Faculty Bibliography

Pancreatic Divisum (PD) is the most common congenital variation of pancreatic duct anatomy, arising when embryological ventral and dorsal endodermal buds fail to fuse ("classic" PD) or only fuse partially ("incomplete" PD). Most patients with PD are asymptomatic, but a subgroup of patients can present with recurrent bouts of pancreatitis. While alcohol and gallstones are the common causes of acquired pancreatitis, PD is a congenital cause of pancreatitis. It is usually suspected in younger individuals with recurrent pancreatitis who also have a family history. Here, we present a rare case of PD in an older individual who presented with recurrent pancreatitis. He underwent cholecystectomy for suspected gallstone pancreatitis but continued to have episodes of pancreatitis. He had a history of alcohol abuse but denied use in the last one year. PD was detected later as the cause. Recurrent pancreatitis led to the development of a pseudocyst and pancreaticopleural fistula (PPF). Medical management improved the pseudocyst and PPF.

Aim/UNASSIGNED:To assess the effect of treating chronic hepatitis C virus (HCV) infection with direct acting antiviral drugs (DAAs) on glycemic control in patients with concomitant diabetes mellitus (DM). Methods/UNASSIGNED:We performed a retrospective case-control study in a viral hepatitis ambulatory clinic in Shreveport, Louisiana, during the period 11/01/2014 to 12/31/2017. All the clinic patient ages 18 years and above with treatment-naïve/biopsy-proven chronic hepatitis C and DM (hemoglobin A1C level ≥ 6.5%) who were eligible for treatment were included in the study. Of 118 such patients, 59 were treated with oral DAAs for 8-12 weeks with the goal of achieving a sustained virologic response (SVR). A control group of 59 patients did not receive treatment for their hepatitis C and was followed in the clinic. Patients in the control group did not receive treatment either due to insurance issues or refusal of hepatitis C treatment. Results/UNASSIGNED:< 0.0001 vs. the treatment group, which had a mean HbA1C decrease of 0.9 ± 0.2%). Conclusion/UNASSIGNED:This controlled study demonstrated that treatment of chronic hepatitis C with DAAs results in statistically significant and meaningful reductions in hemoglobin A1C levels in patients with coexisting diabetic mellitus if a SVR is achieved.

In acute ischemic stroke, early recanalization of the occluded artery is crucial for best outcome to be achieved. Recanalization aims at restoring blood flow to the ischemic tissue (reperfusion) and is achieved with pharmacological thrombolytic drugs, endovascular thrombectomy (EVT) devices, or both. The introduction of modern endovascular devices has led to tremendous anatomical and clinical success with rates of substantial reperfusion exceeding 80% and proven clinical benefit in patients with anterior circulation large vessel occlusions (LVOs). However, not every successful reperfusion procedure leads to the desired clinical outcome. In fact, the rate of non-disabled outcome at 3 months with current EVT treatment is ~1 out of 4. A constraint upon better outcomes is that reperfusion, though resolving ischemic stress, may not restore the anatomic structures and metabolic functions of ischemic tissue to their baseline states. In fact, ischemia triggers a complex cascade of destructive mechanisms that can sometimes be exacerbated rather than alleviated by reperfusion therapy. Such reperfusion injury may cause infarct progression, intracranial hemorrhage, and unfavorable outcome. Therapeutic hypothermia has been shown to have a favorable impact on the molecular elaboration of ischemic injury, but systemic hypothermia is limited by slow speed of attaining target temperatures and clinical complications. A novel approach is endovascular delivery of hypothermia to cool the affected brain tissue selectively and rapidly with tight local temperature control, features not available with systemic hypothermia devices. In this perspective article, we discuss the possible benefits of adjunctive selective endovascular brain hypothermia during interventional stroke treatment.