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1.
MedUNAB ; 24(2): 268-275, 20210820.
Article in Spanish | LILACS | ID: biblio-1291948

ABSTRACT

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.


Subject(s)
Hyperglycinemia, Nonketotic , Infant, Newborn , Epilepsy , Glycine , Hiccup
2.
Rev. colomb. gastroenterol ; 35(4): 542-544, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1156338

ABSTRACT

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.


Subject(s)
Humans , Male , Aged , Hiccup , Gastroesophageal Reflux , Fundoplication , Hernia, Hiatal
3.
Article in Korean | WPRIM | ID: wpr-761293

ABSTRACT

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating autoimmune disease of central nervous system characterized by relapsing attacks that target the optic nerves and spinal cord, as well as aquaporin-4 (AQP4) enriched periventricular brain regions. The area postrema (AP), located in the dorsal medulla, is the chemosensitive vomiting center and has high AQP-4 expression. The AP syndrome with unexplained hiccups, nausea, and vomiting is one of the core clinical characteristics in the NMOSD and maybe the first presenting symptom. We experienced a 25-year-old woman presented with intractable vomiting, dizziness and oscillopsia. Upbeat nystagmus detected on the bedside examination led to comprehensive neurological workups including magnetic resonance imaging, and she was diagnosed as the AP syndrome. Ten months later, she experienced a recurrence as a longitudinally extensive transverse myelitis and the diagnosis was finally compatible with NMOSD without AQP4-IgG. NMOSD, especially the AP syndrome, should be considered in any dizzy patient with intractable vomiting, and detailed neuro-otologic and neuro-ophthalmologic examinations are warranted for the correct diagnosis.


Subject(s)
Adult , Area Postrema , Autoimmune Diseases , Brain , Central Nervous System , Diagnosis , Dizziness , Female , Hiccup , Humans , Magnetic Resonance Imaging , Myelitis, Transverse , Nausea , Neuromyelitis Optica , Nystagmus, Pathologic , Optic Nerve , Recurrence , Spinal Cord , Vomiting
4.
Article in English | WPRIM | ID: wpr-713143

ABSTRACT

Hiccup is an intermittent, involuntary and erratic contraction of the diaphragm, immediately followed by a laryngeal closure. Persistent and intractable hiccups are rare but severe, keeping a person from doing daily activities; these can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration. Therefore, proper treatments are necessary. We present a case with intractable hiccup treated with an unusual treatment. A 61-year-old man presented with intractable hiccups, which started 6 years ago after subarachnoid and intraventricular hemorrhage. Conventional pharmacologic treatments including metoclopramide, gabapentin, and baclofen were unsuccessful. Cooperating with cardiothoracic surgeons, phrenic nerve clipping operation was done under intraoperative electrophysiologic monitoring. This method was successful that the symptoms were relieved. Reversible clipping done under intraoperative electrophysiologic monitoring can be a promising therapeutic method for persistent and intractable hiccups in patients with stroke.


Subject(s)
Baclofen , Dehydration , Depression , Diaphragm , Electromyography , Fatigue , Hemorrhage , Hiccup , Humans , Malnutrition , Methods , Metoclopramide , Middle Aged , Phrenic Nerve , Stroke , Surgeons , Weight Loss
5.
Article in English | WPRIM | ID: wpr-714056

ABSTRACT

Hiccups are an involuntary contraction of the diaphragm that may repeat several times per minute. In general, hiccups are very common, transient, and self-limited. However, if the condition persists longer than days or months, it impacts a patient's quality of life. Pharmacologic and non-pharmacologic methods are used for the treatment of persistent or intractable hiccups. Nerve block and stimulation have been shown to be effective through neural pathway interruption or stimulation of the hiccup reflex arc. Stellate ganglion block (SGB) is an injection of local anesthetic adjacent to a group of nerves in the neck known as the stellate ganglion. The authors report a case of SGB as an effective treatment for a patient with intractable hiccups resulting from right lateral medullary syndrome.


Subject(s)
Diaphragm , Hiccup , Humans , Lateral Medullary Syndrome , Neck , Nerve Block , Neural Pathways , Quality of Life , Reflex , Stellate Ganglion , Sympathetic Nervous System
6.
Article in English | WPRIM | ID: wpr-717172

ABSTRACT

While most benign hiccups can be controlled with empirical therapy, intractable hiccups lasting longer than one month tend to have significant adverse effects with obscure etiology. Treatment strategies for intractable hiccups have not been established. Only a few sporadic cases of bilateral phrenic nerve blockage have been reported. Here, we report a case of intractable hiccups that lasted five weeks in a 56-year-old male patient with a lung cancer above the right diaphragm. We hypothesized that his intractable hiccups were caused by irritation and mass effect caused by the lung cancer. We performed an ultrasound-guided right unilateral phrenic nerve pulsed radiofrequency treatment, and the patient's intractable hiccups were successfully managed without complication.


