why these associations may exist. “There are many possible contributing factors to these findings, and given the different interactions we observed, a single explanation is unlikely. However, the greater impact of maternal alcoholism on the various psychological problems in female offspring may be related in part to the relative absence of a stable female role model when growing up. Supporting this idea is our finding that female offspring of alcoholic mothers showed a pattern of increased odds for the type of disorders that are typically more prevalent in men.”

Researchers hope this study may influence efforts to care for children of alcoholics. Morgan said, “It’s been clear for a long time that children of alcoholics are at greatly increased risk for psychiatric disorders. Being able to describe who is most at risk for what disorder and under what circumstances may guide efforts at efficient prevention, recognition, and treatment.”

Other authors are Rani A. Desai and Marc N. Potenza of the Department of Psychiatry and Child Study Center, Yale School of Medicine.

Continuous monitoring improves blood sugar control

Wed, 9 Jun 2010 00:00:00 EDT

(June 2010) A year-long clinical trial by Yale University and other institutions showed that treatment with sensor-augmented insulin pumps, which include a system of continuous glucose monitoring, leads to significantly greater control of type 1 diabetes than a daily regimen of multiple insulin injections. Results of the STAR 3 trial were presented at the annual meeting of the American Diabetes Association, and appear online in the New England Journal of Medicine.

The multicenter, randomized and controlled trial compared the efficacy of both methods in 485 adult and child patients. At one year, average plasma glucose concentrations – which indicate blood sugar control in type 1 diabetes – were significantly lower for both adults and children in the pump-therapy group, compared with the injection-therapy group.

Improved glycemic control can reduce the complications associated with type 1 diabetes, but maintaining that control is challenging, particularly for children. “This technology of combining insulin pumps and continuous glucose monitoring can help patients safely reach their goal of glycemic control, while minimizing the risk of severe hypoglycemia and weight gain,” says William Tamborlane, MD, section chief of pediatric endocrinology for Yale Medical Group, a member of the steering committee of the study and second author on the paper.

Recent studies on the effectiveness of using insulin pumps or continuous glucose monitoring devices alone showed that among adults, they improve blood sugar levels better than daily injections. But results in children have been inconsistent. In this new study by Yale and other institutions, sensor-augmented pump therapy, which integrates the two technologies and allows patients and doctors to monitor treatment and response through internet-based software, benefited children as significantly as adults.

“Sensor-augmented pump therapy will be helpful to all patients with type 1 diabetes who were until now unable to effectively control their blood sugar levels, but it will be particularly beneficial for younger patients,” said Jennifer Sherr, MD, who, along with Stuart A. Weinzimer, MD, and Lori Carria, who were the other Yale investigators involved in the study.

The study was supported by Medtronic, Novo Nordisk, LifeScan, Bayer Healthcare and Becton Dickinson. It was also partly funded by the Yale Clinical and Translational Science Award (CTSA) grant from the National Center for Research Resources at the National Institutes of Health.

Tamborlane reports receiving consulting fees from Medtronic Diabetes as a member of the Diabetes Advisory Board.

Yale scientists implant regenerated lung tissue in rats

Tue, 8 Jun 2010 00:00:00 EDT

(June 2010) A Yale University-led team of scientists reports that it has achieved an important first step in regenerating fully functional lung tissue that can exchange gas, which is the key role of the lungs. Their paper appears in the June 24 issue of Science Express.

Lung disease accounts for around 400,000 deaths each year in the United States. Lung tissue is difficult to regenerate because it does not generally repair or regenerate beyond the microscopic level. The only current way to replace damaged adult lung tissue is to perform lung transplantation, which is highly susceptible to organ rejection and infection and achieves only 10 to 20 percent survival at 10 years.

The Yale team’s goal was to see if it was possible to successfully implant tissue-engineered lungs, cultured in vitro, that could serve the lung’s primary function of exchanging oxygen and carbon dioxide. They took adult rat lungs and first removed their existing cellular components, preserving the extracellular matrix and hierarchical branching structures of the airways and vascular system to use later as scaffolds for the growth of new lung cells.

They then cultured a combination of lung-specific cells on the extracellular matrix, using a novel bioreactor designed to mimic some aspects of the fetal lung environment. Under the fetal-like conditions of the bioreactor, the cells repopulated the decellularized matrix with functional lung cells. When implanted into rats for short intervals of time (45-120 minutes), the engineered lungs exchanged oxygen and carbon dioxide similarly to natural lungs.

