Hiccups Research Articles

Analysis of clinical and imaging characteristics of NMOSDs patients based on the 2015 version of diagnostic criteria

Objective To analyze the clinical and imaging features of serum NMO-IgG-positive and NMO-IgG-negative Chinese patients with neuromyelitis optica spectrum disorders (NMOSDs) based on the 2015 version of diagnostic criteria. Methods Retrospective analyses of clinical and imaging data were held on 96 patients with NMOSDs (64 NMO-IgG-positive patients and 32 NMO-IgG-negative patients) who were admitted to Tangdu Hospital of the Fourth Military Medical University from January 2013 to December 2015. Results Gender ratio, age, age of onset, duration and annual relapse rate between NMO-IgG-positive and NMO-IgG-negative patients were of no significant difference. Symptoms of spinal cord involvement were most common during the first attack, with incidence rate of 48.44% (31/64) and 56.25% (18/32), respectively, for NMO-IgG-positive and NMO-IgG-negative patients, while limb numbness was most frequent. Among the first-episode optic nerve symptoms, unilateral visual loss was more common in NMO-IgG-positive patients (12/16) and bilateral visual loss was more frequent in NMO-IgG-negative patients (6/9). Intractable hiccups and vomiting suggestive of area postrema involvement was more common in NMO-IgG-positive group than that in NMO-IgG-negative group (11/18 vs 2/7), but the difference between 2 groups was not significant ( P = 0.087, 0.202). The first-episode lesions of spinal cord were most frequently located in the cervical cord in both groups [41.67% (15/36) vs 11/17]. The incidence rates of both cervicothoracic cord lesions [41.67% (15/36) vs 1/17] and spinal cord lesions ≥ 7 vertebral segments [36.11% (13/36) vs 1/17] were significantly higher in NMO-IgG-positive group than those in NMO-IgG-negative group ( P = 0.008, 0.022). The occurrence rates of intracranial lesions [90.63% (29/32) vs 14/17] and contiguous lesions involving medulla and cervical cord (6/11 vs 1/2) between 2 groups had no significant difference ( P = 0.702, 1.000). During the disease course, there were no significant differences in the incidence of spinal cord [84.38% (54/64) vs 84.38% (27/32)], contiguous lesions involving medulla and cervical cord (9/19 vs 3/6) and intracranial lesions [86.54% (45/52) vs 83.33% (25/30)] between 2 groups ( P = 1.000, 1.000, 0.934). Conclusions Analysis of clinical and imaging features between NMO-IgG-positive and NMO-IgG-negative Chinese patients with NMOSDs according to the 2015 version of diagnostic criteria is helpful to further improve diagnostic level of the disease. DOI: 10.3969/j.issn.1672-6731.2016.09.007

Hiccups

Hiccups

Unusual Esophageal Foreign Body

Question: A 38-year-old man presented with complaints of mild dysphagia after the ingestion of a dinner fork about 1.5 hours ago, while attempting to induce vomiting. Physical examination was unremarkable, with no hypersialosis or subcutaneous emphysema. Blood sample analysis was normal. A plain chest radiograph revealed a radiopaque fork in the esophagus without evidence of pneumomediastinum (Figure A, B). Because the patient arrived during the night and was asymptomatic, the attempt to extract the foreign body endoscopically was organized on the following morning to so that a digestive surgeon could see the patient if perforation occurred during removal. The examination was performed under general anesthesia with endotracheal intubation. What is your diagnosis? Look on page 604 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI. At the time of the upper gastrointestinal endoscopy, the fork had migrated to the stomach without injury to the upper gastrointestinal tract (Figure C). It was successfully removed, the end of the tines ahead, and gripped by a rat tooth grasping forceps, using a protector hood to avoid perforating the esophagus (Figure D). When the fork reached the upper esophageal sphincter, the neck was flexed in hyperextension to align the axis of the esophagus and the pharynx to allow the manual removal of the fork with the help of a Magill forceps. We describe a case of fork ingestion in the esophagus as part of a rare eating disorder consisting in self-induced vomiting. Cases of fork ingestion in the esophagus are rarely described in the medical literature. Ingestion of a fork is described in 2 circumstances: self-induced vomiting (an eating disorder) and attempts to stop a chronic hiccup. Because long objects are unlikely to pass through the stomach, endoscopic removal is compulsory and requires a skilled endoscopist as well as accessories, because the removal of sharp and pointed objects have a higher risk of perforation. Different techniques have been described to remove forks from the upper gastrointestinal tract1Birk M. Bauerfeind P. Deprez P. et al.Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.Endoscopy. 2016; 48: 489-496Crossref PubMed Scopus (276) Google Scholar: strong-toothed graspers with the help of a protector hood, double wire-loop snare technique, or surgically gastrotomy. The main principles of endoscopic removal are to orient the long axis of the object in the line of removal and to present the blunt end as the leading end. Devices developed to protect the gastrointestinal tract during the removal of any sharp object include soft latex protector hoods and overtubes. However, the pointed ends of a metallic fork could perforate the soft latex of a protector hood and injure the esophagus.2Bertoni G. Sassatelli R. Conigliaro R. et al.A simple latex protector hood for safe endoscopic removal of sharp pointed gastroesophageal foreign bodies.Surg Endosc. 1992; 6: 255-258Crossref PubMed Scopus (22) Google Scholar In our patient, a systematic gastrograffin study and computed tomography scan confirmed the absence of iatrogenic perforation and the patient was discharged from hospital with advice to seek for psychiatric follow-up. We thank Yves Horsmans (Department of Gastroenterology, Cliniques universitaires Saint-Luc, UCL, Brussels, Belgium) for critically reading the manuscript.