Subject(s)
Diaphragm , Hiccup , Humans , Lung Neoplasms , Lung , Male , Middle Aged , Phrenic Nerve , Pulsed Radiofrequency Treatment , Ultrasonography
7.
Article in English | WPRIM | ID: wpr-728808

ABSTRACT

Klinefelter syndrome a genetic disorder with various clinical manifestations. Neurological symptoms, such as seizures, are rarely reported with Klinefelter syndrome, and it response well to anti-epileptic drugs. A 5-month-old boy visited the Inha university hospital due to jerking movements and hiccups. The patient had been diagnosed with Klinefelter syndrome at birth and had a medical history of admission to the neonatal intensive care unit due to opisthotonus and ocular deviation at 26 days of age. The patient's serum testosterone level was decreased and his anti-Müllerian hormone level was increased. The brain image examination was normal and the electoencephalography and other blood test results showed no specific findings. However, after admission, the patient recurred generalized tonic-clonic-seizures recurred intermittently even after the administration of antiepileptic drugs. This paper reports a case of non-febrile seizures in a child with Klinefelter syndrome who presented with a refractory course.


Subject(s)
Anticonvulsants , Brain , Child , Epilepsy , Hematologic Tests , Hiccup , Humans , Infant , Infant, Newborn , Intensive Care, Neonatal , Klinefelter Syndrome , Male , Parturition , Seizures , Testosterone
8.
Article in English | WPRIM | ID: wpr-765896

ABSTRACT

BACKGROUND: Herpes zoster of the head and neck commonly presents with Ramsay Hunt syndrome. However, vesicular eruptions may occur on the pharyngeal or laryngeal area with multiple lower cranial-nerve (CN) palsy. CASE REPORT: We report on the case of a 54-year-old man with herpes zoster of the pharynx and larynx with multiple CN palsy and persistent hiccups. He initially developed progressive dysphagia, hoarseness, and persistent hiccups (CN IX and X). After admission, Dizziness, hearing impairment, and peripheral facial palsy (CN VII and VIII) were complicated. The results of a polymerase chain reaction test of saliva and vesicular fluid from the ear and throat were strongly positive for varicella zoster virus. The progression of CN palsy was in an ascending sequence. CONCLUSION: We suggest that the sequence of CN palsy may be either ascending or descending, depending on the initial site of involvement.


Subject(s)
Cranial Nerve Diseases , Cranial Nerves , Deglutition Disorders , Dizziness , Ear , Facial Paralysis , Head , Hearing Loss , Herpes Zoster Oticus , Herpes Zoster , Herpesvirus 3, Human , Hiccup , Hoarseness , Humans , Laryngitis , Larynx , Middle Aged , Neck , Paralysis , Pharynx , Polymerase Chain Reaction , Saliva
10.
Article in English | WPRIM | ID: wpr-67450

ABSTRACT

Neuromyelitis optica spectrum disorder (NMOSD) may present with area postrema syndrome, which is characterized by intractable vomiting and hiccups. Hyponatremia is common in NMOSD and is mostly associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). In contrast to SIADH, cerebral salt wasting syndrome (CSWS) causes hyponatremia, which is associated with severe natriuresis and extracellular volume depletion in patients with cerebral disease. To our knowledge, hyponatremia associated with CSWS has not been reported in a patient with NMOSD. Here, we describe a NMOSD presenting with hyponatremia, which may be caused by CSWS following area postrema syndrome.


