a b s t r a c tWarfarin is one of the most commonly prescribed oral anticoagulant for prevention of thromboembolic events. The effect of this drug is measured by monitoring prothrombin time expressed as International Normalized Ratio (INR). In some cases, however, the measurement of plasma concentration of warfarin was emphasized. In the present study, reversed phase high performance liquid chromatography (HPLC) was used to estimate the plasma drug levels. A total of 185 patients were enrolled in this study. Five milliliter of venous blood was collected using sodium EDTA tubes for pharmacokinetic analysis. Solid phase extraction was used to recover the warfarin and it's metabolite from plasma using isopropanol and potassium phosphate buffer (40:60) mobile phase. Warfarin, 7-hydroxy warfarin and carbamazepine (internal standard) were separated on a C18 column and had the retention time 3.6 min, 2.9 min and 5.9 min, respectively. The assay was linear in warfarin concentration ranges of 0.1e5 mg/ml. The extraction recovery was found to be x85%. The mean plasma concentrations of warfarin and 7-hydroxy warfarin were found to be 3.47 AE 1.87 (SD) mg/ml, 1.25 AE 0.81 (SD) mg/ml, respectively. Through the present study the plasma concentrations of warfarin, 7-hydroxy warfarin and their metabolic ratio was determined. The assay was sensitive to follow warfarin pharmacokinetics in a patient with warfarin therapy for 3 months and above.

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Hydatid cyst of the heart is a rare but potentially fatal disease. There have been reports of the occurrence of such cysts, but we present here a unique experience of mistaken identity of a right ventricular intramyocardial hydatid cyst for a mediastinal hydatid cyst, leading to a dangerous intraoperative procedure.

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We report an unusual complication that occurred late in the postoperative period, due to a damaged and malpositioned peripherally inserted central catheter (PICC) used for central venous pressure monitoring during esophagocoloplasty and for postoperative parenteral nutrition. On the seventh postoperative day, the development of a leak from the neck wound coincided with the administration of intravenous fluids via the PICC. The leak had occurred as a result of slow erosion of the left internal jugular vein (IJV) by the damaged edges of the catheter.