Neurotransmitters in hiccups.

Hiccups are the sudden involuntary contractions of the diaphragm and intercostal muscles. They are generally benign and self-limited, however, in some cases they are chronic and debilitating. There are approximately 4000 admissions for hiccups each year in the United States. The hiccup reflex arc is composed of three components: (1) an afferent limb including the phrenic, vagus, and sympathetic nerves, (2) the central processing unit in the midbrain, and (3) the efferent limb carrying motor fibers to the diaphragm and intercostal muscles. Hiccups may be idiopathic, organic, psychogenic, or medication-induced. Data obtained largely from case studies of hiccups either induced by or treated with medications have led to hypotheses on the neurotransmitters involved. The central neurotransmitters implicated in hiccups include GABA, dopamine, and serotonin, while the peripheral neurotransmitters are epinephrine, norepinephrine, acetylcholine, and histamine. Further studies are needed to characterize the nature of neurotransmitters at each anatomical level of the reflex arc to better target hiccups pharmacologically.

Acute and chronic oxalate toxicity in Miniature Horses associated with soursob (Oxalis pes‐caprae) ingestion

SummaryOver the period of 11 years (2004–2015) 14 miniature horses in six separate outbreaks presented with clinical signs consistent with acute or chronic oxalate toxicity. All animals had access to Oxalis pes‐caprae or soursob. Miniature horses with acute oxalate toxicity and hypocalcaemia had muscle fasciculations, tremors and synchronous diaphragmatic flutter; these horses responded to treatment with intravenous and oral calcium. Chronic oxalate toxicity was associated with ill‐thrift, stiffness, enlarged heads, kyphosis and neurological signs. These animals had normal serum calcium concentrations, but increased serum alkaline phosphatase activity. Radiographs indicated that affected animals had bones that were osteopenic, often with pathological fractures. Bones that were examined histologically showed increased osteoclastic and osteoblastic activity, consistent with nutritional secondary hyperparathyroidism and fibrous osteodystrophy. These animals were treated, with mixed success, with oral calcium supplementation. A palatability trial showed that horses will readily eat soursobs, and measured total oxalate concentrations in soursobs collected from five different properties ranged from 13.5 to 18.5%. The presentation of affected animals with either acute hypocalcaemia or nutritional secondary hyperparathyroidism, together with a history of grazing soursobs, suggest that acute and chronic oxalate toxicity are the cause of the clinical signs seen in affected miniature horses.

