SDF-1 modulates periodontal ligament-Mesenchymal Stem Cells (pdl-MSCs).

BACKGROUND/OBJECTIVES: In this in vitro study, the effects of Stromal cell-derived factor-1 (SDF-1) was evaluated on the periodontal ligament-Mesenchymal Stem Cells (pdl-MSCs) functions. MATERIAL AND METHODS: Real-time cell analyzer-single plate (RTCA-SP) was employed for proliferation, and RTCA-dual purpose (DP) was utilized for pdl-MSCs migration potential treated with different SDF-1 concentrations (0, 0.1, 1, 10, 100, 200, and 400 ng/ml). Based on the dose-response findings, 10 ng/ml SDF-1 was used for further mRNA experiments. RNAs isolated at 6 and 24 h were checked using quantitative RT-PCR for mineralized tissue-associated genes including type I collagen (COL I), osteocalcin (OCN), osteopontin (OPN), and runt-related transcription factor 2 (Runx2). cRNA was synthesized for 6 h, and whole-genome array analysis was performed for over 47.000 probes. Data were subjected to quantile normalization before analysis. RESULTS: Increased proliferation and migration were observed in pdl-MSCs treated with 0.1, 1, and 10 ng/ml SDF-1. Increased COL I was observed at both time points: 6 and 24 h. While there was no significant change for OCN, OPN, and Runx2 at 6 h, SDF-1 up-regulated OCN and OPN, but down-regulated Runx2 mRNA expressions at 24 h. IL-8 and ESM1 genes were differentially expressed over twofold when the pdl-MSCs were exposed to SDF-1 at whole-genome array analysis. IL-8 induction was confirmed with RT-PCR. CONCLUSION: Findings of this study displayed that SDF-1 modulated pdl-MSCs which were important for periodontal regeneration, inducing migration and proliferation, and regulating extracellular matrix synthesis in favor of the formation of new attachment.

Real-time cell analysis of the cytotoxicity of orthodontic brackets on gingival fibroblasts.

PURPOSE: The aim of this study was to evaluate the cytotoxic effects of 6 different orthodontic bracket types on human gingival fibroblasts (HGFs) using the xCELLigence system.
 METHODS: The orthodontic brackets used in this study were gold-plated steel (Apollo Gold), titanium (Rematitan), stainless steel (Equilibrium 2), lucid ice (Inspire ICE), metal-reinforced ceramic (Clarity) and composite (OrthoFlex). Gingival fibroblasts were isolated from human gingival connective tissue of systemically healthy individuals. Tested brackets were incubated in DMEM culture medium for 72 hours according to ISO 10993-5 standards. Gingival fibroblasts were maintained with Dulbecco modified Eagle medium containing 10% fetal bovine serum. The xCELLigence system was used to evaluate cell survival. The statistical analysis used was ANOVA and Tukey-Kramer multiple comparison tests.
 RESULTS: When the data were evaluated in the 30th hour, Apollo Gold showed significant decreases in cell index (P<0.001). It also showed statistically significant decreases (P<0.001) in the 65th hour, but Clarity and Inspire ICE showed significant increases in cell indices (P<0.001, P<0.01). In the 114th hour, Clarity and Equilibrium 2 showed statistically significant increases in cell indices (P<0.001). Inspire ICE and Rematitan demonstrated significant increases (P<0.05). There were significant decreases in cell index of Apollo Gold (P<0.001). 
 CONCLUSIONS: The tested brackets are suitable for clinical application, but further studies using different test methods are needed for gold-plated brackets.

Periodontal ligament cell behavior on different titanium surfaces.

AIM: The purpose of this study was to investigate proliferation, morphology, mineralization and mRNA expressions of mineralized tissue associated proteins of PDL cells on smooth (S), sandblasted small-grit (SSG), sandblasted large-grit (SLG) and sodium titanate (NaTi) coated titanium alloys, in vitro. METHODS AND MATERIALS: PDL cells were cultured with DMEM media containing 10% FBS on the S, SSG, SLG and NaTi titanium surfaces. PDL cell proliferation, mineralization and immunohistochemistry experiments for Bone Sialoprotein (BSP) were performed. The morphology of the PDL cells was examined using confocal and scanning electron microscopy (SEM). Gene expression profiles of cells were evaluated using a quantitative-polymerase chain reaction (Q-PCR) for type I collagen (COL I), Osteocalcin (OCN), osteopontin (OPN) and Runt-related transcription factor-2 (Runx2) on days 7 and 14. RESULTS: Proliferation results on days 6 and 10 were similar in groups, while those of day 13 revealed a decrease in the NaTi group when compared to the S group. NaTi surface induced BSP mRNA expression which was correlated with mineralization tests and BSP immunostaining results. Increased Runx2 mRNA expression was also noted in the NaTi surface when compared to other surfaces. CONCLUSIONS: This study considers the NaTi surface as a potential alternative to SSG and SLG surfaces. This surface might provide a promising environment for PDL ligament-anchored implants.

