Intractable Hiccups, an Unusual Presentation of Renal Cell Carcinoma

Hiccups are involuntary spasms of the diaphragm with closure of the glottis. This involves a complex neural pathway which includes the phrenic, vagus and the sympathetic pathways, it is usually self-limiting and resolves within a few minutes after onset. Hiccups are described as chronic when it lasts more than 48 hours and intractable when it persists for more than a month. Intractable hiccups are said to have an organic cause in 80% of cases and the remaining 20% psychogenic in origin, Some of the organic causes of intractable hiccups include: liver cancer, adrenal tumours, and kidney tumours. We present a case of right renal cell carcinoma which presented as intractable hiccups and was successfully managed by performing a radical right nephrectomy.

Sedation-associated hiccups in adults undergoing gastrointestinal endoscopy and colonoscopy

AIM:To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy;BDE) with sedation is different from those without sedation in terms of quantity,duration and typical onset time.METHODS:Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups:EGD without sedation (Group A) and BDE with sedation (Group B).The use of sedation was based on the patients' request.Anesthesiologists participated in this study by administrating sedative drugs as usual.A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients.The incidence,duration and onset time of hiccups were measured in both groups.In addition,the association between clinical variables and hiccups were analyzed.RESULTS:A total of 435 patients were enrolled in the study.The incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%,respectively).The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio:8.79,P < 0.001) after adjustment.The incidence of hiccups in males under sedation was high (67.4%).The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P = 0.0028).The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P = 0.018).CONCLUSION:Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation.Midazolam was significantly associated with an increased risk of hiccups.Furthermore,patients with GERD are prone to develop hiccups.

Risk Factors for Cancer Chemotherapy-Induced Hiccups (CIH)

Background: Hiccups are common somatic side effects of medication. Our previous analysis of the clinical risk factors for hiccups identified chemotherapy as a factor related to hiccup risk. Therefore, in the present study, we investigated the risk factors for hiccups associated with chemotherapy. Methods: We included all patients who received cancer chemotherapy and were hospitalized at the Musashino Red Cross Hospital between April 2014 and December 2014. We investigated patient demographics, physical characteristics, and other clinical factors to identify the risk factors for chemotherapy-induced hiccups (CIH). We conducted univariate and multivariable analysis to compare the CIH group and the non-CIH and determined risk factors of CIH. Results: Hiccups were identified in 48 of 292 patients with an incidence rate of 16.4%. Univariate analysis revealed that the male gender, pain, and nausea and vomiting were related to CIH. It also showed that cisplatin, pemetrexed, gemcitabine, etoposide, dexamethasone, and metoclopramide were related to CIH.A correlation which was found with doses of cisplatin, pemetrexed, gemcitabine, and etoposide. Multivariable analysis identified male gender (OR, 72.69;95% CI, 6.95 - 757.64), nausea and vomiting (OR, 52.01;95% CI, 3.93 - 447.13), dexamethasone (OR, 4.55;95% CI, 1.12 - 16.91), cisplatin (OR, 3.84;95% CI, 1.52 - 9.70), and etoposide (OR, 3.72;95% CI, 1.14 - 12.11) as independent risk factors for hiccups. Conclusions: The present study is the first one to report risk factors for the development of CIH. Our results suggest that male gender, having nausea, and the drugs dexamethasone, cisplatin, and etoposide are important risk factors for CIH. These results may assist in elucidation of the underlying mechanisms and guide therapy to reduce hiccup risk.

An Analysis on the Therapeutic Effects of Auriculo-Acupuncture in 38 Obstinate Hiccup Cases of Different Races

The author of this article has treated 38 cases of obstinate hiccup from different countries by using the auriculo-acupuncture therapy, and obtained satisfactory therapeutic results as reported in the following.

ACUPUNCTURE TREATMENT OF 40 CASES OF SEVERE HICCUP BASED ON DIFFERENTIATION OF SYMPTOMS AND SIGNS

In the present study, the authors selected points according to differentiation of symptoms and signs and applied filiform needles to treating 40 cases of hiccup who had tried treatment with Western and Chinese drugs but without any effect and achieved satisfactory results. After acupuncture treatment, 34 cases (85 %) were cured, 4 (10 %) improved markedly and 2(5 %) improved, with total effective rate of 100 %.