Subject(s)
Area Postrema , Hiccup , Humans , Hyponatremia , Inappropriate ADH Syndrome , Natriuresis , Neuromyelitis Optica , Vomiting , Wasting Syndrome
11.
Article in English | WPRIM | ID: wpr-58952

ABSTRACT

Our case had hiccups arising in an adolescent with the attention deficit and hyperactivity disorder (ADHD) and conduct disorder (CD) after adding aripiprazole treatment to extended-release methylphenidate. Actually, antipsychotics are also used in the treatment of hiccups, but studies suggest that they can cause hiccups as well. Within 12 hours of taking 2.5 mg aripiprazole added to extended-release methylphenidate at a dose of 54 mg/day, 16-year-old boy began having hiccups in the morning, which lasted after 3–4 hours. As a result, aripiprazole was discontinued and methylphenidate was continued alone because we could not convince the patient to use another additional drug due to this side effect. Subsequently, when his behavior got worsened day by day, his mother administered aripiprazole alone again at the dose of 2.5 mg/day at the weekend and continued treatment because hiccup did not occur again. But when it was administered with methylphenidate on Monday, hiccup started again next morning and lasted one hour at this time. In conclusion, we concluded that concurrent use of methylphenidate and aripiprazole in this adolescent led to hiccups.


Subject(s)
Adolescent , Antipsychotic Agents , Aripiprazole , Conduct Disorder , Cytochrome P-450 CYP2D6 , Hiccup , Humans , Male , Methylphenidate , Mothers
12.
Article in Korean | WPRIM | ID: wpr-149861

ABSTRACT

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.


Subject(s)
Adult , Bronchitis , Eczema , Hiccup , Humans , Injections, Epidural , Meals , Midazolam , Trigger Points
13.
Article in English | WPRIM | ID: wpr-83628

ABSTRACT

Lethargy in newborns usually indicates central nervous system dysfunction, and many conditions such as cerebrovascular events, infections, and metabolic diseases should be considered in the differential diagnosis. Nonketotic hyperglycinemia is an autosomal recessive error of glycine metabolism, characterized by myoclonic jerks, hypotonia, hiccups, apnea, and progressive lethargy that may progress to encephalopathy or even death. Cerebral sinovenous thrombosis is a rare condition with various clinical presentations such as seizures, cerebral edema, lethargy, and encephalopathy. Here, we report the case of a newborn infant who presented with progressive lethargy. An initial diagnosis of cerebral venous sinus thrombosis was followed by confirmation of the presence of nonketotic hyperglycinemia.


Subject(s)
Apnea , Brain Edema , Central Nervous System , Diagnosis , Diagnosis, Differential , Glycine , Hiccup , Humans , Hyperglycinemia, Nonketotic , Infant, Newborn , Lethargy , Metabolic Diseases , Metabolism , Muscle Hypotonia , Myoclonus , Seizures , Sinus Thrombosis, Intracranial , Thrombosis
14.
Arch. argent. pediatr ; 112(5): e206-e208, oct. 2014. ilus
Article in Spanish | LILACS | ID: lil-734276

ABSTRACT

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.


Subject(s)
Humans , Infant, Newborn , Male , Citrullinemia/diagnosis , Citrullinemia/complications , Hiccup/etiology
15.
Medicina (B.Aires) ; 74(1): 57-59, ene.-feb. 2014.
Article in Spanish | LILACS | ID: lil-708557

ABSTRACT

El hipo es una contracción espasmódica involuntaria del diafragma que desencadena una inspiración súbita y cierre abrupto de la glotis originando un sonido característico. Según su duración se clasifica en ataque de hipo, hipo persistente o hipo intratable o rebelde. Presentamos el caso de un varón de 75 años de edad con hipo rebelde que le impedía conciliar el sueño, diurno y nocturno, asociado a eructos, de tres años de evolución, refractario al tratamiento con clorpromazina. Luego de una extensa evaluación se llegó al diagnóstico de tumor en seno etmoidal derecho. Se efectuó la resección del tumor y posterior radioterapia local con desaparición del hipo. Consideramos ésta una causa rara de hipo rebelde que generó un desafío diagnóstico y terapéutico.


Hiccup is a spasmodic involuntary contraction of the diaphragm which triggers a sudden inspiration and an abrupt closure of the glottis with a characteristic sound. Regarding its duration, it is classified as hiccup attack, persistent hiccup or rebellious or intractable hiccup. We present the case of a 75 old male with rebellious hiccup which prevented him to fall asleep by day or by night, associated with belches lasting for three years, refractory to chlorpromazine. An extensive evaluation led to the diagnosis of right ethmoid sinus tumor. The tumor resection was performed and after subsequent local radiotherapy the hiccup disappeared. We consider this a rare cause of rebellious hiccup that generated a diagnostic and therapeutic challenge.


