Hipo persistente: una rara complicación de una inyección epidural transforaminal de corticoides / Persistent hiccup: a rare complication of a transforaminal epidural corticoid injection / Soluços persistentes: uma complicação rara da injeção peridural transforaminal de corticosteroide

Se describe el caso de un paciente que instaló un hipo persistente luego de recibir una inyección epidural transforaminal lumbar de corticoides. Se destaca que es una complicación raramente reportada y por ende poco conocida por quienes practican intervencionismo en dolor. Se discuten los posibles mecanismos por los que puede presentarse, se reseña la evolución observada, y se describe el tratamiento instituido. Se señala el impacto que el hipo puede tener sobre la calidad de vida.

The case of a patient who installed a persistent hiccup after receiving a lumbar transforaminal epidural injection of corticosteroids is described. It is highlighted that it is a rarely reported complication and little known by those who practice interventional pain medicine. Possible mechanisms by which it may occur are discussed, the evolution observed and the treatment instituted are reviewed. The impact that hiccups can have on quality of life is pointed out.

Descrevemos o caso de um paciente que desenvolveu soluços persistentes após receber uma injeção peridural transforaminal lombar de corticosteróides. Ressalta-se que é uma complicação pouco relatada e, portanto, pouco conhecida por quem pratica o intervencionismo na dor. Discutem-se os possíveis mecanismos pelos quais pode ocorrer, revisa-se a evolução observada e descreve-se o tratamento instituído. O impacto que os soluços podem ter na qualidade de vida é apontado.

Síntomas gastrointestinales como manifestación de neuromielitis óptica: un reporte de caso / Gastrointestinal symptoms as a manifestation of Neuromyelitis Optica: A Case Report / Sintomas gastrointestinais como manifestação de neuromielite óptica: um reporte de caso

Se presenta el caso de una mujer en la quinta década de la vida que ingresa al servicio de urgencias con manifestaciones gastrointestinales consistentes en vómito e hipo. Después de múltiples estudios e intervenciones por especialistas, se piensa en el origen central de los síntomas. Se realiza una resonancia magnética nuclear (RMN) cerebral que permite el enfoque del caso y posterior confirmación del diagnóstico de una enfermedad dentro del espectro de la neuromielitis óptica, positiva para anticuerpos anti-acuaporinas-4. El tratamiento con esteroide y anticuerpo monoclonal (Rituximab) llevan a un control adecuado de la enfermedad.

We present a case report of a woman in her 50s admitted to the emergency room with gastrointestinal manifestations consisting of vomiting and hiccups. After a series of studies and interventions by specialists, a brain magnetic resonance imaging (MRI) is performed in order to find the central origin of the symptoms. This allows the approach of the case and subsequent confirmation of the diagnosis of Neuromyelitis optica, positive for anti-acuaporin-4 antibodies. Finally, it seems that treatment with steroids and monoclonal antibodies leads to proper control of the disease.

Se apresenta o caso de uma mulher na quinta década de vida que ingressa ao serviço de urgências com manifestações gastrointestinais consistentes em vômito e soluço. Depois de múltiplos estudos e intervenções por especialistas, se pensa na origemcentral dos sintomas. Se realiza uma ressonância magnética nuclear (RMN) cerebral que permite o enfoque do caso e posterior confirmação do diagnóstico de uma doença dentro do espectro da neuromielite óptica, positiva para anticorpos anti-acuaporinas-4. O tratamento com esteroide e anticorpo monoclonal (Rituximab) levam a um controle adequado da doença.

