Pneumothorax ex vacuo is a rare type of pneumothorax which forms adjacent to an atelectatic lobe. It is seen preferentially with atelectasis of the right upper lobe and is the result of rapid atelectasis producing an abrupt decrease in the intrapleural pressure with subsequent release of nitrogen from pleural capillaries. Treatment
Treatment consists of bronchoscopy rather than chest tube drainage. Radiographically, pneumothorax ex vacuo is suggested when an atelectatic lobe or lung, particularly right upper lobe atelectasis, is surrounded by a focal pneumothorax. Related illness
"Trapped lung" presents in the same way as pneumothorax ex vacuo and can occur in patients with visceral pleural thickening and following drainage of an effusion. == References ==
Patients who have a rise in creatinine on three or more occasions, even if their eGFR is > 60 ml/min/
1.73m2 require further evaluation, including a urinalysis for haematuria, proteinuria, a review of their medical history with attention paid to cardiovascular, urological and medication history, and blood pressure control and management. Overt proteinuria should be further quantified with a urine protein to creatinine ratio. Discontinuation
For patients who have achieved long term remission, it is recommended to discontinue lithium gradually and in a controlled fashion. Cluster headaches, migraine and hypnic headache
Studies testing prophylactic use of lithium in cluster headaches (when compared to verapamil), migraine attacks and hypnic headache indicate good efficacy. Adverse effects
Sources for the following lists. Very Common (> 10% incidence) adverse effects of lithium include
Confusion
Constipation (usually transient, but can persist in some)
Decreased memory
Diarrhea (usually transient, but can persist in some)
Dry mouth
EKG changes — usually benign changes in T waves
Hand tremor (usually transient, but can persist in some) with an incidence of 27%. If severe, psychiatrist may lower lithium dosage, change lithium salt type or modify lithium preparation from long to short acting (despite lacking evidence for these procedures) or use pharmacological help
Headache
Hyperreflexia — overresponsive reflexes
Leukocytosis — elevated white blood cell count
Muscle weakness (usually transient, but can persist in some)
Myoclonus — muscle twitching
Nausea (usually transient)
Polydipsia — increased thirst
Polyuria — increased urination
Renal (kidney) toxicity which may lead to chronic kidney failure
Vomiting (usually transient, but can persist in some)
Vertigo
Weight gainCommon (1–10%) adverse effects include
Acne
Extrapyramidal side effects — movement-related problems such as muscle rigidity, parkinsonism, dystonia, etc.