Background: Among the various diaphragm-sparing alternatives to interscalene block, costoclavicular block (CCB) demonstrated a low hemidiaphragmatic paresis (HDP) occurrence but an inconsistent analgesic effect in arthroscopic shoulder surgery. We hypothesized that a larger volume of local anesthetic for CCB could provide sufficient analgesia by achieving sufficient supraclavicular spreading. Methods: Sixty patients scheduled for arthroscopic rotator cuff repair were randomly assigned to receive CCB using one of two volumes of local anesthetic (CCB20, 0.75% ropivacaine 20 ml; CCB40, 0.375% ropivacaine 40 ml). The primary outcome was the rate of complete analgesia (0 on the numeric rating scale of pain) at 1 h postoperatively. The secondary outcomes included a sonographic assessment of local anesthetic spread, diaphragmatic function, pulmonary function, postoperative opioid use, and other pain-related experiences within 24 h postoperatively. Results: The rates of complete analgesia were not significantly different (23.3% [7/30] and 33.3% [10/30] in the CCB20 and CCB40 groups, respectively; risk difference 10%, 95% CI [–13, 32], P = 0.567). There were no significant differences in other pain-related outcomes. Among the clinical factors considered, the only factor significantly associated with postoperative pain was the sonographic observation of supraclavicular spreading. There were no significant differences in the incidence of HDP and the change in pulmonary function between the two groups. Conclusions Using 40 ml of local anesthetic does not guarantee supraclavicular spread during CCB. Moreover, it does not result in a higher rate of complete analgesia compared to using 20 ml of local anesthetic in arthroscopic shoulder surgery.

BACKGROUND: Many investigators have found transforming growth factor-1 (TGF-1) to be elevated in tumors. Changes in responsiveness to TGF-1 have been linked to malignant transformation, tumor progression and tumor regression. Many malignant cell lines of epithelial or hematopoietic origin are refractory to the antiproliferative effects of TGF-1. However, a little is known about the association of TGF-1 with progression of malignant tumor. METHODS: In this study, we measured the plasma level of TGF-1 in various cancer patients and evaluated the utility of plasma TGF-1 as a possible tumor marker. Plasma TGF-1 levels were measured using enzyme-linked immunosorbent assay in cancer patients and normal controls. Carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) as tumor marker were compared with TGF-1 in the aspects of sensitivity and specificity. RESULTS: The mean of plasma TGF-1 levels was 1.2 19 +/-0.834 ng/ml in normal controls, 5.491 +/-3.598 ng/ml in breast cancer, 12.670 +/-10.386 ng/ml in lung cancer, 5.747 +/-3.228 ng/ml in hepatocellular carcinoma and 10.854 +/-7.996 ng/ml in cervical cancer. In comparison with CEA and AFP, TGF-1 is more sensitive. CONCLUSION: We conclude that the high levels of TGF-1 are common in the plasma of cancer patients. These result s suggest that the plasma TGF-1 level can be a potent tumor marker in various cancer patients.
alpha-Fetoproteins ; Breast Neoplasms ; Carcinoembryonic Antigen ; Carcinoma, Hepatocellular ; Cell Line ; Enzyme-Linked Immunosorbent Assay ; Humans ; Lung Neoplasms ; Plasma* ; Research Personnel ; Sensitivity and Specificity ; Uterine Cervical Neoplasms