Yale Medical Group anesthesiologist Laura Niklason, MD, PhD, lead author of the study, says, “We succeeded in engineering an implantable lung in our rat model that could efficiently exchange oxygen and carbon dioxide, and could oxygenate hemoglobin in the blood. This is an early step in the regeneration of entire lungs for larger animals and, eventually, for humans.”

The team found that the mechanical characteristics of the engineered lungs were similar to those of native tissues and, when implanted, were capable of participating in gas exchange. “Seeded and cultured epithelium displays remarkable hierarchical organization within the lung matrix, while seeded endothelial cells efficiently repopulate the lung vasculature, Niklason said.

The Yale team says this is an important first step, but a great deal more research must be done to see if fully functional lungs can be regenerated in vitro, implanted and sustained in their functioning. Niklason says that for this technology to be applicable to patients, it is likely that years of research with adult stem cells will be needed to repopulate lung matrices and produce fully functional lungs.

Sweeping changes are recommended for American diet

Tue, 8 Jun 2010 00:00:00 EDT

(June 2010) In the face of soaring obesity rates in the United States, a national dietary advisory committee that includes a Yale University professor is recommending sweeping changes to the American diet: a reduction in overall calorie consumption, drastically reducing the intake of sodium and added sugars, and shifting diets to more seafood and plant-based foods.

The report, prepared by the 2010 Dietary Guidelines Advisory Committee, will be forwarded to the U.S. Department of Agriculture and the U.S. Department of Health and Human Services and will become the foundation for updated federal guidelines on nutrition, diet and health. The recommendations also could influence existing food assistance programs such as school lunches and food stamp and industry regulation.

Rafael Pérez-Escamilla, a professor at the Yale School of Public Health, is among the 13 national experts who worked for the past two years on the comprehensive evaluation and review of existing federal nutrition guidelines and put forth the proposed changes. The dietary guidelines are updated every five years.

As many as two-thirds of adults and one-third of children are considered to be either overweight or obese in the United States, which results in a range of health problems and chronic diseases. If followed, the committee’s recommendations could have a significant effect on the health and waistlines of Americans, Pérez-Escamilla said.

With the support of the current administration, including first lady Michelle Obama, who has used the committee’s preliminary findings as the foundation of her own anti-obesity initiatives, and advances in nutritional science, there is a real chance to reverse current trends.“There is no doubt in my mind that this is a historic opportunity,” Pérez-Escamilla said. “We put forward the best science.”

Specifically, the advisory committee recommends:

Reduce maximum recommended daily sodium consumption from 2,300 mg to 1,500 mg for adults. This will require the cooperation of the food industry as the majority of sodium intake comes from processed foods.
Shift to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk products while consuming only moderate amounts of lean meats, poultry and eggs.
Significantly reduce the intake of foods containing added sugars and solid fats. Solid fats should be less than 10 percent of calorie intake. Foods with these components have excess calories and few, if any nutrients.
Meet the 2008 Physical Activity Guidelines for Americans.

Doctors team up to help girls take control of PCOS

Mon, 7 Jun 2010 00:00:00 EDT

A staff of experts at the Yale Adolescent PCOS (Polycystic Ovarian Syndrome) Program are diagnosing and treating the disorder early, keeping patients healthy.

More heart patients survive, but more are readmitted

Fri, 4 Jun 2010 00:00:00 EDT

While their in-hospital and 30-day mortality has decreased, the number of heart failure patients readmitted or discharged to a skilled nursing facility has increased.

Yale Medical Group mourns the loss of Joseph Slade, MD

Tue, 1 Jun 2010 00:00:00 EDT

Yale Medical Group orthopaedic surgeon Joseph Slade III, MD, who died in May, was a unique contributor to the field of hand surgery.

Study is a breakthrough for Tourette syndrome

Wed, 26 May 2010 00:00:00 EDT

A major breakthrough uses behavioral therapy to reduce motor and vocal tics in children with Tourette syndrome.

Guidelines for heart device decisions at end of life

Mon, 24 May 2010 00:00:00 EDT

New guidelines are available for doctors making decisions about heart-assisting devices at the end of life.