bsugis spring meeting march 18, 2014 lieven depypere, willy coosemans, georges decker, hans van...
TRANSCRIPT
![Page 1: BSUGIS Spring Meeting March 18, 2014 Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux Department of thoracic surgery,](https://reader038.vdocuments.us/reader038/viewer/2022110321/56649ce45503460f949b161c/html5/thumbnails/1.jpg)
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
![Page 2: BSUGIS Spring Meeting March 18, 2014 Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux Department of thoracic surgery,](https://reader038.vdocuments.us/reader038/viewer/2022110321/56649ce45503460f949b161c/html5/thumbnails/2.jpg)
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
![Page 3: BSUGIS Spring Meeting March 18, 2014 Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux Department of thoracic surgery,](https://reader038.vdocuments.us/reader038/viewer/2022110321/56649ce45503460f949b161c/html5/thumbnails/3.jpg)
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)
![Page 4: BSUGIS Spring Meeting March 18, 2014 Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux Department of thoracic surgery,](https://reader038.vdocuments.us/reader038/viewer/2022110321/56649ce45503460f949b161c/html5/thumbnails/4.jpg)
BSUGIS Spring Meeting March 18, 2014
PETCT
![Page 5: BSUGIS Spring Meeting March 18, 2014 Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux Department of thoracic surgery,](https://reader038.vdocuments.us/reader038/viewer/2022110321/56649ce45503460f949b161c/html5/thumbnails/5.jpg)
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
![Page 6: BSUGIS Spring Meeting March 18, 2014 Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux Department of thoracic surgery,](https://reader038.vdocuments.us/reader038/viewer/2022110321/56649ce45503460f949b161c/html5/thumbnails/6.jpg)
BSUGIS Spring Meeting March 18, 2014
• The patient was sheduled for neo-adjuvant therapy
![Page 7: BSUGIS Spring Meeting March 18, 2014 Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux Department of thoracic surgery,](https://reader038.vdocuments.us/reader038/viewer/2022110321/56649ce45503460f949b161c/html5/thumbnails/7.jpg)
BSUGIS Spring Meeting March 18, 2014
Q2.2 what neo-adjuvant therapy?
• Chemotherapy• Chemoradiotherapy
![Page 8: BSUGIS Spring Meeting March 18, 2014 Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux Department of thoracic surgery,](https://reader038.vdocuments.us/reader038/viewer/2022110321/56649ce45503460f949b161c/html5/thumbnails/8.jpg)
BSUGIS Spring Meeting March 18, 2014
Q2.3 functional assessment
• Before neo-adjuvant therapy• After neo-adjuvant therapy• Before and after neo-adjuvant therapy
![Page 9: BSUGIS Spring Meeting March 18, 2014 Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux Department of thoracic surgery,](https://reader038.vdocuments.us/reader038/viewer/2022110321/56649ce45503460f949b161c/html5/thumbnails/9.jpg)
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
![Page 10: BSUGIS Spring Meeting March 18, 2014 Lieven Depypere, Willy Coosemans, Georges Decker, Hans Van Veer, Philippe Nafteux Department of thoracic surgery,](https://reader038.vdocuments.us/reader038/viewer/2022110321/56649ce45503460f949b161c/html5/thumbnails/10.jpg)
BSUGIS Spring Meeting March 18, 2014
Transthoracic heart ultrasound: • adjacent structure on the aortic valve
without hemodynamic problems: endocarditis?
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BSUGIS Spring Meeting March 18, 2014
Q2.5 Next step?
• Antibiotics further• Stop antibiotics and start eventually after
new cultures• Switch antibiotics• Cardiac surgery
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BSUGIS Spring Meeting March 18, 2014
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