Vanishing Lung Syndrome, or Idiopathic Giant Bullous Emphysema, with Pneumothorax, and Subcutaneous Emphysema in a 58-Year-Old Female Smoker with Chronic Obstructive Pulmonary Disease.

BACKGROUND Vanishing lung syndrome (VLS), also known as idiopathic giant bullous emphysema, is a rare manifestation of chronic obstructive pulmonary disease (COPD) and usually occurs in middle-aged smokers. This report presents a 58-year-old female smoker with COPD and VLS who presented with spontaneous pneumothorax. The pneumothorax was managed with a chest tube and was later complicated by massive subcutaneous emphysema. CASE REPORT A 58-year-old woman with a past medical history of long-term smoking and COPD presented with worsening shortness of breath. Upon initial evaluation, she had tachypnea and hypoxia (SpO2 93%). Chest radiography revealed a new right-sided pneumothorax on top of extensive bullous disease, which the patient already had. The drainage of the pneumothorax was successful with a pigtail catheter. However, during the following night, after insertion of the pigtail catheter, the patient developed massive subcutaneous emphysema, which was confirmed with imaging. The patient remained hemodynamically stable, and diffuse subcutaneous crepitus was present on examination. The pigtail catheter was repositioned, resulting in complete resolution of the subcutaneous emphysema in the following 2 weeks. CONCLUSIONS This case highlights the importance of a timely diagnosis and management of the possible presentations and complications of VLS. Complications such as pneumothorax are life-threatening and require urgent management, taking precedence over the curative treatment for VLS, surgical bullectomy.

Frequency of Medication Non-compliance in Hypertensive Patients Presenting with Stroke: A Case-control Study.

Introduction Medication compliance (MC) is essential for optimum control and delaying disease progression and complications in chronic illnesses. Patients with hypertension have been repeatedly studied for their pattern of MC in the literature. However, whether or not lack of MC is an issue grave enough to cause medical complications of hypertension is still not clear. The aim of this study was to evaluate if the lack of MC is related to hypertension-related stroke. Methods In this case-control, observational study, 100 hypertensive patients admitted with hypertensive stroke were included. These cases were compared with 200 hypertensive patients without any major hypertensive complication recruited from outpatient clinics. Medication compliance was calculated using the Morisky Medication Adherence Scale (MMAS). Data was entered and analysed using SPSS v. 22.0. Results High compliance patients were more in the control group than the cases (34.5% vs. 27%), similar was with medium (41.5% vs. 30%). and low compliance patients (43% vs. 24%; p = 0.003). In both high compliant and moderate-to-low compliant group, mean systolic and diastolic blood pressure was higher among the cases (p <0.05). Among high compliant patients, cases were taking more pills per day than the controls (p = 0.032). Among moderate-to-low compliant patients, 80% perceived themselves to be highly compliant and only 20% perceived to be low complaint in the cases, as compared to 60% controls perceiving themselves compliant and 40% as low complaint (p = 0.001). Conclusion The incidence of low medication adherence is significantly higher in patients with major hypertensive complications such as stroke as compared to hypertensive patients without any major complication.