Real-time cell analysis of the cytotoxicity of orthodontic mini-implants on human gingival fibroblasts and mouse osteoblasts.

INTRODUCTION: The aim of this study was to evaluate the cytotoxic effects of orthodontic mini-implants on gingival fibroblasts and osteoblasts. METHODS: The orthodontic mini-implants used in this study were Orthodontic Mini Implant (Leone, Florence, Italy), MTN (MTN, Istanbul, Turkey), AbsoAnchor (Dentos, Daegu, South Korea), IMTEC Ortho (3M Unitek, IMTEC, Ardmore, Okla), VectorTAS (Ormco, Glendora, Calif). The materials were incubated in Dulbecco's modified eagle's culture medium for 72 hours according to ISO 10993-5 standards (surface area-to-volume ratio of the specimen to cell-culture medium, 3 cm(2)/mL). A real-time cell analyzer (xCELLigence, Roche Applied Science, Mannheim, Germany; ACEA Biosciences, San Diego, Calif) was used to evaluate cell survival. After seeding 200 µL of the cell suspensions into the wells of the E-plate 96, gingival fibroblasts were treated with bioactive components released by the metallic materials and monitored every 15 minutes for 190 hours. For the proliferation experiments, the statistical analyses used were 1-way analysis of variance and Tukey-Kramer multiple comparisons tests. RESULTS: There was no significant differences between the human gingival fibroblast cell indexes of the control and study groups (P >0.05). When evaluated at 27 and 96 hours, only the VectorTAS mini-implants showed statistically significant decreases in the M3T3 cell index (P <0.001) compared with the control group. No significant differences were found among the control and all study groups (P >0.05). Furthermore, the Leone and MTN mini-implants showed statistically significant decreases (P <0.001) at 190 hours. Also, the VectorTAS mini-implants demonstrated a significant decline (P <0.05) at the same time in the M3T3 cell index. CONCLUSIONS: These findings provide fundamental knowledge and new insights for future design and development of new biocompatible titanium alloys for orthodontic mini-implants and temporary anchorage devices.

Real-time cell analysis of the cytotoxicity of the components of orthodontic acrylic materials on gingival fibroblasts.

INTRODUCTION: The aim of this study was to evaluate the cytotoxicity of 3 orthodontic acrylic materials and 2 manipulation methods. METHODS: The orthodontic acrylic materials Orthocryl EQ (Dentaurum, Ispringen, Germany), Orthoplast (Vertex Dental, Zeist, The Netherlands), and O-80 (Imicryl, Konya, Turkey) were prepared with 2 polymerization methods (doughing and spray on). Totally, 60 cylinders (5 × 2 mm), fabricated by using a different acrylic and method, were divided into 6 groups. Gingival fibroblasts were isolated from gingival connective tissue of systemically healthy subjects. Materials were incubated in Dulbecco's modified eagle's medium culture medium (Biological Industries, Beit Haemek, Israel) for 72 hours according to ISO 10993-5 standards (surface area to volume ratio of the specimen to cell-culture medium: 3 cm(2)/mL). Gingival fibroblasts were maintained with Dulbecco's modified eagle medium containing 10% fetal bovine serum. A real-time cell analyzer (RT-CES, xCELLigence; Roche Applied Science, Mannheim, Germany, and ACEA Biosciences, San Diego, Calif) was used to evaluate cell survival. After seeding 200 µL of the cell suspensions into the wells (20,000 cells/well) of the E-plate 96, gingival fibroblasts were treated with bioactive components released by the acrylic materials (1/1 and 1/2 dilutions) and monitored every 15 minutes for 121 hours. For the proliferation experiments, the statistical analyses used were 1-way analysis of variance (ANOVA) and Tukey-Kramer multiple comparisons tests. RESULTS: There was no significant difference between the cell indexes of the control and study groups for the 1/1 and 1/2 dilutions at 21 and 32 hours. When evaluated at 68 hours, all 1/2 dilutions of acrylic materials showed statistically insignificant differences (P >0.05) except for Orthoplast (P <0.05). But all acrylic materials were different from the control group in the 1/1 dilutions (P <0.001). At 121 hours, all test groups were significantly different from the untreated control group (P <0.001). CONCLUSIONS: The results indicate that the long cycle increased the cytotoxicity of the tested materials, and there was no significant difference between the spray-on and doughing methods on cytotoxicity.