Singulto persistente en dos pacientes con infección por SARS-CoV-2: reporte de casos y revisión de la literatura / Persistent Singult in Two Patients with SARS- CoV-2 Infection: Case Report and Literature Review

Resumen En la actual pandemia por COVID-19, se han descrito manifestaciones poco frecuentes como la rabdomiólisis y la encefalomielitis aguda. Una de las presentaciones atípicas del SARS-CoV-2, es el singulto, que son contracciones repetitivas involuntarias de los músculos intercostales y del diafragma, cuyo origen puede ser gastrointestinal, neurogénico o infeccioso por tuberculosis e influenza, entre otros. En el presente reporte se describen los casos de 2 pacientes cuyo síntoma principal para el diagnóstico de infección por SARS-CoV-2 fue el singulto, asociado con un patrón de afección pulmonar bilateral; a propósito de los casos, se incluye una revisión en la literatura de diferentes pacientes y de los factores relacionados en cada uno.

Abstract In the current COVID-19 pandemic, unusual manifestations such as rhabdomyolysis and acute encephalomyelitis have been described. One of the atypical presentations of COVID-19 is hiccups, which are involuntary repetitive contractions of the intercostal muscles and diaphragm, whose origin can be gastrointestinal, neurogenic, or infectious due to tuberculosis, influenza, among others. This report describes the cases of two patients in whom the main symptom for the diagnosis of SARS-CoV-2 infection, was hiccups associated with a pattern of bilateral pulmonary involvement; a review of the literature is included.

Neumomediastino espontáneo asociado a episodio grave y persistente de hipo / Spontaneous pneumomediastinum associated with severe and persistent episode of hiccups

Resumen Introducción: El neumomediastino espontáneo es la presencia de aire libre en el mediastino que no ocurre por un trauma torácico o esofágico directo. Es un padecimiento muy raro, que usualmente ocurre en pacientes con asma, infecciones respiratorias o aspiración de cuerpo extraño. Se reportan pocos casos asociados a eventos de singultos por reflujo grave. Caso clínico: Se presenta el caso de una paciente de 10 años con neumomediastino espontáneo y extensión al cuello secundario a un episodio grave y persistente de hipo sin antecedentes de asma, trauma, cirugía, infección aguda, aspiración de cuerpo extraño ni ejercicio intenso con Vasalva. Conclusiones: La irritación del tercio distal del esófago produjo los episodios graves y persistentes de hipo que incrementaron la presión intratorácica, que a su vez por efecto Macklin, desencadenó el neumomediastino. El diagnóstico se realiza con estudios de imagen. El tratamiento es conservador, con resolución del cuadro clínico entre 5 y 7 días después de la hospitalización.

Abstract Background: Spontaneous pneumomediastinum is the presence of free air in the mediastinum that does not occur from direct thoracic or esophageal trauma. It is a very rare condition usually related to patients with asthma, respiratory infections, or foreign body aspiration. Only a few cases are reported to be associated with severe reflux events. Case report: We present the case of a 10-year-old female with spontaneous pneumomediastinum extending to the neck secondary to severe and persistent hiccups, with no history of asthma, trauma, surgery, acute infection, foreign body aspiration, and intense exercise with Vasalva. Conclusions: The irritation of the distal third of the esophagus produced severe and persistent episodes of hiccups that increased the intrathoracic pressure, which in turn triggered the pneumomediastinum by Macklin effect. The diagnosis is made with imaging studies. The treatment is conservative with resolution of the clinical picture between five and seven days after hospitalization.

Olanzapine-induced hiccups： a case report / 四川精神卫生

The case report aims to raise the concern of clinicians about hiccups as an adverse reaction in olanzapine treatment. A 47-year-old male patient with epileptic mental disorder appeared symptoms of persistent hiccups on the fourth day of treatment with sodium valproate and carbamazepine jointing 10 mg/d olanzapine， and the symptoms disappeared two days after olanzapine withdrawal. The patient began to take olanzapine again， hiccups reappeared seven days after administration and relieved two days after withdrawal. During the whole treatment period， the dosage of sodium valproate and carbamazepine remained unchanged， indicating that the hiccups was induced by olanzapine. This case suggests that the possibility of hiccups should be considered in the clinical application of olanzapine.