CLINICAL OBSERVATION ON 138 CASES OF SEVERE HICCUP TREATED BY ACU-MOXIBUSTION

Severe hiccup was treated by auriculo-acupuncture plus moxa cone moxibustion,with hydro-acupuncture when the patient was very feeble. The second group was treated by auriculo-acupuncture with gentle moxibustion and the third one, with warm-needling moxibustion. Compari-son made in 138 cases revealed that the first group was very satisfactory, the cured rate being 100%,that of the 2nd and 3rd groups were 91. 3% and 82. 35% respectively. Statistical treatment revealedP【0.05 with significant difference between the first and second groups, P value between the firstand third groups was P【0.01, with very significant difference. There was no significant differencebetween the 2nd and 3rd groups, P】0.05.

CLINICAL OBSERVATION ON ACUPUNCTURE TREATMENT OF REFRACTORY HICCUP

76 cases of refractory hiccup were treated with acupuncture at Neiguan(PC 6) andGongsun(SP 4) P0ints. Left-right crossing point prescription, i. e. left Neiguan(PC 6 ) combined withright Gongsun(SP 4 ), or right Neiguan(PC 6 ) with left Gongsun(SP 4 ), was adopted, During theacupuncture treatment any Chinese and Western medicines were suspended. The patient took a supinePosition. A 40 mm-length filiform needle was perpendicularly inserted into a depth of 0. 5 - 1. 0 cunand twirled at a large amplitude for 3 minutes. It was retained for 20 minutes with once manipulationeach five minutes. The treatment was given once daily, 7 days constituting one therapeutic course. As aresult, 72 cases (94 - 7 % ) were cured within 3 days and the total effective rate was 100 %.

CLINICAL TREATMENT OF 121 CASES OF HICCUP CAUSED BY CEREBRAL OPERATION WITH VIBRATION ACUPUNCTURE ON SCALP

The treatment effect of vibration acupuncture manipulation on hiccup caused by cerebraloperation was investigated. One hundred and twenty-one cases of hiccup caused by cerebral operationwere mainly treated by needling the anterior oblique line of parieto temPOral region, according to thecondition of operation, the two 1ines lateral to the forehead were used as the supplementary lines. Resu1ts: 30 cases of 121 patients were cured after 1 - 2 treatments; 66 cases after 3 - 4 treatments; 16cases 5 - 10 treatments; 7 cases were ineffective. The t0tal effective rate was 94. 2 %. Hiccup occursdue to deficiency of qi after cerebral operation. Vibration acupuncture can stimu1ate channels and collateral and enforce qi and peng. So the method is effect.

Does (supra)gastric belching trigger recurrent hiccups?

Twenty-four hours multichannel intraesophageal impedance and pH monitoring in a patient who suffered from recurrent hiccups for more than a year revealed frequent supragastric belching and pathological oesophageal acid exposure. Furthermore, a temporal relationship between the start of a hiccup episode and gastric belching was observed. The data support the hypothesis that there is an association between supragastric belching, persistent recurrent hiccups and gastro-oesophageal reflux disease, and that gastric belching may evoke hiccup attacks.

Twenty-five Cases of Obstinate Hiccup Treated by Point Injection at Tianding

From 1997 to 2000, the author treated 25 cases of obstinate hiccup by injecting chlorpromazine and 654-2 injection at Tianding (LI 17), with satisfactory therapeutic results as reported in the following.

Treatment of 60 Cases of Hiccup by Puncturing Points Lateral to Haiquan

Hiccup is a commonly encountered disease clinically, but difficult to control. The attack is often accidental. If it is mild, the patient can recover without receiving any treatment. But, in case the attack lasts long, the patient suffers a lot, and needs to be treated in time. In recent years, the author has treated 60 cases of hiccup by puncturing points lateral to Haiquan (EX-HN11) with satisfactory results, which is reported as follows.

Acupuncture Treatment of Hiccup

Case History Mr. Wang, a 40-year old administrative director from an official unit in Beijing, paid his first visit on March 5, 2001, with the chief complaint of frequent hiccup for 20 days. ……

Auricular Needle-Embedding Therapy for Treatment of Stubborn Hiccup

Stubborn hiccup refers to the involuntary spasm of the diaphragm, which cannot be relieved by medication of both Chinese and western drugs. Since 1993, the authors of this article have adopted auricular needle-embedding therapy for treatment of this disease, and obtained quite satisfactory therapeutic results. A report follows.

