Effect of perioperative myocardial infarction on late survival in patients undergoing coronary artery bypass surgery

From the Seattle Heart Watch angiography registry, the baseline characteristics and late survival of 77 patients who sustained operative infarction (new Q waves) with myocardial revascularization were compared with 1790 patients who underwent coronary artery bypass without perioperative infarction. With the exception of coronary collateral vessels, which were less frequently seen in the patients with perioperative infarction, no baseline or operative characteristic distinguished between the two groups. Late survival was clearly adversely affected by perioperative infarction. Five-year survival was 76% in patients with perioperative infarction, compared with 90% in those with no perioperative infarction.     

Mechanistic study of solubility enhancement of nifedipine using vitamin E TPGS or solutol HS-15

The objective of our study was to find mechanisms responsible for solubility enhancement of nifedipine in solid dispersions of vitamin E TPGS and/or solutol HS-15. Solid dispersions of nifedipine with selected polymers such as vitamin E TPGS, solutol HS-15, PEG(1,000), and lipocol C-10 of varying drug/polymer ratios were prepared by a fusion method. The solubility enhancement was found to be in the order of vitamin E TPGS > solutol HS-15 > lipocol C-10 > PEG(1,000). Lipocol C-10, with a similar hydrophilic-lipophilic value as vitamin E TPGS, showed a comparable retained solubility enhancement during saturation solubility studies but had lower dissolution profile. Overall, vitamin E TPGS showed the best solubility and dissolution performance, while solutol HS-15 and lipocol C-10 demonstrated moderate solubility enhancements. Solid dispersions of vitamin E TPGS as prepared by microfluidization technique initially showed slightly higher solubility compared with samples prepared by fusion method, but eventually it became the same as the study progressed. However, solid dispersion of solutol HS-15 as prepared by microfluidization demonstrated a significant, sustained increased in solubility over its sample when prepared by fusion method. Based on these results, we concluded that enhanced solubility using vitamin E TPGS and solutol HS-15 resulted from a partial conversion of crystalline drug to the amorphous form, increase in wettability of the drug by water soluble polymers, better separation of drug particles, micellar solubilization of drug by high concentrations of surfactant polymers, and interaction between polymer and drug at the molecular level.