Two Cases of Hiccups Successfully Treated with Keishininjinto / 日本東洋医学雑誌

Persistent or intractable hiccups worsen the activity of daily life and the quality of life of patients, but are sometimes difficult to treat. There are no recommended therapies in Western medicine for hiccups, and Kampo medicine can often be used. However, there have been no case reports on keishininjinto for hiccups. We experienced two cases of hiccups successfully treated with keishininjinto. Case 1 was a 68-year-old man who continued intractable hiccups for 3 years. Case 2 was an 81-year-old man who developed persistent hiccups during mechanical ventilation. Both cases had spontaneous sweat, tendency of diarrhea, epigastric discomfort and resistance, and cold of epigastrium, so we diagnosed them as keishininjinto-sho. It took 6 months to improve hiccups after administration of keishininjinto in case 1 and 1 week in case 2. Keishininjinto can be effective for hiccups with interior and cold pattern.

Hiperglicinemia no cetósica neonatal, fenotipo atenuado / Neonatal nonketotic hyperglycinemia, attenuated phenotype / Hiperglicinemia não-cetótica neonatal, fenótipo atenuado

Introducción. La Hiperglicinemia no Cetósica (HNC) es un error innato del metabolismo de herencia autosómica recesiva, cuya principal característica es la acumulación de glicina en los fluidos corporales, producido por una falla en el complejo de clivaje enzimático de este aminoácido. Presentación del caso. Presentamos el caso de un recién nacido de 36 semanas, con adaptación neonatal espontánea, sin historia de noxa perinatal ni hipoglicemia documentada, quien tras un corto período de 24 horas presentó deterioro neurológico progresivo, rápida alteración del estado de conciencia hasta el coma y falla ventilatoria. Llamó la atención al ingreso la hipotonía severa generalizada, hiporreflexia, ausencia de reflejos primitivos, con episodios de hipo aislado y movimientos oculares anormales. Ante la sospecha de un error innato del metabolismo se realizó el perfil de aminoácidos donde se evidenció elevación significativa de la glicina, 1417 mmol/L (referencia 94-553 umol/L). Se solicitaron aminoácidos en líquido cefalorraquídeo, glicina muy elevada 1263 mmol/L (referencia 3-7 umol/L), con lo que se confirma la sospecha de hiperglicinemia no cetósica. Se decidió iniciar manejo con benzoato de sodio y dextrometorfano. La resonancia magnética inicial fue normal, en estudio control se encontraron al igual que en el electroencefalograma hallazgos reportados previamente en la literatura para esta patología. Discusión. La mayoría de los niños con HNC se presentan en el período neonatal o en la primera infancia, y solo los casos más leves se presentan al final de la infancia o la niñez. En las presentaciones de inicio neonatal, el 85% tiene HNC grave y el 15% tiene forma atenuada, como este caso. El diagnóstico de la HNC se hace con base en la sospecha clínica, confirmada por los hallazgos de laboratorio, con la alteración característica de la glicina tanto en plasma como en el LCR y soportada por los hallazgos de las neuroimágenes y electroencefalograma (EEG). Conclusiones. La HNC no es una condición tan inusual, aunque sí posiblemente subdiagnosticada por la forma de presentación tan catastrófica, además porque no produce grandes desarreglos metabólicos de rápido diagnóstico. Por este motivo, ante un paciente con cuadro clínico sugestivo, con coma, alteración respiratoria y convulsiones de difícil manejo, y muy característicamente hipo, debe solicitarse el estudio de aminoácidos en plasma, neuroimágenes y EEG, con el fin de instaurar un manejo temprano.