Boron regulates mineralized tissue-associated proteins in osteoblasts (MC3T3-E1).

The aim of this study was to determine the effects of boron (B) on the cell-survival, proliferation, mineralization and mRNA expression of mineralized tissue-associated proteins. Additionally, determination of the effects of B on the BMP-4, -6 and -7 protein levels of pre-osteoblastic cells (MC3T3-E1) was also intended. The effects of B (pH 7.0) concentrations (0, 0.1, 1, 10, 100, 1000, 2000, 4000, 8000 and 10,000 ng/ml) on the survival of the cells were evaluated at 24 and 96 hrs with MTT assay. To evaluate the proliferation in long term, MC3T3-E1 cells were treated with different concentrations of B (0, 0.1, 1, 10, 100 and 1000 ng/ml) and were counted on days 2, 5, and 14. While in short term, decreased cell survival rate was observed at 1000 ng/ml and above, at long term no statistically significant difference was detected in different B concentrations applied. Slight decreases at the proliferation of the B-treated groups were determined on days 5 and 14 but one-way analysis of variance revealed that the difference was statistically insignificant. In mineralization assay, increased mineralized nodules were apparently observed in B treatment (1 and 10 ng/ml concentrations) groups. Based on quantitative RT-PCR results, remarkable regulation in favor of osteoblastic function for Collagen type I (COL I), Osteopontin (OPN), Bone Sialoprotein (BSP), Osteocalcin (OCN) and RunX2 mRNA expressions were observed in B treatment groups in comparison with untreated control groups. Increased BMP-4, -6 and -7 protein levels were detected at 0.1, 1, 10 and 100 ng/ml B concentrations. Results of the study suggest that at the molecular level B displays important roles on bone metabolism and may find novel usages at the regenerative medicine.

Reduction of spinal cord injury with pentobarbital and hypothermia in a rabbit model.

OBJECTIVES: to evaluate the effects of hypothermia and pentobarbital on spinal cord ischaemia induced in a rabbit model. MATERIALS AND METHODS: thirty-two rabbits, allocated into four equal groups, had the infrarenal aorta clamped distal to the left renal artery and above the iliac bifurcation for 40 min. Groups 3 and 4 had infusion of 15 mg/kg of pentobarbital intravenously for 5 min, 15 min before the cross-clamping. Groups 2 and 4 had infusion of 20 ml of Ringer's lactate (LR) solution at 3 degrees C for 3 min during aortic cross clamp into the isolated aortic segment. Group 1 was untreated and served as control. Postoperative functions of spinal cord were assessed. RESULTS: paraplegia occurred in all rabbits in Group 1, in one in each of Groups 2 and 3, whereas no paraplegia was observed in Group 4. In addition 2 and 3 animals of Groups 2 and 3, respectively revealed varying degree of neurological disturbances, whereas all animals of Group 4 had normal function. This difference between Groups 2, 3, and 4 vs Group 1 was significant (p<0.002). So was the difference between Groups 2 and 4 (p=0.03), whereas the difference between Groups 3 and 4 was not significant. CONCLUSIONS: hypothermia and pentobarbital was more effective than hypothermia alone for prevention of spinal cord ischaemia in a rabbit model.

Desmopressin usage in elective cardiac surgery.

BACKGROUND: Desmopressin acetate (DDAVP) has been implicated as a promising agent to reduce blood loss in patients undergoing cardiopulmonary bypass. METHODS: The effects of intraoperative desmopressin were studied in 66 patients undergoing coronary artery bypass grafting, randomized equally into desmopressin and control groups. The desmopressin group received 0.3 microg/kg desmopressin at the end of cardiopulmonary bypass. RESULTS: Fibrinogen level of both groups significantly reduced at postoperative 2nd hr, whereas a significant rise was observed at postoperative 24th hr with an intergroup difference favoring the control group (p=0.0307). In the desmopressin group, the activation time of factor VIII shortened during the whole postoperative period being significant (p=0.0127) at postoperative 24th hr. Postoperative von Willebrand factor (vWF) levels of the desmopressin group were significantly higher than the preoperative ones. The control group did not show such important changes in factor VIII and vWF measurements. Platelet aggregation times of both groups prolonged at postoperative 2nd hr. The control group showed significant elevation in ADP induced aggregation time at 2nd hr and significant reductions of platelet activation percentage in response to ADP, epinephrine, collagen and ristocetin at 2nd hr. Postoperative blood loss as well as blood transfusion need did not differ between the two groups. CONCLUSIONS: Despite the improved platelet functions, desmopressin does not seem to have obvious beneficial effects on postoperative hemostasis in patients without any bleeding disorder and undergoing elective cardiac surgery.

