A renal transplant patient with intractable hiccups and review of the literature

Intractable hiccups in transplanted patients may be caused by various medical conditions including infections. We report a case of a 44-year-old man who suffered from intractable hiccups after cadaveric kidney transplantation. We identified 3 different hiccup periods with different causes: 1) steroid and anesthetics use, 2) severe ulcerose herpetic and mycotic esophagitis, and 3) pleuropneumonia caused by nosocomial methicillin-resistant Staphylococcus epidermidis and pulmonary abscess requiring thoracic surgery.     

Termination of intractable hiccups with digital rectal massage

A 60-year-old man with acute pancreatitis developed persistent hiccups after insertion of a nasogastric tube. Removal of the latter did not terminate the hiccups which had also been treated with different drugs, and several manoeuvres were attempted, but with no success. Digital rectal massage was then performed resulting in abrupt cessation of the hiccups. Recurrence of the hiccups occurred several hours later, and again, they were terminated immediately with digital rectal massage. No other recurrences were observed. This is the second reported case associating cessation of intractable hiccups with digital rectal massage. We suggest that this manoeuvre should be considered in cases of intractable hiccups before proceeding with pharmacological agents.     

Persistent postoperative hiccups: a review

The pathogenesis of persistent postoperative hiccups is not known. Hiccups can present as a symptom of a subphrenic abscess or gastric distention, and metabolic alterations may also cause hiccups. The hiccups may develop because of increased activity in neural reflex pathways not yet fully defined. Numerous treatment modalities have been tried but with questionable success. Valproat has proven effective in two trials investigating persistent non–surgical hiccups. The simple application of a nasogastric tube may successfully treat the hiccups, possibly because of an alteration of the activity in the reflex neural pathways involved. The available literature on the treatment of persistent hiccups is reviewed, and a treatment protocol for persistent postoperative hiccups is provided.     

针刺天突穴为主配合旋覆代赭汤治疗顽固性呃逆临床观察

目的:观察针刺天突穴为主配合旋覆代赭汤治疗顽固性呃逆的疗效。方法:60例符合纳入标准的顽固性呃逆患者,随机分为两组。治疗组30例,针刺天突穴为主配合旋覆代赭汤内服;对照组30例,东茛菪碱肌注,口服吗丁啉、维生素B6;两组疗程均为1周。观察两组临床的疗效。结果:治疗1周后治疗组的总有效率96.6%,高于对照组的64.3%(P<0.01)。结论:针刺天突穴为主配合旋覆代赭汤治疗顽固性呃逆疗效优于西药对照组。并且安全,可以在临床推广应用。     

Two cases of baclofen-induced encephalopathy in hemodialysis and peritoneal dialysis patients

Abstract

Hiccups are a spasmodic contraction of the diaphragm and usually transient phenomenon that affects nearly everyone. When hiccups develop, the patients are administrated antispastic agent, such as baclofen. Baclofen is widely used for the treatment of this spastic movement disorders. Also, baclofen is a gamma-aminobutyric acid (GABA) derivative that induces presynaptic motor neuron inhibition and produces a central antispastic response. Baclofen toxicity is rare and has been reported with intrathecal pump and orally administered baclofen, particularly in patients with poor renal function. Herein, we report two cases of encephalopathy in hemodialysis and peritoneal dialysis patients who received low doses of baclofen for persistent hiccups.     

Gabapentin in the Treatment of Persistent Hiccups in Advanced Malignancy

Hiccups are a distressing symptom in advanced malignancies in the setting of palliative care. A case of persistent hiccups treated with oral Gabapentin is presented to highlight the clinical and ethical dilemmas in patients with advanced malignancy. A 70-year-old male with non-small cell cancer of the lung with widespread metastases presented with persistent hiccups. The patient and family sought only symptom relief from home, without hospitalization or further investigations. The hiccups were dramatically relieved by oral Gabapentin, highlighting the recent reports that mention this molecule as being useful for hiccups. Gabapentin is a simple tool that may be utilized by palliative care physicians to relieve hiccups in advanced malignancies.     

中西医对肿瘤所致顽固性呃逆的认识和治疗

顽固性呃逆可出现在恶性肿瘤患者手术、放化疗过程中以及治疗结束后的各个阶段,因其发作时间长,一般治疗难以缓解,或缓解后容易反复,故严重影响着肿瘤病人的心理与治疗。文章在中西医对其发病机理的认识上,探讨目前临床上使用的各种治疗方法,结果认为对肿瘤所致顽固性呃逆的治疗上,强调中西医结合,优势互补,既能减轻西药的毒副作用,又能改善中药起效缓慢的弱点,不失为一种安全、有效的治疗方法。     

痛泻要方加减对中风后顽固性呃逆临床研究

目的:观察以疏肝实脾理气法则应用痛泻要方加减在治疗中风后顽固性呃逆的临床研究。方法:将43例中风后顽固性呃逆患者随机分治疗组22例,对照组21例,对照组给予常规的西医药物治疗。治疗组运用疏肝实脾理气法则根据辨证分析应用痛泻要方加减用药治疗。结果:治疗组总有效率86.36%;对照组总有效率52.38%。两组总有效率比较,差异有显著性意义(P0.05)。结论:以疏肝实脾理气法则应用痛泻要方加减在治疗中风后顽固性呃逆有较好的疗效。疏肝实脾理气的辨证思路为临床治疗中风后呃逆提出新的观点。     

The relationship between hiccups and heart rate in the fetus

Objective. The purpose of this study was to determine the effect of fetal hiccups on fetal heart rate from 20 weeks of gestation onward.

Methods. One thousand four hundred and fifty-six collected fetal heart rate tracings from three cohorts that participated in longitudinal studies of fetal neurobehavioral development were reviewed retrospectively for fetal hiccups. Tracings were recorded at four-week intervals from 20 weeks. A hiccup-free period before or after the episode of hiccups was used as the control fetal heart rate; thus each fetus was used as its own control. The paired t-test was used for statistical analysis.

Results. From 28 weeks onward, the mean fetal heart rate increased with hiccups reaching statistical significance at 32 weeks. Fetal heart rate variability was unaffected by hiccups until 36 weeks, at which time it decreased during hiccup periods.

Conclusion. This change in response to fetal hiccups may represent another neurodevelopment milestone for the fetus.