41/84. Persistent periodic hiccups following brain abscess: a case report. A case is reported of a patient with periodic persistent hiccups and secondary generalised epilepsy lasting for a period of five years following a right temporal brain abscess. The recurring episodes of hiccups had a ten day rhythmicity and unlike epileptic convulsions were unresponsive to treatment. ( info) |
42/84. Hiccups: esophageal manometric features and relationship to gastroesophageal reflux. gastroesophageal reflux (GER) has been reported to be a cause of hiccups. Conversely, some reports state that hiccups cause or adversely affect GER disease. There have been few descriptions in the literature of what hiccups do to esophageal motility. We present a patient with long-standing symptomatic GER and intractable hiccups. Esophageal manometry during hiccups showed absence of LES pressure and absence of peristaltic activity in the esophageal body in response to swallowing, factors which could aggravate GER. Esophageal motility in the absence of hiccups was normal. Antireflux surgery in our patient relieved heartburn but not hiccups. Based on our case and a review of the literature, we believe that clinicians should be cautious in recommending antireflux surgery to treat hiccups in patients with both hiccups and heartburn. ( info) |
43/84. Intractable hiccups--an early feature of Addison's disease. Hiccups has not been previously reported as a manifestation of Addison's disease. We report two cases where persistent hiccups was an early feature of Addison's disease. Steroid replacement cured the symptoms in both patients with no recurrence. ( info) |
44/84. Interactional treatment of intractable hiccups. This article provides a comprehensive review of the literature regarding nonmedical approaches to the understanding and treatment of intractable hiccups. The author provides a rationale for an interactional view and presents a case in which post-surgical hiccups were successfully treated, using principles developed by the Mental research Institute. Of particular interest is the manner in which the therapist managed a system that included the victim's wife, a physician, and other medical personnel who were all trying to eliminate the hiccups. Interventions were designed primarily to alter meanings attributed to the hiccups and, thus, to intervene in the system that was maintaining the problem. This article is presented as a response to Weakland's call for research and practice in family somatics. ( info) |
45/84. Long-standing hiccup in a patient with sarcoidosis. The patient was a 67-year-old male. A diagnosis of sarcoidosis was made both by transbronchial lung biopsy and by scalene node biopsy. The findings of his chest roentgenogram were categorized as the group II. There were no symptoms during follow-up period of one year at the out-patient clinic with no medication. The chest X-ray findings of the patient were slowly progressive. Intractable hiccup developed one year after his first visit to the hospital. With administration of prednisolone, serum angiotensin converting enzyme level decreased promptly, and the incidence of the hiccup attack decreased. As the dose of prednisolone was tapered, the hiccup recurred. All the drugs used for hiccup including quinidine sulfate and metoclopramide was not effective. A thoracic CT revealed slight enlargement of mediastinal lymph nodes. A brain CT and a brain MRI demonstrated no abnormalities. acetazolamide, which induces acidosis in brain extra-cellular fluid, worsened the symptoms. As prednisolone was given again, infiltrates on the chest roentgenogram began to resolve and the incidence of hiccup decreased. We concluded that the long-standing hiccup observed in this patient may be brought by the lesion in central nervous system due to sarcoidosis. ( info) |
| Chronic hiccups may be a problem of great significance to the affected patient. A 62-year-old man with severe heartburn and persistent hiccups despite numerous diagnostic tests and therapeutic drug trials presented to our clinic. Esophageal motility and intraluminal pH studies demonstrated decreases in intraesophageal pressure during hiccups and acid exposure during 68% of the measured time. The patient underwent Nissen fundoplication, which improved his heartburn but not his hiccups. The association between gastroesophageal reflux and hiccups is discussed. Our experience suggests that the presence of hiccups and gastroesophageal reflux in the same patient may be coincidental rather than having a cause-and-effect relationship. ( info) |
47/84. Hiccups and esophageal dysfunction. Presented herein are the detailed esophageal manometric, radiologic, ambulatory pH, and scintigraphic findings from a patient who developed protracted and recurrent hiccups (singultus) after a lateral medullary infarction. Because of the usually transient and benign nature of hiccups, previous reports on esophageal dysfunction during hiccups have been sporadic and confined to manometric findings. Utilizing various esophageal function techniques, the main features observed during hiccups were esophageal body dilation and aperistalsis, absent lower esophageal sphincter relaxation in response to swallowing, poor emptying of the distal two-thirds of the esophageal body, and low distal esophageal pH. Most of these features normalized in the absence of hiccups. A comparison is made of these findings during prolonged hiccups with those of esophageal achalasia. ( info) |
48/84. Chronic hiccups. patients with chronic hiccups should be carefully examined for an underlying disorder while receiving symptomatic treatment. Treatment includes physical maneuvers, drugs such as chlorpromazine, metoclopramide, anticonvulsants or quinidine, and other, less tested modalities such as hypnosis. Only those patients with disabling hiccups that do not respond to conservative treatment should be considered for phrenic nerve surgery. ( info) |
49/84. Psychogenic polydipsia with hyponatremia: report of eleven cases. Psychogenic polydipsia is an uncommon clinical disorder characterized by excessive water-drinking in the absence of a physiologic stimulus to drink. The excessive water-drinking is well tolerated unless hyponatremia supervenes. This report describes 11 patients with psychogenic polydipsia and hyponatremia (ten men and one woman) who were collectively hospitalized a total of 70 times for treatment of complications of this disorder. This group differs from the classical patient with psychogenic polydipsia, ie, a hospitalized schizophrenic, in that none was institutionalized and there was a high incidence of chronic alcoholism (10), intractable hiccups (7), self-induced vomiting (6), and laboratory evidence for rhabdomyolysis (5). ( info) |
50/84. Sleep hiccup. The present study is the first to prove the presence of hiccup during sleep polygraphically. hiccup (Hc) penetrates all sleep stages; in REM sleep, it becomes randomized. The amplitude and frequency of sleep Hc have stage-dependent characteristics, and a linear regression appears with every sleep cycle. Sleep Hc may alternate, but does not coexist with, periodic leg movements. Related to inspiration, sleep Hc presents a right deviation when compared with wake Hc. The sleep pattern in persistent sleep Hc is disturbed in a nonspecific manner. Sleep Hc is not associated with sleep apnea. Sleep synchronizes the breathing rate with the hiccupping rate. During light sleep, the Hc rate exceeds the breathing rate, whereas during deep sleep, the breathing rate exceeds the Hc rate. ( info) |