BMJ case reports
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Nasogastric tube insertion is a common clinical procedure carried out both by doctors and other paramedical personnel. Misplacement of the nasogastric tube into the tracheobronchial tree is not uncommon. ⋯ Laryngospasm is not uncommon in anaesthetic practice; however, reports of recurrent laryngospasm are very sparse. We report a case of misplaced nasogastric tube causing recurrent laryngospasm.
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Acute appendicitis is one of the most common conditions requiring emergency surgery. However, acute appendicitis presenting with left lower quadrant abdominal pain is extremely rare. ⋯ The malpositioned inflamed appendix was clearly identified in the left side of the abdomen, with the characteristic CT findings of uncomplicated intestinal malrotation. Left-sided acute appendicitis should be considered in the differential diagnosis of young patients presenting with left lower quadrant pain, in order to avoid delay in diagnosis and guide the surgical intervention.
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Case Reports
Striking temporally dynamic ECG changes associated with recurrent chest pain in a case of myopericarditis.
A 33-year-old man without medical history or cardiovascular disease risk factors presented with recurrent progressively worsening chest pain that had been preceded by few days of flu like illness. His initial ECG and troponin rise supported the diagnosis of myopericarditis for which he was treated with aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) with good response initially. He later on developed severe recurrent chest pain and became tachycardic and hypotensive. ⋯ The patient did well on conservative management with NSAIDs. He did not undergo urgent coronary angiography which would not have offered the patient any clinical benefit at the time and would have put him at procedural risk unnecessarily. The diagnosis of myopericarditis was confirmed retrospectively with typical features on cardiovascular magnetic resonance.