Combined thoracoabdominal aneurysm repair and off-pump coronary artery surgery.

Off-pump coronary revascularization using local stabilizing devices and less invasive methods are getting more interest with good results. To our knowledge we report the first operation of which concomitant coronary revascularization using "Octopus" device and thoracoabdominal aneurysm repair has been done without extracorporeal circulation with successful outcome. Repair of the aorta and patency of the descending aorta to coronary saphenous bypass graft were showed with angiography at postoperative 6 month.

Regional lidocaine infusion reduces postischemic spinal cord injury in rabbits.

Paraplegia secondary to spinal cord ischemia is a devastating complication in operations on the descending and thoracoabdominal aorta. We hypothesized that the tolerance of the spinal cord to an ischemic insult could be improved by means of regional administration of lidocaine. Thirty-one New Zealand white rabbits were anesthetized and spinal cord ischemia was induced by the placement of clamps both below the left renal vein and above the aortic bifurcation. The animals were divided into 5 groups. Aortic occlusion time was 20 minutes in Group 1 and 30 minutes in all other groups. Groups 1 and 2 functioned as controls. Lidocaine (Group 5) or normal saline solution (Group 3) was infused into the isolated aortic segment after cross-clamping. Group 4 animals received 20% mannitol regionally, before and after reperfusion. Postoperatively, rabbits were classified as either neurologically normal or injured (paralyzed or paretic). Among controls, 20 minutes of aortic occlusion did not produce any neurologic deficit (Group 1: 0/4 injured), while 30 minutes of occlusion resulted in more consistent injury (Group 2: 6/8 injured). Animals that received normal saline (Group 3) or mannitol (Group 4) regionally showed 80% neurologic injury (4/5). Animals treated with the regional lidocaine infusion (Group 5) showed much better neurologic outcomes (7/9 normal: 78%). This superiority of Group 5 over Groups 2, 3, and 4 was significant (P <0.02). We conclude that regional administration of lidocaine reduced neurologic injury secondary to spinal cord ischemia and reperfusion after aortic occlusion in the rabbit model.

Circulatory arrest to protect transplant kidney in a patient with chronic type III dissection.

With broader indications for renal transplantation and improved allograft survival, it is anticipated that the problem of aortic disease in the post-transplant patient will be encountered with increasing frequency. We report a technique of protecting the transplant kidney from ischemic damage during distal aortic surgery. A 30-year-old renal transplant patient who had undergone an operation for ruptured chronic type III dissection 3 years previously underwent abdominal aortic aneurysm repair under hypothermic circulatory arrest. The patient recovered uneventfully and is presently doing well 1 year after the operation. Hypothermic circulatory arrest could be used in selected cases as a useful alternative for transplant kidney protection.

Neurologic complications after deep hypothermic circulatory arrest: types, predictors, and timing.

To determine the nature of neurologic dysfunction after deep hypothermic circulatory arrest during aortic arch surgery, we reconsidered the cases of 154 patients who had undergone aortic arch surgery (either of the ascending or transverse aorta, or both) between November 1993 and July 1999. Temporary postoperative neurologic dysfunction was seen in 9 patients (5.8%), and another 3 patients (1.9%) experienced stroke. Patients with temporary neurologic dysfunction had no new infarct and were discharged home with no residual symptoms. Computed tomographic scans revealed that 2 patients with stroke had multiple infarcts in the brainstem, and the 3rd had bilateral border-zone infarcts. The patients with brainstem infarcts died on postoperative days 7 and 15, and the patient with border-zone infarct was discharged home with no symptoms 3 months after surgery. Univariate analysis revealed that patients with neurologic deficits had significantly higher rates of history of hypertension, concomitant coronary artery bypass grafting, cardiac ischemia times longer than 90 minutes, and chronic renal failure. A multivariate logistic regression analysis revealed that the significant preoperative variables associated with neurologic deficits were a history of hypertension and a cardiac ischemia time longer than 90 minutes. Deep hypothermic circulatory arrest is a safe and useful technique for protection of the brain during surgery for complex aortic problems. In future, some patients at extreme risk for perioperative neurologic complications might be offered novel neuroprotective agents, in combination with deep hypothermia.