Introduction. Nonketotic hyperglycinemia (NKH) is an autosomal recessive innate error of metabolism, whose main characteristic is the accumulation of glycine in body fluids, produced by a failure in the enzymatic cleavage complex of this amino acid. Case Presentation. We present the case of a 36-week-old newborn, with spontaneous neonatal adaptation, no history of perinatal noxa or documented hypoglycemia, who after a short period of 24 hours presented progressive neurological deterioration, rapid alteration of consciousness to coma and ventilatory failure. At admission the patient was noted for severe generalized hypotonia, hyporeflexia, absence of primitive reflexes, with episodes of isolated hiccups and abnormal eye movements. In view of the suspicion of an innate error of metabolism, an amino acid profile was performed, showing a significant elevation of glycine, 1417 umol/L (reference 94-553 umol/L). Amino acids were requested in cerebrospinal fluid, glycine very elevated 1263 umol/L (reference 3-7 umol/L), confirming the suspicion of nonketotic hyperglycinemia. It was decided to start treatment with sodium benzoate and dextromethorphan. The initial MRI was normal; in the control study, findings previously reported in the literature for this pathology were found, as well as in the electroencephalogram. Discussion. Most children with NKH will display it in the neonatal period or early infancy, with only the mildest cases presenting in late infancy or childhood. In neonatal-onset cases, 85% have severe NKH and 15% have attenuated form, as in this case. The diagnosis of NKH is made based on clinical suspicion, confirmed by laboratory findings, with the characteristic alteration of glycine in both plasma and CSF and supported by neuroimaging and electroencephalogram (EEG) findings. Conclusions. NKH is not such an unusual condition, although it is possibly underdiagnosed because of its catastrophic presentation and because it does not produce major metabolic disorders that are quickly diagnosed. For this reason, in a patient with a suggestive clinical condition, with coma, respiratory alteration and unmanageable seizures, and very characteristically hiccups, the study of amino acids in plasma, neuroimaging and EEG should be requested, in order to establish early treatment.

Introdução. A hiperglicinemia não-cetótica (HNC) é um erro inato do metabolismo de herança autossômica recessiva, cuja principal característica é o acúmulo de glicina nos fluidos corporais, produzido por uma falha no complexo de clivagem enzimática deste aminoácido. Apresentação do caso. Apresentamos o caso de um recém-nascido de 36 semanas, com adaptação neonatal espontânea, sem história de noxa perinatal nem hipoglicemia documentada, que após um curto período de 24 horas apresentou deterioração neurológica progressiva, alteração rápida de consciência até coma e falha ventilatória. Na admissão, eram notáveis a hipotonia grave generalizada, hiporreflexia, ausência de reflexos primitivos, com episódios de soluços isolados e movimentos oculares anormais. Diante da suspeita de erro inato no metabolismo, foi realizado o perfil de aminoácidos, onde foi constatada elevação significativa da glicina, 1417umol/L (referência 94-553 umol/L). Foram solicitados aminoácidos no líquido cefalorraquidiano, glicina muito alta 1263umol/L (referência 3-7 umol/L), confirmando a suspeita de hiperglicinemia não-cetótica. Foi decidido iniciar o tratamento com benzoato de sódio e dextrometorfano. A ressonância magnética inicial foi normal, tanto em estudo controle quanto no eletroencefalograma, foram encontrados achados previamente relatados na literatura para esta patologia. Discussão. A maioria das crianças com HNC estão no período neonatal ou na primeira infância, e apenas os casos mais leves ocorrem na infância ou na infância tardia. Nas apresentações de início neonatal, 85% têm HNC grave e 15% têm forma atenuada, como neste caso. O diagnóstico de HNC é feito com base na suspeita clínica, confirmada por achados laboratoriais, com alteração característica da glicina tanto no plasma quanto no LCR e apoiado por achados de neuroimagem e eletroencefalograma (EEG). Conclusões. A HNC não é uma condição tão incomum, embora possivelmente seja subdiagnosticada por sua apresentação catastrófica, também por não produzir grandes distúrbios metabólicos que possam ser diagnosticados rapidamente. Por esse motivo, em um paciente com quadro clínico sugestivo, com coma, distúrbios respiratórios e convulsões de difícil manejo, e soluços muito característicos, deve ser solicitado um estudo de aminoácidos no plasma, neuroimagem e EEG a fim de estabelecer um tratamento rápido.

