Introduction: Inflammation plays a significant role in the development of atherosclerosis, and inflammatory markers could be used in risk assessment of patients with ischaemic heart disease. The use of such markers could be beneficial in younger patients, since in this group, prevention is more effective than treatment of myocardial infarctions, as long‐term prognoses are often unfavourable. Aim: Our goal was to examine the value of inflammatory biomarkers as an assessment tool for cardiovascular risk in a population with a premature ischaemic heart disease. Materials and Methods: We analysed laboratory test results of 100 consecutive patients hospitalized in the John Paul II Hospital in Krakow, Poland between 2014–2017. Inclusion criteria was cardiovascular disease diagnosed in coronarography under the age of 55 years for women and 45 years for men. We excluded patients with incomplete data and acute infections. The remaining 90 patients were divided into groups based on the reason of admission (myocardial infarction or elective diagnostics). Results: White blood cell count (median of 6.990 × 10 3 per/μl in comparison to 8.535 × 10 3 /μl) and absolute neutrophil count (median of 4060 × 10 3 /μl and 5360 × 10 3 /μl ) were lower in the group admitted for diagnostics. Although inflammatory biomarkers (platelet distribution width, white blood cells) were within normal ranges, we observed higher values (above the medians for studied population) in the group admitted to hospital due to acute coronary syndrome. Conclusion: Inflammatory biomarkers could be useful in the assessment of cardiovascular risk in patients with a premature ischaemic heart disease. Since the measured values of the inflammatory biomarkers were within normal range in the examined population, further studies should be conducted to determine appropriate cut‐off values. JRCD 2019; 4 (2): 37–41.

Background: Wunderlich’s syndrome (WS) is an extremely rare condition, characterised by spontaneous haemorrhage into the subcapsular, perirenal, and retroperitoneal spaces. The most common cause is renal angiomyolipoma. Classic symptoms, such as acute flank pain, flank mass, and hypovolemic shock, known as Lenk’s triad, have limited sensitivity and specificity for detecting WS. High mortality may be related to the difficulties in diagnosis, poor disease recognition, and non‐specific symptoms and signs. Computed tomography (CT) is the method of choice for the diagnosis of WS. Depending on the severity of symptoms, a conservative or invasive approach is reasonable. Methods and results: We report the case of a 58‐year‐old male with multivalvular heart defect, atrial fibrillation, and exacerbation of chronic heart failure complicated with nontraumatic bleeding into the retroperitoneal space. CT revealed a massive (14x11x26 cm) retroperitoneal and perirenal haematoma. The patient was successfully treated with transfusion of red blood cells, fresh frozen plasma, and intravenous fluids. Simultaneously, heart failure treatment was initiated. In view of the chronic and idiopathic character of the haematoma and successful conservative treatment, there was no indication for surgery. Discussion: Several factors might have contributed to the bleeding. First, the patient was receiving anticoagulant treatment to reduce the risk of arterial thromboembolism in atrial fibrillation. Another possible cause is post‐radiation vasculopathy, an adverse effect of previous radiation therapy for malignant granuloma. The third factor which could have contributed to bleeding was the exacerbation of chronic heart failure and pulmonary hypertension. JRCD 2019; 4 (2): 51-55.

Research into the spirituality/religiosity of patients is considered as an important area of study, together with studies of quality of life (QoL).The purpose of this article was to recognise if and how the category of spirituality/religiosity is regarded from a QoL perspective. To reach this goal, a review of Polish research in various fields of social sciences (psychology, sociology, pedagogy) was conducted. The scope of these studies was determined and indicators of spirituality/religiosity were explored from the viewpoint of various theories with special emphasis on those relating to the QoL. JRCD 2018; 3 (8): 259–265

