Objective To investigate a possible relationship between a deficiency in serum selenium concentration and first trimester miscarriage. Design An observational study. Setting A teaching hospital in South Wales. Participants and methods Serum selenium, albumin and total protein concentration were measured in 40 women admitted with first trimester nonrecurrent miscarriage. The results were compared with an equal number of age‐matched nonpregnant healthy volunteers, and also from 40 pregnant women attending the antenatal clinic for booking in the first trimester. Results A reduction in serum selenium normally occurs in the first trimester of pregnancies that progress to term. However, a further statistically highly significant decrease in serum selenium was observed in those women who miscarried. Conclusion Further studies are required to assess the potential benefits of selenium supplements.

The chosen methods of applied sport psychology practitioners should be underpinned by their personal core beliefs and values (Poczwardowski, Sherman, & Ravizza, 2004). However, many novice practitioners unquestioningly adopt the dominant method of the field (Fishman, 1999), and thus might find themselves incongruent in terms of their professional philosophy (Tudor & Worrall, 2004). This article aims to highlight questions that practitioners might reflect on to achieve greater congruence in terms of their philosophy of practice. Autoethnographic accounts of consultancies by a recently qualified practitioner are used to explore one practitioner’s journey toward congruence in professional philosophy. Insights arising from these consultancies for the practitioner are provided, and the wider implications for the training and certification and accreditation of practitioners are considered.

Purpose: To describe a case of ropivacaine toxicity following an ultrasound guided interscalene block and discuss the possible mechanisms involved. Clinical features:A 76-yr-old woman with multiple myeloma was scheduled for open reduction and internal fixation following a pathological fracture of her left upper humerus. She developed central nervous system toxicity with ropivacaine 15 min after a carefully placed ultrasound-guided interscalene catheter. The dose of ropivacaine was within recommended limits and there was no evidence that the catheter was intravascular. Surgery proceeded uneventfully under general anesthesia. The interscalene catheter was left in situ for postoperative evaluation and intravascular injection was ruled out with a colour Doppler study. The total ropivacaine plasma concentration was 3.68 µg·mL -1 . Neurological evaluation, contrast computerized tomography and electroencephalogram were normal. The patient was discharged home with no sequelae. Advanced age, malnutrition, epinephrine and possible elevation of α-1 -acid glycoprotein levels could have altered the pharmacokinetics of plasma ropivacaine and possibly contributed to delayed neurotoxicity. Conclusions:Local anesthetic toxicity is an uncommon but well documented complication of regional anesthesia. Careful monitoring and preparedness for managing complications during the conduct of regional anesthesia cannot be overemphasized. Experience from this case suggests that local anesthesia toxicity can happen within safe dose limits and without intravascular placement despite careful attention to needle and catheter placement, fractionated dosing and frequent aspirations.

No abstract

No abstract