Causa infrecuente de hipo crónico / Rare cause of chronic hiccups

Resumen El hipo crónico es un síntoma que puede provocar una invalidez significativa y a menudo revela una enfermedad subyacente. A continuación, se presenta el caso de un varón de 68 años que ingresó con hipo de más de 3 meses de duración que se asociaba con epigastralgia, vómitos posprandiales y pérdida ponderal. Había sido intervenido en 2 ocasiones debido a una enfermedad por reflujo gastroesofágico y hernia hiatal, una primera en la que se realizó una fundoplicatura y, posteriormente, una reintervención consistente en el cierre de los pilares diafragmáticos y re-Nissen laparoscópico. La clínica se debía a una obstrucción hiatal por acodamiento de la fundoplicatura previa y fue resuelta mediante la reposición hiatal a los parámetros anatómicos y desmontaje del Nissen previo.

Abstract Chronic hiccups is a rare symptom that can lead to significant disability and often reveals an underlying disease. The following is the case of a 68-year-old man who was admitted due to hiccups that had lasted more than 3 months associated with epigastric pain, postprandial vomiting, and weight loss. He had undergone surgery twice due to gastroesophageal reflux disease and hiatal hernia. During the first procedure, a fundoplication was performed, and then, he underwent a reoperation consisting of diaphragmatic pillars closure and laparoscopic Nissen. The symptoms were caused by a hiatal obstruction due to the kinking of the previous fundoplication and were resolved by repositioning the hiatus to anatomical parameters and dismantling the previous Nissen.

Clinical effect of acupuncture Yingxiang point in the treatment of 60 patients with hiccups / 中国基层医药

Objective@#To observe the clinical effect of acupuncture Yingxiang point in the treatment of hiccups.@*Methods@#120 cases with hiccups were selected, and they were randomly divided into treatment group and control group according to the digital table, 60 cases in each group.The control group was given conventional acupoint acupuncture.The treatment group received acupuncture internal Yingxiang acupuncture point.The total effective rate and effective time of treatment were observed.@*Results@#The total effective rate of the treatment group was 100.0%, which of the control group was 96.7%, the difference between the two groups was not statistically significant (P>0.05). The effective time between the two groups had statistically significant difference (χ2=10.75, P=0.00).@*Conclusion@#Acupuncture Yingxiang point in the treatment of hiccups can enhance the treatment effect and shorten treatment time.

Hiperglicinemia no cetósica: mutación novedosa en el gen aminometiltransferasa. A propósito de un caso / Nonketotic hyperglycinemia: novel mutation in the aminomethyl transferase gene. Case report

La hiperglicinemia no cetósica es un raro trastorno metabólico autosómico recesivo hereditario causado por una deficiencia en el sistema enzimático de división de la glicina mitocondrial. Se desconoce la incidencia general de la hiperglicinemia no cetósica, aunque es mayor en ciertas poblaciones, como las del norte de Finlandia (1/12 000) y de la Columbia Británica (1/63 000). Se sabe que son tres los genes que causan hiper-glicinemia no cetósica: GLDC, AMT y GCSH. Las mutaciones en el gen AMT son responsables del 20% de los casos de hiperglicinemia no cetósica. En este artículo describimos una mutación novedosa del codón de terminación (c.565C>T, p.Q189*) del gen AMT en un niño de cuatro meses de vida con hiperglicinemia no cetósica.

Nonketotic hyperglycinemia is a rare autosomal recessively inherited metabolic disorder, caused by a deficiency in the mitochondrial glycine cleavage system. The overall incidence of nonketotic hyperglycinemia is unknown, but is higher in certain populations such as north Finland (1/12,000) and British Colombia (1/63,000). Three genes (GLDC, AMT and GCSH) are known to cause nonketotic hyperglycinemia. Mutations in the AMT gene are responsible for 20% of nonketotic hyperglycinemia cases. We describe a novel stop codon mutation (c.565C>T, p.Q189*) in AMT gene in a four-month male infant with nonketotic hyperglycinemia.