<b>半夏厚朴湯が著効した脳出血既往のある持続性吃逆の2症例</b>

<b>半夏厚朴湯が著効した脳出血既往のある持続性吃逆の2症例</b>

Chronic subdural hematoma with persistent hiccups: A case report

Abstract Supratentorial hiccup is a rare condition and no patients with persistent hiccups and chronic subdural hematoma have been reported. A 38-year-old man with intractable hiccups, headache, and nausea was admitted to our hospital. Computed tomography revealed a supratentorial chronic subdural hematoma on the left side. After burr hole surgery to remove the hematoma his hiccups disappeared immediately and he was discharged home on the 3rd postoperative day with no neurological deficits. Although the role of the supratentorial nervous system in hiccups is not clearly understood, supratentorial areas play an important role in the stimulation or suppression of the hiccup centers. Chronic hiccups may be a presenting symptom of chronic subdural hematoma attending headache with nausea if it has no gastrointestinal abnormality.

AKT question relating to hiccups

AKT question relating to hiccups

AKT answer relating to hiccups

AKT answer relating to hiccups

Tramadol associated with hiccups

Tramadol associated with hiccups

How to manage persistent hiccups in patients undergoing mechanical ventilation?

Abstract not availableBangladesh Journal of Medical Science Vol.14(2) 2015 p.213-214

Clinical characteristics of 62 patients with suspected Ebola virus infection at admission in a holding center in Sierra leone

Objective The aim of this study is to analyze the clinical features of patients with Ebola virus (EBOV) infection at admission and to provide information for clinicians to manage patients with suspected Ebola virus disease (EVD). Methods Sixty-two suspected EVD cases visited China-Sierra leone Friendship Hospital which was set up by the first medical team from the Chinese People′s Liberation Army in Africa were enrolled in this study. Demographic information, medical history and symptoms were collected for all the patients at admission. Reverse transcription polymerase chain reaction (RT-PCR) was used to confirm or exclude the diagnosis. Data were compared between patients with or without EBOV infection by t test for ages, days from symptoms onset to admission, and χ2 test for proportion of symptoms. Results Of 62 patients, 35 were male and 27 were female, average age was (27.3±15.4) years. Forty cases were diagnosed with EVD, and 22 were excluded. The incubation period for EVD patients was estimated to be 2 to 24 days with an average of (8.8±5.7) days. EBOV positive patients showed higher proportions of fever, nausea/vomiting, diarrhea, fatigue/weakness, loss of appetite and sore throat than those of EBOV negative patients (all P<0.05). The proportions of eye pain, hiccup and insomnia were low in EBOV positive patients, while none was in EBOV negative patients. Only one patient had bloody stool at admission. An average of (8±5) symptoms were noted in EVD patients at admission compared with (4±3) symptoms in non-EVD patients (t=8.46, P=0.001). The number of symptoms at admission was optimal in diagnosing EVD with cut-off value of 6. The sensitivity, specificity, positive predictive value and negative predictive value were 50.0%, 86.4%, 87.0% and 48.7%, respectively. Thirty-six out of 62 patients had a history of contact with confirmed or suspected EVD cases, including 22(55.0%) in EBOV positive patients and 14(63.6%) in EBOV negative patients (χ2=0.44, P=0.596). Among 36 cases with definite EVD contact history, 19(86.4%) presented with fever and 20(90.9%) presented with fatigue in EBOV positive patients, while 6(42.9%) presented with fever and 5(35.7%) presented with fatigue in EBOV negative patients (both P<0.05). Conclusions Among suspected EVD patients, those who are diagnosed with EVD by RT-PCR have more symptoms than those with negative results, including fever, nausea/vomiting, diarrhea, fatigue/weakness, loss of appetite and sore throat, etc. Though these symptoms are not specific, they provide clues for diagnose EVD in the very early stage for clinicians. Key words: Hemorrhagic fever, ebola; Holding center; Clinical features

Baclofen-Induced Encephalopathy in End Stage Renal Disease.

Baclofen is a highly used centrally acting GABA agonist that continues to be an effective therapy for spasticity and chronic hiccups. The renally dependent excretion determines the circulating concentrations and guides effective dosing to decrease adverse reactions. Caution should be considered in administering baclofen to patients with decreased renal function. We present a patient with end stage renal disease on hemodialysis with recent baclofen ingestion who presented with toxic encephalopathy that was resolved with additional dialysis sessions.

食道内に形成された経腸栄養剤の塊が慢性吃逆を誘発したと考えられた一症例

食道内に形成された経腸栄養剤の塊が慢性吃逆を誘発したと考えられた一症例

What is the best treatment for chronic hiccups?

What is the best treatment for chronic hiccups?

