Gossips Which Experts Claim Crizotinib Takes To A End, Here Are My Follow-Up
  • This raises the question of whether serial photographic records filed within the patient's case notes might have rendered the rapidly progressive

    nature of the condition more readily apparent. Second the surgical team when confronted with a confused and incoherent elderly patient, mistakenly assumed that there was an underlying cognitive impairment and hence rationalised the possibility of an inadvertent burn. While his previously independent status was noted in his clerking history, this was overruled by the presumed diagnosis. Rather than compartmentalising the patient's issues into ��medical�� and ��surgical���� a more collaborative approach between medical and surgical teams might have prevented this ��snapshot�� error where the context of the patient's previous meprobamate clinical course was neglected. Third, only a medical student who had initially clerked the patient was able to claim full continuity of care. She briefly questioned the diagnosis of a burn, but the opportunity

    to utilise her knowledge of the patient's presenting history and the appearance of his arm, was overlooked. Learning points This case highlights the importance of detailed, accurate handovers and case note documentation, to ensure that clinicians subsequently reviewing the patient for the first time can appreciate a clinical deterioration. Clinicians should be wary of assuming pre-existing cognitive impairment in the elderly and infirm. Collateral history is invaluable. Clinicians should readily reconsider their diagnoses if new or discordant information emerges. Clinical photographs may be useful to objectively document appearances within the case notes. Patients�� consent should be sought where possible. Footnotes Contributors: RV wrote the case report. AM reviewed the manuscript, contributed to a literature review, suggested amendments to the manuscript and approved the final version. PC reviewed the manuscript, made amendments and approved the final version. Competing interests: None. Patient consent: Obtained. Provenance and peer review: Not commissioned; externally

     peer reviewed.""A 23-year-old woman presented to the primary care clinic with a 10-month history of progressive left facial asymmetry, sinking of left eye and deepening of the superior palpebral sulcus. She denied headache, periocular pain, double vision, scalp or face tenderness. Her medical history was negative for sinus tumours, trauma, surgery or allergic rhinosinusitis. Physical examination showed left-sided enophthalmos with hypoglobus, sunken sulcus appearance to the left upper lid and left-sided deviation of the nasal septum with no obvious infection, the rest of ophthalmic examination was intact. CT of the orbits and sinuses (figure 1) revealed left enophthalmos, downward retraction of the orbital floor, total mucosal opacification and reduced volume of the left maxillary sinus. Diagnosis of silent sinus syndrome was made.

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