<b>Two Cases of Persistent Hiccups with a Previous History of Cerebral Hemorrhage, Successfully Treated with Hangekobokuto Extract</b> / 日本東洋医学雑誌

We report our experience with two patients who had a previous history of cerebral hemorrhage and presented with persistent hiccups. Hangekobokuto was found to be effective in these patients. Case 1 was a 49-year-old man with a history of cerebral hemorrhage who experienced persistent hiccups as a result of pulmonary aspiration that occurred while he was admitted to the hospital for heat stroke. Abdominal palpation revealed epigastric resistance and tenderness. Metoclopramide and shakuyakukanzoto were administered without any amelioration of the symptoms, but the symptoms disappeared 1 hr after changing the drug regimen to hangekobokuto. Case 2 was a 64-year-old man who experienced persistent hiccups 28 days after suffering a cerebral hemorrhage. Abdominal palpation revealed epigastric resistance and tenderness and a lack of resistance at the lower abdomen. Because a regimen of metoclopramide and shakuyakukanzoto was similarly ineffective, we changed the drug regimen to hangekobokuto, and the symptoms subsequently disappeared 7 hr after administration. The symptoms did not recur in either patient following treatment. Hangekobokuto can be effective in cases of persistent hiccups is worth considering as a treatment option.

Suspicious psychogenic hiccup after interventional pain procedures: A case report

Several cases of the hiccups that occurred after interventional pain procedures have been previously reported. A 34-year-old man had suffered from persistent hiccups that started after epidural and trigger point injection of steroid. His hiccups were stopped during meals and sleep. Furthermore, hiccups did not occur after intravenous or intramuscular steroid injection due to eczema and bronchitis, and after interventional pain procedure that was performed under sedation with midazolam. Hence, we suspected that his hiccups had resulted from a psychogenic cause.

Effect of acupuncture combined with acupoint sticking therapy on intractable hiccups of elderly patients with cerebral apoplexy / 现代临床护理

Objective To study the effect of acupuncture combined with acupoint sticking therapy on intractable hiccups of elderly patients with cerebral apoplexy. Methods Sixty patients with intractable hiccups after stroke were randomly divided into observation group and control group with 30 cases in each group. The control group was treated by routine nursing, while the observation group was treated by acupuncture on the accupoints of Neiguan, Zusanli, Zanzhu, Zhongwan, Fengchi, 2 times a day and meantime, the accupoint of Yongquan point was externally addressed with evodiarutaecarpa once before going to bed. The two groups were compared in terms of healing time and effectiveness time. Result The total effectiveness rate of the observation group was higher than that of the control group (P < 0.05). Conclusion Acupuncture combined with acupuncture addressing is effective in treating of intractable hiccups.

A case that Goshuyuto was effective for intractable hiccups caused by the medulla oblongata dissemination of the cerebellum melanoma

<b>Introduction:</b> Goshuyuto was effective in a case with intractable hiccups caused by the medulla oblongata dissemination of the cerebellum melanoma. <b>Case:</b>A 54-yearold male patient was diagnosed cerebellum malignant melanoma. He suffered from intractable hiccups caused by the medulla oblongata dissemination lesion of this melanoma. He was treated with some Western medicines such as Baclofen, Metoclopramide, Chlorpromazine and Clonazepam, which are usually used for the treatment of hiccups, but they were not effective. Therefore we gave him Goshuyuto which is Kampo medicine and his hiccups subsided immediately. Since then, he continues taking Gosyuyuto about a year and there has been no recurrence of hiccups thus far. <b>Conclusion:</b> Taking of Kampo medicine is the useful choice for a patient whom Western medicine is ineffective.