Sub‑acute toxicity of a hydro‑ethanolic whole plant extract of Synedrella nodiflora (L) Gaertn in rats

Objectives: Synedrella nodiflora (L) Gaertn (family Asteraceae) is traditionally used in Ghana for the management of epilepsy, hiccup and threatened abortion. The anticonvulsant and other related neuro‑pharmacological effects of a hydro‑ethanolic extract in murine models have been established. To this end, we evaluated a sub‑acute toxicity of the hydro‑ethanolic whole plant extract in rats. Materials and Methods: The effects of a continuous 14‑day oral administration of the extract (100, 300 and 1000 mg/kg) on haematological and serum biochemical parameters were measured. Results: The extract produced no mortality in the rats treated during the study period. The extract also did not significantly affect any of the haematological and serum biochemical indices measured. Conclusion: This result suggests that a 14‑day oral administration of the hydro‑ethanolic extract of Synedrella nodiflora is relatively safe in Sprague‑Dawley male rats under the present laboratory conditions. Key words: Male rats, sub‑acute toxicity, Synedrella nodiflora

Novel Use of Chicory for the Treatment of Hiccups in Liver Obstruction: In Iranian Traditional Medicine

Dear Editor, A hiccup is the result of an involuntary, intermittent spasmodic contraction of the diaphragm and the inspiratory intercostal muscles. Based on Iranian Traditional Medicine, hiccups are stomach diseases and movements in the stomach with the combination of spasmodic contraction followed by a stretching distention (1). Although hiccups may be a temporary action which need no treatment, sometimes a refractory hiccup would be disturbing to a normal life. According to Avicenna, a hiccup may occur due to different causes, one of which occurs because of liver obstruction. We experienced the successful use of Chicory to cure two cases of hiccups caused by liver obstruction and inflammation in digestion Clinic of Shahid Beheshti Medical Faculty. The first case was a 78 year old male with two years of refractory and chronic hiccup, who was under a common drug treatment. Due to his refusal in using the drugs because of their side effects, his hiccups were continuous and loud enough to disturb his sleep, eating routines. It also was so severe that made him depressed. Other symptoms included pains and heaviness in RUQ. These two symptoms based on Avicenna are Pathgnomonic of liver obstruction. This was resolved by one dose of 10% syrup of Chicory, which was orally taken. It was used for three weeks before breakfast. In the middle of the second week, his problem was slighter so that it was completely gone by the end of third week. The subject was under control for six months. The problem appeared again at the end of the third month, so we started the same treatment. By the end of the sixth months, he never complained. The other patient was a 54 year old male with an intermittent hiccup, which occurred almost every day, worsening lately. He had been under medical treatment; however, his hiccups were not completely cured. The same treatment was prescribed to him in three weeks and after the 2nd week, the hiccup was resolved and there was seen no relapse within six months of control. In the Allopathic medicine hiccup etiology is not pretty clear. As far as it is known hiccups are caused by various factors such as neurologic or non-neurologic agents, cerebral tumors, prostate cancer, abdomen surgery, MI, hepatitis, gastritis, duodenitis, esophageal reflux, peptic ulcer, and esophagitis (2-4). To cure a hiccup, in the Allopathic medicine metoclopramide, chlorpromazine, baclofen, gabapentin, Phernic nerve neurolysis, and nerve blocks are used (2, 4). The best result was obtained by using Gabapentin in acute cases. In Traditional medicine, which goes back to Hippocrates, BC 460 hiccups are sometimes defined as a symptom of prognosis and it has been also mentioned that if hiccups are accompanied with red eyes, it indicates bad prognosis which can be indicative of encephalitis, gastritis, and neuritis attaching stomach and brain (1, 5). In Avicenna's view, hiccups are known as stomach diseases. He relates it to the cardia of stomach. Hiccups sometimes happen due to the interaction between stomach and diseases in other organs such as hepatitis and liver obstruction. In this study we investigated those hiccups caused by liver disease (5). Chicory belongs to the Composite family with the scientific name of Chicorium Intybus L. which is used as Diuretic, appetizer, and cholagogue (6-8). In ITM (Iranian Traditional Medicine), Chicory is known as Handba and is an Opener that is the literal translation for MOFATTEH. It is bile and blood intensity and Heddat (Acuity) reliever, and its root is deeply opener and MOLATTEF (to dilute dense humor with moderate heat) of humors (3). It is also useful for refining blood and swelling organs. Its usage dose is from 4 to 12 grams (9). Considering the weak effects of chemical drugs on treatment of refractory hiccups and their side effects, Chicory which was also proved useful in this study with no recorded side effect, (10) is recommended as an appropriate treatment for chronic hiccups caused by liver disease.