Essential thrombocythemia is one of the Ph-negative myeloproliferative neoplasms treated with hydroxyurea. An alternative strategy may be a therapy with thromboreductin. The aim of the study was to compare the effectiveness of hydroxyurea and thromboreductin treatment, defined by a decrease in the platelet count. The study group consisted of 154 patients with essential thrombocythemia diag‐ nosed and treated at the Outpatient Clinic of Hematology in Krakow, Poland between 1995 and 2016. Patients were included in the study at the start of cytoreductive treatment. 102 patients was treated with hydroxyurea and 52 patients treated with thromboreducin. We set the limit values for the number of platelets on levels : <800 x 10 9 /L, <600 x 10 9 /L, <450 x 10 9 /L and <350 x 10 9 /L. Afterwards, the analysis of the time required to achieve each point was performed. A comparison of hydroxyurea and thromboreductin groups showed that the number of platelets at the beginning of therapy was significantly lower in patients treated with hydroxyurea. Platelets value in the last control was significantly lower in patients treated with thromboreductin than hydroxyurea. The change in total platelet count over the time was significantly higher in the thromboreductin group. Patients treated with thromboreductin had a faster platelets reduction lower than 450 x10 9 /L. Tromboreductin is effective in reducing the number of platelets in patients with resistant essential thrombocythemia or intolerant of hydroxyurea regardless of age. JRCD 2018; 3 (8): 266–270

Patients with atrial fibrillation (AF) are at increased risk of stroke and systemic thromboembolism and prevention of such episodes is ensured by choosing appropriate anticoagulation. In paroxysmal drug‐refractory AF, catheter ablation is the recommended choice of treatment. The decision on whether to stop administration of oral anticoagulant before catheter ablation procedures is often unclear. We present the case of a 67‐year‐old hypertensive woman with a 5‐year history of symptomatic, drug‐refractory paroxysmal AF, who was admitted for pulmonary vein isolation (PVI) and was anticoagulated with dabigatran. After successful transseptal puncture, an intravenous injection of 10 000 units of heparin was administered. Radiofrequency ablation was initiated at the left pulmonary trunk. After the second application of radiofrequency ablation, a drop in arterial blood pressure to 70/50 mmHg was observed. Urgent echocardiography revealed the presence of fluid within the epicardial surface of the left ventricular apex up to 19 mm, behind the right ventricle and right atrium up to 11 mm. Subsequently, all catheters were removed from the left atrium, and 50 mg of protamine sulfate, dopamine, and intravenous fluids were immediately administered. Idarucizumab was urgently delivered to the catheterisation laboratory and was available during patient hospitalisation in the intensive care unit. However, prior to patient discharge, echocardiography revealed only a trace amount of fluid in the pericardium and the use of idarucizumab was not indicated. Interruption of anticoagulation treatment with dabigatran before ablation is not required. Idarucizumab increases the safety of PVI in patients treated with dabigatran. JRCD 2018; 3 (8): 281–283

Increased incidence of lymphomas in patients with rheumatoid arthritis has been reported and may be associated with several factors, including genetic factors, chronic inflammation, and immunosuppressive treatment. Intravascular large cell lymphoma (ILCL) is a rare subtype of large cell lymphoma with undetectable lymphoma cells in peripheral blood and without any extravascular localisation. Diag- nosis is often delayed because bone marrow, spleen, and cerebrovascular fluid may not be involved and there are no specific laboratory studies for intravascular large cell lymphoma. We report the case of a 63-year-old woman with a 10-year history of seropositive rheumatoid arthritis and intravascular large cell lymphoma recognised at autopsy. The patient presented with progressive central nervous system-related symptoms mimicking vasculitis without lymphadenopathy or bone marrow involvement. Malignant lymphoproliferative disorders should be considered in RA patients with varying clinical presentation, even in the absence of lymphadenopathy and bone marrow involvement. JRCD 2018; 4 (1): 15-17.

May‐Thurner Syndrome is a rare vascular disease in which the right common iliac artery compresses the left common iliac vein. It occurs 5 times more often in women than in men, usually in their 20s and 40s. Patients suffer from deep vein thrombosis, post‐thrombotic syndrome, and pulmonary embolism. They usually present with swelling of the left leg, chronic leg pain, skin colour changes, tingling and/or numbness of the affected limb, varicosities, phlebitis, and venous stasis ulcers. Available diagnostic tests include venous duplex ultrasound, computed tomography, magnetic resonance imaging, venography, and intravascular ultrasound. Endovascular therapy, including angioplasty, stenting, and catheter‐directed thrombolysis is the current mainstay of treatment. Long‐term anticoagulation and elastic compression stockings are used to prevent recurrent blood clot formation and decrease the risk of post‐thrombotic syndrome. Thrombophilia screening is essential, as it would aid in the decision‐making process regarding continuation of anticoagulant therapy. We present the case of a 38‐year‐old woman in her fourth pregnancy, presenting with persistent left leg oedema and recurrent deep vein thrombosis, eventually diagnosed with May‐Thurner Syndrome. JRCD 2018; 4 (1): 22-25.