Citrulinemia de presentación atípica: hipo persistente: a propósito de un caso / Citrullinemia with an atypical presentation: persistent hiccups: case report

Se informa el caso de un neonato que desarrolló encefalopatía en el transcurso de los primeros tres días de vida. Presentaba hipo persistente, que evolucionó a coma profundo 72 horas después de la admisión al hospital. Los parámetros de septicemia y el análisis del líquido cefalorraquídeo (LCR) fueron normales. Tras la evaluación metabòlica, se confirmó la presencia de hiperamoniemia e hipercitrulinemia. El índice de la concentración de LCR/glicina en plasma era normal. Esto no coincidió con nuestro diagnóstico inicial de hiperglicinemia no cetósica, que suele manifestarse con hipo. Se recomienda tener en cuenta la deficiencia de ácido argininosuccínico sintetasa (ASD por su sigla en inglés; citrulinemia) de inicio neonatal en el diagnóstico diferencial de encefalopatía asociada con hipo durante el período neonatal, lo que sugiere una enzimopatía congénita.

We report an infant who developed encephalopathy within the first 3 days of life. He had persistent hiccups that progressed to deep coma 72 hours after admission. The sepsis parameters and cerebrospinal fluid examination (CSF) were normal. The metabolic evaluation confirmed hyperammonemia, and hypercitrullinemia. The ratio of CSF/plasma glycine concentration was normal. This did not agree with our initial diagnosis of nonketotic hyperglycinemia where hiccups is present more often. Neonatal onset of argininosuccinic acid synthetase deficiency (ASD; citrullinemia) should be brought in mind in the differential diagnosis of encephalopathy in association with hiccups in the neonatal period suggesting inborn errors of metabolism.

Successful Treatment of Intractable Hiccups with Benztropine / 대한소아신경학회지

In general, intractable hiccups are uncommon. Various drugs and interventions have been reported, but there is no consensus on the treatment of intractable hiccups. We report a patient with meningitis and rhombencephalitis who presented with intractable hiccups that were resolved following treatment with benztropine. A 17-year-old boy was admitted to another hospital with a two-week history of fever and headache. A cerebrospinal fluid (CSF) test showed an increased white blood cell (WBC) count (290/muL, monocytes 100%). He was diagnosed with meningitis and treated with ceftriaxone. Two days after admission, hiccups started and lasted for eight days, despite treatment with phenobarbital, diazepam, haloperidol, phenytoin, and chlorpromazine. He was transferred to our hospital for further evaluation and treatment. He was clinically diagnosed with rhombencephalitis based upon the findings of brain magnetic resonance imaging (MRI). The fever and headache disappeared one day later. However, the hiccups persisted, despite symptomatic treatment with chlorpromazine, gabapentin, and metoclopramide. The hiccups disappeared after one day of adding benztropine without relapse. Benztropine can be considered in the treatment of intractable hiccups.

Clinical Oservation on Transdermal Acupoint Electric Stimulatlion Treat Intractable Hiccups of Blood Diseases Patients / 浙江中医药大学学报

Objective To observe the clinical effect of the transdermal acupoint stimulation treatment on intractable hiccups of patient with blood disease. [Methods]The 57 inpatients with intractable hiccups induced by chemotherapy or corticosteroids were randomly divided into two groups, percutaneous acupoint electric stimulation group and control group with Ritalin injecting in zusani, from January 2010 to December 2013. Clincal effect and adverse reaction were compared and analyzed after treatment. [Result]There was no significant difference on the clinical effect between two groups,while the adverse reaction in percutaneous acupoint electric stimulation therapy group was relatively mild.[Conclusion] Percutaneous acupoint electric stimulation is an effective method for the treatment of intractable hiccups, which should be popularized in clinical practice.

