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A patient who developed hiccups after laparotomy was treated with numerous drugs with limited success. A left phrenic nerve crush was eventually successful. A review of published work showed that the drugs most likely to succeed were chlorpromazine and metoclopramide, and that phrenic nerve injection and crush should be considered if these failed.
Every new empiric observation made over two millenia fueled the dispute as to whether hiccup (Hc) is a digestive or a respiratory reflex. A review of the literature, focusing attention on the probable mechanism of Hc, shows Hc as a neurogenic dysfunction of the 'valve function' between the inspiratory complex and the glottis closure complex.
Intractable hiccup and nausea (IHN) was found in eight of 47 cases of relapsing neuromyelitis optica (NMO) (17%) but in none of 130 cases of multiple sclerosis (MS). IHN resolved with methylprednisolone. In six cases, MRI detected linear medullary lesions involving the pericanal region, the area postrema, and the nucleus tractus solitarius. Like long and centrally located myelitis, a linear medullary lesion causing IHN may distinguish NMO from MS.
A case of intractable hiccup as a complication of a ventriculoperitoneal shunt is reported. Other reported intra-abdominal complications are listed.
Carvedilol (6.25 mg, 4 times daily) relieved 2 years of constant hiccupping, marked tardive dyskinesia, compulsive self-induced vomiting, and feelings of hopelessness and low mood in a 59-year-old African-American man. He previously failed trials of ranitidine, chlorpromazine, promethazine, tegaserod, ondansetron, metoclopramide, pantoprazole, pyloric injections of botulinum toxin A, and a vagal nerve stimulator. At a 5-month follow-up, improvement was maintained; there had been several instances of rapid relapse on carvedilol discontinuation.
Pneumomediastinum and subcutaneous emphysema generally occurs following trauma to the esophagus or lung. It also occurs spontaneously in such situations of elevating intra-thoracic pressure as asthma, excessive coughing or forceful straining. We report here on the rare case of a man who experienced the signs of pneumomediastinum and subcutaneous emphysema after a prolonged bout of intractable hiccup as the initial presenting symptoms of multiple sclerosis.
Absent and reversed UA end-diastolic blood flow is usually a poor prognostic sign. However, in 19 fetuses evaluated in the Fetal Diagnosis and Treatment Unit, we observed an unusual pattern of intermittent, significantly decreased, or reversed UA blood flow that coincided with a demonstration of fetal hiccuping. No evidence of cardiac arrhythmia, heart failure, or uteroplacental dysfunction was found in these fetuses. With one exception, all Doppler evaluations were otherwise normal. A potential mechanism of intermittent fetal UA blood flow reversal is discussed.
Drugs are rarely the cause but should be screened for in cases of persistent hiccups.
Combretastatin B1, a polyhydroxybibenzyl compound extracted from the fruit of Combretum kraussii, known to contain 'hiccup nut' toxin, reversibly increased the duration, but not the peak or the rate of rise, of the action potential in rat sensory neurones by approximately 300%. This effect was only seen when it was applied to the extracellular side of the membrane. No effects on the resting potential were observed. K+ delayed rectifier currents were inhibited in neurones and in human myotubes with an IC50 of about 300 microM; the HERG-type inward rectifier channels in tumour cells were inhibited to a greater degree. Due to its selective action and the similarity of its blockade to that produced by class III antiarrhythmic drugs, the toxin could be the origin of compounds of potentially significant pharmacological interest.
The link between the Maltese islands and the Army Medical Services was forged during the Wars of Revolutionary France, 1792 to 1802. This article looks at the two-year long blockade of the French garrison in Malta, Nelson's so called "very long hiccup" (1), and at the origins of the Army Medical Services in the Maltese islands.
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