Acupuncture relieves chemotherapy-induced refractory hiccup: A report of two cases

The aim of the study was to present two cases that illustrate the beneficial effects of acupuncture on chemotherapy-induced refractory hiccup in cancer patients. This report described two patients with diffuse large B cell lymphoma(DLBCL) and right upper pulmonary lobe moderate-differentiation adenocarcinoma(p T1 N0 M0) who experienced chemotherapy-induced refractory hiccup. Alternative treatment was administered to relieve the symptoms of refractory hiccup. The patients were treated with acupuncture 30 min prior to chemotherapy. The selected acupoints included Zusanli(ST36), Taichong(LR3), Zhongwan(CV12), Jiuwei(RN15), and Neiguan(PC6). The symptoms related to chemotherapy-induced refractory hiccup were completely relieved after treatment with 2 to 3 cycles of acupuncture. Based on our experience, we conclude that these two cancer patients benefited from acupuncture treatment, suggesting that acupuncture not only plays a role in pain control, but is also effective in relieving chemotherapy-induced refractory hiccup in cancer patients. The beneficial outcomes need large-scale studies to examine the effectiveness of acupuncture treatment for relieving chemotherapy-induced refractory hiccup in cancer patients.

Acupuncture Treatment for 57 Cases of Hiccup

In recent years, the author has treated 57 cases of hiccup due to radiotherapy, chemotherapy or introducing therapy by acupuncture with satisfactory results as reported in the following.

Effect of Antiemetic Agents on Hiccups during Chemotherapy in Patients with Lung Cancer

Hiccups commonly occur in patients undergoing chemotherapy for lung cancer and may diminish their motivation for treatment. Therefore, it is important to characterize the hiccups and their risk factors. We examined the medical records of 120 patients with lung cancer during their initial chemotherapy and extracted data on the patients’ profiles and the onset, duration, and severity of their hiccup episodes. We found the incidence of hiccups to be 19.2% among the patients. Hiccups appeared within 3 days of beginning the chemotherapy and disappeared within 4 days. Hiccups hindered sleep in two patients. The characteristics of the hiccups episodes in our study were not different from those of previous studies. We also investigated distinctive features of the patients who developed hiccups. The occurrence of hiccups was associated with gender, age, and the treatment with platinum agents. Antiemetic agents, dexamethasone and neurokinin-1 receptor antagonists, also showed significant effects on hiccup episodes. Although the dose-responsive effect of dexamethasone on hiccups was insignificant and the effects of two neurokinin-1 receptor antagonists, aprepitant and fosaprepitant, on hiccups appeared identical. From these results, we suggest that a high incidence of hiccups may be anticipated with a prophylactic use of antiemetic agents, dexamethasone and neurokinin-1 receptor antagonists.

Postoperative Hiccup Induced by LMA—A Case Report with Literature Review

Background: The laryngeal mask airway (LMA) has become popular due to simplicity of its use and its important function in difficult airway management. However, some complications have been associated with its use. A case report and review of literature on hiccups associated with the use of LMA is presented. Case Report: A 24-year-old man who presented with a right inguinoscrotal hernia was scheduled for elective surgery under general anaesthesia. He denied any co-existing medical illness. Physical examination showed a normal healthy patient and he was placed in class 1 of the American Society of Anesthesiologist (ASA) physical status category. After premedication with 0.6 mg atropine, general anaesthesia was induced with 200 mg of intravenous propofol. Size 5 classic LMA was inserted, and surgery had lasted for 45 minutes. He had hiccups immediately after removal of the LMA which lasted for 6 minutes, and stopped about 95 seconds after 0.6 mg intravenous atropine was given. Conclusion: Complications from the use of LMA may be rare but still possible. It is important to adhere to the guidelines for insertion and removal of the LMA and perioperative use of the device should strictly be by trained personnel.

Case Report on Hiccup and Lateral Medullary Syndrome

The case study is aimed at providing a more thorough analysis of a case of lateral medullary syn-drome presented only with persistent hiccup after eating lunch the study hopes to generate an interest for further studies into the topic and focuses on abnormal unusual presentations of lateral medullary syndrome. Ethical committee has approved this case after taking consent from the patient and explaining to him the importance of the case in clinical practice.

Covid Pneumonitis Presenting as Intractable Hiccups

Background: Hiccups, also known as Singletus, can be a cause of worry and anxiety for most patients when persistent. It has long been associated with various infectious pathologies. Its association with SARS-COV-19 is relatively new with only a few cases reported so far. This case report highlights a unique presentation of Covid pneumonitis as intractable hiccups as the only symptom. With adequate laboratory and instrumental investigations, the aetiology was found to be Covid pneumonitis. Once the cause was detected and treatment initiated, the symptoms subsided. Conclusion: While hiccup can be a sign of various underlying chronic illnesses, its association with Covid-19 is relatively new with very few literatures reporting this finding. It is very crucial for clinicians to keep a high index of suspicion in patients presenting with hiccups.