Clinical approach on standardized treatment of patients with intractable hiccups by acupuncture combined with acupoint injection / 中国中西医结合急救杂志

Objective To observe the clinical efficacy of acupuncture combined with acupoint injection for treatment of patients with intractable hiccups and to seek its standard therapeutic regimen. Methods A prospective study was conducted. Eighty-six patients with intractable hiccups in various clinical departments in the First Affiliated Hospital of Xinjiang Medical University met the inclusion criteria of this study were selected,and according to the different treatment options they were divided into observation group and control group with 43 cases in each group. In the observation group,on the basis of treatment for their primary diseases,the rules of soothing the chest oppression and regulating the flow of qi(Kuanxiong Liqi)and regulating the stomach and sending down abnormally ascending qi(Hewei Jiangni)were followed in treatment,and acupuncture was carried out at Danzhong,Neiguan(double=bilateral acupoints),Zusanli(double),Sanyinjiao(double),Taichong(double)with the needle staying for 20 minutes each time,1 mL metoclopramide injection was injected at each of the bilateral Zusanli acupoints,once a day. In the control group,the patients received intramuscular injection of 10 mg metoclopramide once a day. Both groups were treated for consecutive 7 days. After treatment for 3 days and 5 days,the clinical efficacy was observed,and before treatment and after treatment for 3,5,7 days,the changes of hiccups frequency and persistent duration were investigated. Results Compared with the control group,the total effective rates in observation group on the 3rd and 5th day after treatment were significantly increased〔3 days:88.4%(38/43)vs. 51.2%(22/43),5 days:95.3%(41/43)vs. 62.8%(27/43),both P<0.01〕. With the prolongation of therapy,the hiccups frequency was gradually decreased and the persistent duration of hiccup was gradually shortened,reaching the lowest degree on the 7th day after treatment,and the changes were more significant in the observation group〔hiccups frequency(times/day):0.57±0.08 vs. 2.04±1.78,hiccup duration time(minutes/time):1.07±0.68 vs. 9.23±5.69,both P<0.05〕. Conclusion The therapeutic effects of acupuncture combined with acupoint injection for treatment of patients with intractable hiccups are superior to signal western medicine therapy.

Soluço persistente tratado por hipnose / Persistent hiccup treated by hypnosis

É relatado o caso de paciente com queixa de soluço persistente, com duração de pelo menos 1 ano, e que havia tentado diversos tipos de tratamento, farmacológicos ou não, sem qualquer melhora. Foi proposto o tratamento por hipnose durante cerca de dois anos, obtendo-se a sua total remissão. Este relato constitui-se em referência, basicamente porabordar sintomatologia pouco compreendida, por intermédio de terapêutica pouco conhecida e de pouco uso médico: a hipnose. Sabe-se que o soluço, na maioria das vezes, resolve-se espontaneamente, por meio de medicação ou com medidas de fácil execução (apneia forçada, por exemplo). A queixa, entretanto, pode se tornar crônica em alguns pacientes, altamente debilitante e trazendo prejuízos consideráveis, inclusive sociais.

This is a case report of a patient complaining of persistent hiccup for at least 1 year and who had tried several different treatments, pharmacological or else, without improvement. A two-year treatment with hypnosis was proposed and resulted in total remission. This report can be seen as a reference, basically because it approaches little understoodsymptoms through an also little known therapy, rarely used in medicine: hypnosis. It is known that hiccups are more often resolved either spontaneously or with medication or through easy-to-perform steps (forced apnea, for example). The complaint, however, may become chronic in some patients and can be highly debilitating, bringing considerable damage, including social problems.

Two Cases of Baclofen-Induced Encephalopathy in Hemodialysis and Peritoneal Dialysis Patients.

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 balcofen. 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. We suggest that, in patients with chronic kidney disease (CKD), baclofen should be avoided or started at a low dose. If the renal insufficiency patient develops toxic baclofen-induced encephalopathy, hemodialysis may be the proper treatment to improve clinical symptoms.