Subject(s)
Aged , Humans , Male , Carcinoma, Squamous Cell/complications , Ethmoid Sinus , Hiccup/etiology , Paranasal Sinus Neoplasms/complications
16.
Article in English | WPRIM | ID: wpr-212035

ABSTRACT

A case of intractable hiccup developed by cavernous hemangioma in the medulla oblongata is reported. There have been only five previously reported cases of medullary cavernoma that triggered intractable hiccup. The patient was a 28-year-old man who was presented with intractable hiccup for 15 days. It developed suddenly, then aggravated progressively and did not respond to any types of medication. On magnetic resonance images, a well-demarcated and non-enhancing mass with hemorrhagic changes was noted in the left medulla oblongata. Intraoperative findings showed that the lesion was fully embedded within the brain stem and pathology confirmed the diagnosis of cavernous hemangioma. The hiccup resolved completely after the operation. Based on the presumption that the medullary cavernoma may trigger intractable hiccup by displacing or compression the hiccup arc of the dorsolateral medulla, surgical excision can eliminate the symptoms, even in the case totally buried in brainstem.


Subject(s)
Adult , Brain Stem , Diagnosis , Hemangioma, Cavernous , Hiccup , Humans , Medulla Oblongata , Pathology
17.
Article in English | WPRIM | ID: wpr-146988

ABSTRACT

PURPOSE: This study was conducted to evaluate the efficacy and safety of azasetron compared to ondansetron in the prevention of delayed chemotherapy-induced nausea and vomiting. MATERIALS AND METHODS: This study was a multi-center, prospective, randomized, double-dummy, double-blind and parallel-group trial involving 12 institutions in Korea between May 2005 and December 2005. A total of 265 patients with moderately and highly emetogenic chemotherapy were included and randomly assigned to either the azasetron or ondansetron group. All patients received azasetron (10 mg intravenously) and dexamethasone (20 mg intravenously) on day 1 and dexamethasone (4 mg orally every 12 hours) on days 2-4. The azasetron group received azasetron (10 mg orally) with placebo of ondansetron (orally every 12 hours), and the ondansetron group received ondansetron (8 mg orally every 12 hours) with placebo of azasetron (orally) on days 2-6. RESULTS: Over days 2-6, the effective ratio of complete response in the azasetron and ondansetron groups was 45% and 54.5%, respectively (95% confidence interval, -21.4 to 2.5%). Thus, the non-inferiority of azasetron compared with ondansetron in delayed chemotherapy-induced nausea and vomiting was not proven in the present study. All treatments were well tolerated and no unexpected drug-related adverse events were reported. The most common adverse events related to the treatment were constipation and hiccups, and there were no differences in the overall incidence of adverse events. CONCLUSION: In the present study, azasetron showed inferiority in the control of delayed chemotherapy-induced nausea and vomiting compared with ondansetron whereas safety profiles were similar between the two groups.


Subject(s)
Antineoplastic Agents , Constipation , Dexamethasone , Drug Therapy , Hiccup , Humans , Incidence , Korea , Nausea , Ondansetron , Prospective Studies , Serotonin Antagonists , Vomiting
18.
The Korean Journal of Pain ; : 103-111, 2014.
Article in English | WPRIM | ID: wpr-188396

ABSTRACT

Nefopam (NFP) is a non-opioid, non-steroidal, centrally acting analgesic drug that is derivative of the non-sedative benzoxazocine, developed and known in 1960s as fenazocine. Although the mechanisms of analgesic action of NFP are not well understood, they are similar to those of triple neurotransmitter (serotonin, norepinephrine, and dopamine) reuptake inhibitors and anticonvulsants. It has been used mainly as an analgesic drug for nociceptive pain, as well as a treatment for the prevention of postoperative shivering and hiccups. Based on NFP's mechanisms of analgesic action, it is more suitable for the treatment of neuropathic pain. Intravenous administration of NFP should be given in single doses of 20 mg slowly over 15-20 min or with continuous infusion of 60-120 mg/d to minimize adverse effects, such as nausea, cold sweating, dizziness, tachycardia, or drowsiness. The usual dose of oral administration is three to six times per day totaling 90-180 mg. The ceiling effect of its analgesia is uncertain depending on the mechanism of pain relief. In conclusion, the recently discovered dual analgesic mechanisms of action, namely, a) descending pain modulation by triple neurotransmitter reuptake inhibition similar to antidepressants, and b) inhibition of long-term potentiation mediated by NMDA from the inhibition of calcium influx like gabapentinoid anticonvulsants or blockade of voltage-sensitive sodium channels like carbamazepine, enable NFP to be used as a therapeutic agent to treat neuropathic pain.