Intractable hiccup caused by spinal cord lesions in demyelination disease

ObjectiveThis study aimed to summarize the clinical features of patients who presented intractable hiccup (IH) without brain and medulla oblongata (MO) lesions.MethodThis study included six patients who were diagnosed with inflammatory demyelinating myelitis, categorized as neuromyelitis optica (NMO), multiple sclerosis (MS), and myelitis. Patients who presented IH with cervical lesions but without MO lesions were also included. Clinical profiles, laboratory data, and magnetic resonance imaging findings were analyzed.ResultsThree out of six patients were diagnosed with NMO, whereas the remaining three were diagnosed with acute myelitis, recurrent myelities, and MS, respectively. The duration of hiccup was from 2 to 23 days (average = 9.33 ± 8.64 days). Five patients (83.33%, patients 1–5) had long segmental lesions and one had a patchy lesion. None of these patients had any MO lesions. Half of them were successfully treated with high-dose methylprednisolone combined with gamma-aminobutyric acid (GABA) inhibitor.ConclusionIH occurred in patients without MO lesion. However, the mechanism remained unclear. Immune factors of demyelinating neuropathy stimulated the hiccup reflex arch. Cervical cord lesions may activate the hiccup center. In general, IH can be controlled by IVMP combined with GABA inhibitor. Unilateral phrenic nerve block may elicit no effect.

Intractable Hiccups: A Rare Presentation of Invasive Colon Adenocarcinoma

Introduction: Hiccups are caused by a sudden onset of diaphragmatic and intercostal muscle contraction followed by laryngeal closure. Patients with GI malignancies get hiccups from many causes, such as chemotherapy agents, steroids, or metastases invading the hiccup reflex. However, hiccups as the presenting symptom of advanced cancer is uncommon, and is rarely found in the literature. We present a case of intractable hiccups as the presenting symptom of invasive colon adenocarcinoma. Case: A 67-year-old male with a history of diabetes and hypertension presented to the hospital with persistent hiccups for two months. Chlorpromazine moderately controlled the hiccups, however, they were sometimes severe enough to induce dyspnea. He denied any abdominal pain, nausea, or vomiting, but did report a 20-lb weight loss, decreased appetite, and increasing lower back pain over a two-week period. A CT scan of the abdomen/pelvis showed a 7-cm heterogeneous, ill-defined mass arising from the rectosigmoid colon with necrotic regions. Pelvic MRI localized the mass to the distal sigmoid with a left psoas muscle abscess. Colonoscopy showed a circumferential polypoid friable mass 20 cm from the anal verge, with a narrowed lumen. Subsequent biopsies revealed invasive adenocarcinoma. The patient had an ex-lap where a rectosigmoid mass adherent to the bladder and small bowel was resected, and a final diagnosis was moderately to poorly differentiated adenocarcinoma, stage III T4BN2A. The patient's hiccups decreased in intensity after his surgery. Discussion: Hiccups can be classified into three categories; self-limiting (due to gastric distention from overeating or aerophagia), that last for <48 hours, persistent, lasting for >48 hours, or, rarely, intractable, lasting for >1 month (due to CNS lesions, mediastinal disease, MI, TB, medications, or GI disorders). GI disorders including GERD, achalasia, gastric distention, SBO, and GI malignancies such as esophageal, pancreatic, and biliary cancers may cause intractable hiccups due to visceral afferent fiber stimulation of the vagus nerve in the hiccup reflex arc. GI malignancies may lead to intractable hiccups from cancer drugs such as cisplatin, which releases 5-HT from vagal afferents starting the hiccup reflex, and steroids, which have receptors within the efferent limb of the hiccup reflex. It is very rare for hiccups to develop in a patient with untreated colon adenocarcinoma. To our knowledge, this is the first case in the literature where invasive colon adenocarcinoma presented as intractable hiccups.

P217 – 1694 Neonatal hiccups: to worry or not to worry?

P217 – 1694 Neonatal hiccups: to worry or not to worry?