An intraaortic solution trial to prevent spinal cord injury in a rabbit model.

OBJECTIVES: to evaluate the effectiveness of an intraaortic delivered solution on preventing spinal cord injury. DESIGN: forty rabbits were allocated into five equal groups. MATERIALS AND METHODS: one clamp was placed just distal to the left renal artery, and another was placed just above the iliac bifurcation for 40 min. Group 1 was not infused (control group). Through a 24G vascular catheter inserted into the isolated aortic segment, 20 ml of LR solution at room temperature (Group 2) 20 ml of LR solution at 3 degrees C (Group 3), and 20 ml of LR solution at 3 degrees C containing 30 mg/kg of methylprednisolone (Group 4) were infused over 3 min. In Group 5, 10 mg/kg of vitamins E and C were delivered two days before the experiment, and 20 ml of LR solution at 3 degrees C containing 30 mg/kg of methylprednisolone, and 10 mg/kg of vitamins E and C was infused at the operation. Postoperative spinal cord function was assessed using Tarlov's criteria. RESULTS: the neurologic status of Groups 3, 4, and 5 was significantly superior to that of Groups 1 and 2. No paraplegia was observed in Groups 4 and 5. Spastic paraplegia occurred in all rabbits of Groups 1 and 2, and in 20% of Group 3. In the electron microscopic evaluation of spinal cord specimens, normal histologic structure was observed in Groups 4 and 5, whereas, some derangements were observed in all others. CONCLUSIONS: intraaortic infusion of a hypothermic blended solution containing methylprednisolone, vitamins C and E provided best protection against postischaemic spinal cord dysfunction.

The side-effects of cardiopulmonary bypass on the lungs: changes in bronchoalveolar lavage fluids.

Although technical refinements have improved the safety of cardiac operations, postoperative dysfunction of lung and other organs occurs frequently after cardiopulmonary bypass (CPB). The aim of the present study was to search the aetiopathogenesis of pulmonary complications due to CBP. Ten patients with stable coronary artery disease, undergoing coronary artery bypass grafting (CABG) surgery, were included in the study. Forty bronchoalveolar lavage (BAL) fluid samplings were performed in the 10 patients. Samples were obtained at the following time periods: (1) preoperatively; (2) at the end of the first hour after anaesthetic induction; (3) at the conclusion of 30 min of crossclamp on CPB; and (4) at the conclusion of 20 h after the end of CPB, postoperatively. Cell contents of bronchoalveolar lavage fluid, alveolar macrophage viability, eosinophil cationic protein (ECP) levels and myeloperoxidase (MPO) concentrations were analysed in each bronchoalveolar lavage fluids. While the percentage of preoperative macrophages was 85.90% and the percentage of preoperative neutrophils was 2.40%, they were 77.00% and 11.30% in the postoperative samples, respectively. Mean alveolar macrophage viability was 96.20% preoperatively and 90.40% in the postoperative period. Preoperative eosinophil cationic protein mean concentration was < 2 microg/l and mean response value (RV) was 28.80. Preoperative mean myeloperoxidase concentration was 7.66 ng/ml. Postoperative eosinophil cationic protein mean response value was 63.40 and mean myeloperoxidase concentration was 59.25 ng/ml. There were significant differences between third and final samples with regard to both neutrophil percentages (p = 0.028) and MPO levels (p = 0.005). While the preoperative mean PaO2 value was 89.39 mmHg and mean SaO2 value was 97.12%, they were calculated in the postoperative arterial blood specimens of patients, without inhaling O2, as 65.31 mmHg and 93.84%. These changes between blood gas analyses reflect the impairment of the lungs (p = 0.009 and p = 0.007, respectively). Neither alveolar macrophage viability nor ECP levels changed significantly between consecutive periods. However, when the results of the first and fourth samples were compared, we saw the cumulative effects of CPB, in that alveolar macrophages lost their viability and ECP mean RVs rose. These changes were statistically significant (p = 0.027 and p = 0.013, respectively). However, postoperative ECP levels were not like those found in a patient with asthma. Also, changes between alveolar macrophage percentages (p = 0.028), between neutrophil percentages (p = 0.036) and between MPO concentrations (p = 0.005) were statistically significant. Again, changes in neutrophil percentages between first and final samples correlated with changes in MPO levels between same periods (r = 0.657, p = 0.039).