Subject(s)
Administration, Intravenous , Administration, Oral , Analgesia , Analgesics, Non-Narcotic , Anticonvulsants , Antidepressive Agents , Calcium , Carbamazepine , Dizziness , Drug-Related Side Effects and Adverse Reactions , Hiccup , Long-Term Potentiation , Molecular Mechanisms of Pharmacological Action , N-Methylaspartate , Nausea , Nefopam , Neuralgia , Neurotransmitter Agents , Nociceptive Pain , Norepinephrine , Shivering , Sleep Stages , Sodium Channels , Sweat , Sweating , Tachycardia
19.
Article in English | WPRIM | ID: wpr-40196

ABSTRACT

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.


Subject(s)
Adolescent , Benztropine , Brain , Ceftriaxone , Cerebrospinal Fluid , Chlorpromazine , Consensus , Diazepam , Encephalitis , Fever , Haloperidol , Headache , Hiccup , Humans , Leukocytes , Magnetic Resonance Imaging , Male , Meningitis , Metoclopramide , Monocytes , Phenobarbital , Phenytoin , Recurrence
20.
Rev. medica electron ; 35(6): 614-621, nov.-dic. 2013.
Article in Spanish | LILACS | ID: lil-696705

ABSTRACT

El hipo persistente (singultus) es aquel que se presenta en forma de un ataque prolongado o ataques recurrentes durante un tiempo determinado, generalmente más de 48 horas, suele resolverse sin tratamiento farmacológico, pero puede ser necesario administrarlo y plantear su estudio etiológico. Esta entidad infrecuente se presenta en un hombre de 63 años, con historia de singultus desde hace tres años, que aparece fundamentalmente posterior a la ingestión de alimentos y persiste durante varios minutos u horas, todos los días. Las causas del singultus pueden ser gastrointestinales (reflujo gastroesofágico, hernia del hiato, esofagitis, úlcera gástrica, pancreatitis, carcinoma esofágico, masas hepáticas, ascitis, cirugía abdominal), neurológicas, vasculares, torácicas, metabólicas, tóxicas, fármacos y otras. Se le realiza interrogatorio y examen físico minucioso, electrocardiograma, rayos X de tórax y abdomen, analítica sanguínea, ultrasonido abdominal, Endoscopia superior, tomografía de tórax y abdomen, además de Manometría esofágica y la prueba terapéutica con omeprazol, diagnosticándose una enfermedad de reflujo gastroesofágico. Se pone tratamiento basado en medidas populares, y medicamentos del síntoma fundamental con cloropromacina (tabletas de 25mg): 1 tableta cada 8 horas, obteniendo mejoría ostensible del mismo, hasta el momento en que se diagnóstica la causa etiológica, donde se pone tratamiento específico de la enfermedad de reflujo gastroesofágico con omeprazol (20mg): 1 Cápsula cada 12 horas y domperidona, obteniendo la desaparición del síntoma que causó la consulta inicial del paciente.


The persistent hiccup (singultus) is the one that shows up as a prolonged attack or recurrent attacks during a determinant period of time, generally, more than 48 hours. It uses to resolve without a pharmacological treatment, but it could be necessary a treatment and posing its etiological study. This infrequent entity is presented in a man, aged 63 years, with a history for three years, appearing mainly after the food intake and persisting for several minutes or hours, every day. The singultus’s causes may be gastrointestinal (gastro-esophageal reflux, hiatal hernia, esophagitis, gastric ulcer, pancreatitis, esophageal carcinoma, hepatica masses, ascites, abdominal surgery), neurological, vascular, thoracic, metabolic, toxic, medicine, and others. We performed a questioning and a meticulous physical examination, an electrocardiogram, thorax and abdominal X-rays, blood analyses, abdominal ultrasound, superior endoscopy, thoracic and abdominal tomography, in addition to esophageal manometry and the therapeutic test with Omeprazol, diagnosing a gastro-esophageal reflux disease. We prescribed a treatment based on popular measures, and medication for the main symptom with chlorpromazine (25 mg tablets): 1 tablet each 8 hours, achieving a clear improvement of the symptom until the moment when the etiological cause was diagnosed and a specific treatment for the gastro-esophageal reflux disease was ordered with omeprazole (20 mg): 1 capsule each 12 hours and domperidona, reaching the disappearance of the symptom that caused the patient´s initial consultation.


Subject(s)
Humans , Male , Middle Aged , Hiccup/etiology , Hiccup/drug therapy , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/drug therapy , Case Reports
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