Upload
garry-harmon
View
215
Download
0
Tags:
Embed Size (px)
Citation preview
BSUGIS Spring Meeting March 18, 2014
Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux
Department of thoracic surgery, University Hospitals Leuven, Belgium
2nd Interactive Case
BSUGIS Spring Meeting March 18, 2014
Male, 79 y
Medical History:• Arterial hypertension• Hiatus hernia with short segment Barrett• Cervical laminoforaminotomt C7-Th1 right.
• Brother died from pancreatic cancer
BSUGIS Spring Meeting March 18, 2014
Clinical presentation:• ASA 2, 177cm, 106kg• August 2014: dysphagia for solid food
Work up:• Diagnosis of EG-juction carcinoma cT3N1M0,
adeno with signet cell differentiation• (upper GI endoscopy, endoscopic US with
punction of lymph node, CT thorax/abdomen, FDG-PET)
BSUGIS Spring Meeting March 18, 2014
PETCT
BSUGIS Spring Meeting March 18, 2014
Q2.1 Would you do a staging laparoscopy as part of the diagnostic work-up?
• Yes• Yes, with insertion of a feeding jejunostomy• No
BSUGIS Spring Meeting March 18, 2014
• The patient was sheduled for neo-adjuvant therapy
BSUGIS Spring Meeting March 18, 2014
Q2.2 what neo-adjuvant therapy?
• Chemotherapy• Chemoradiotherapy
BSUGIS Spring Meeting March 18, 2014
Q2.3 functional assessment
• Before neo-adjuvant therapy• After neo-adjuvant therapy• Before and after neo-adjuvant therapy
BSUGIS Spring Meeting March 18, 2014
• Shortly after start of TPN: fever
with diagnosis of catheter sepsis with acineto-bacter sp, staphylococcus epidermidis, capitis and schleiferi. CVL was removed, vancomycine-piperacilline-tazobactam started and nasoduodenal feeding tube placed. • After 3 weeks vancomycine-piperacilline
Tazobactam: still fever:• Blood culture negative, urine culture negative,
BAL: candica, rare
BSUGIS Spring Meeting March 18, 2014
Transthoracic heart ultrasound: • adjacent structure on the aortic valve
without hemodynamic problems: endocarditis?
BSUGIS Spring Meeting March 18, 2014
Q2.5 Next step?
• Antibiotics further• Stop antibiotics and start eventually after
new cultures• Switch antibiotics• Cardiac surgery
BSUGIS Spring Meeting March 18, 2014
…curious about the evolution?
Register here !