Left ventricular diverticulum associated with Cantrell's syndrome and tetralogy of Fallot in an adult.

In this report we describe the surgical treatment of a 27-year-old patient with complete Cantrell's syndrome, i.e. multiple ventricular septal defect, left ventricular diverticulum, dextrorotation of the heart, an anterior diaphragmatic defect, and a midline supraumbilical abdominal wall defect with tetralogy of Fallot. Resection of the diverticulum was combined with correction of the tetralogy of Fallot and thoracoabdominal defects. The postoperative period was uncomplicated. We have have found only one previous report describing resection of the diverticulum combined with correction of Fallot's tetralogy and thoracoabdominal defects in an adult. One-stage repair of these complex anomalies is technically feasible and should be the treatment of choice.

Cerebral perfusion through separate grafts for repair of acute aortic dissection with torn arch.

We have modified the technique of cerebral perfusion through anastomosed grafts for repair of acute arch dissections that require total arch replacement. We have performed this operation on a 71-year-old man with an acute type-A dissection and an arch tear between the orifices of the brachiocephalic arteries. We used 2 separate grafts for the brachiocephalic arteries and minimized brain ischemia by initiating antegrade selective cerebral perfusion after the 1st anastomosis. The patient had an excellent outcome. This method is simple and provides effective protection. Cerebral ischemic time can be kept under 30 minutes without need of a sophisticated pump setup or a multibranched graft. This affords extra time in case the surgeon encounters an unexpected lesion in the arch.

Coronary artery bypass and carotid endarterectomy: combined approach.

Controversy exists concerning the best management of patients with coronary artery and carotid artery disease. Between June 1994 and July 2000, 88 patients with coronary artery and carotid artery disease underwent combined coronary artery surgery and carotid endarterectomy. Demographics and perioperative variables of these patients were compared with those of 266 patients undergoing isolated coronary artery surgery. Patients in the combined coronary artery bypass grafting and carotid endarterectomy group were elderly patients (p=0.0001) with a higher prevalence of female gender (p=0.0001), left ventricular dysfunction (p=0.006), left main coronary artery disease (p=0.033), triple-vessel coronary artery disease (p=0.002), unstable angina pectoris (p=0.004), and history of prior neurologic events (p=0.0001). Three (3.4%) patients in the combined group and 5 (1.9%) patients in the isolated coronary artery surgery group (p=0.317) developed perioperative myocardial infarction. Two (2.3%) patients in the combined group developed a permanent postoperative neurologic event. Hospital mortality was 5.7% (5 patients) in the combined coronary artery bypass grafting and carotid endarterectomy group and 1.5% (4 patients) in the isolated coronary artery surgery group (p=0.046). Patients with concomitant carotid and coronary artery disease have an advanced arteriosclerosis. Although combined coronary artery bypass grafting and carotid endarterectomy is associated with a higher risk of death and perioperative myocardial infarction than simple coronary artery surgery, this procedure is a preferable approach for these high-risk patients and results in lower neurologic morbidity.

The effects of modified hemofiltration on inflammatory mediators and cardiac performance in coronary artery bypass grafting.

Cardiopulmonary bypass increases the blood levels of various immune mediators, thereby leading to a systemic inflammatory response syndrome, e.g. sepsis, with some hemodynamic alterations, such as vasodilatation, tachycardia, and a decrease in systemic vascular resistance. Perioperative hemofiltration is one of the treatment modalities proposed to prevent this syndrome. Modified hemofiltration has been introduced recently by investigators who recommend that the former standard techniques are ineffective in eliminating the inflammatory mediators. The purpose of this study was to determine the effects of the modified technique on these mediators and on hemodynamic parameters. Forty patients undergoing coronary artery bypass grafting were randomized into equal control and hemofiltered groups. The hemodynamic parameters, as well as blood samples, were taken before and after hemofiltration to assess blood concentrations of interleukin-6, interleukin-8 and neopterin. The hemodynamic parameters and immune mediator levels did not differ between the two groups during the course of the study, except in the immediate postoperative periods, where cardiac output, cardiac index, and systemic vascular resistance values were significantly greater in the hemofiltered group while there were no differences in the immune mediators. The results of our study suggest that the effects of modified hemofiltration on immune mediators are still debatable. The improvement found in cardiac performance could be attributed to the prevention of hemodilution and hypervolemia.