A patient suffering from heparin-associated thrombocytopenia (HAT), recurrent arteriothromboses, and acute renal failure after treatment with standard heparin is described. He failed to improve when therapy was continued with low-molecular-weight (LMW) heparin (Fragmin, Kabi Pfrimmer, Erlangen, FRG). By means of the in vitro heparin-induced platelet activation (HIPA) assay it was shown that standard heparin and the LMW heparins Fragmin and Fraxiparin (Sanofi Labaz, Munich, FRG), as well as the enoxaparine Clexane (Nattermann, Cologne, FRG), all induced platelet activation with the patient's serum. In contrast, the LMW heparinoid Org 10172 (Organon, Oss, The Netherlands) did not cause platelet activation. When the patient was subsequently treated by parenteral administration of Org 10172 as anticoagulant over a period of several weeks the number of platelets rapidly increased and the patient almost completely recovered. This case shows that strong in vivo and in vitro cross-reactivity between standard heparin and LMW heparins may occur, but can be avoided by the use of a novel heparinoid, Org 10172. The HIPA assay provides a simple and sensitive laboratory method for the choice of an innocuous heparin or heparinoid for continued parenteral anticoagulation.
257uptake of speech therapy throughout Britain suggests that families of lower social class are making worse use of the speech therapy provisions available in their vicinity.Detailed analysis was made of a high-risk group of children, comprising 1-6% of all the 7-year-olds, who were considered to have a marked speech defect in the absence of any auditory difficulty after evaluation of a large amount of data available on speech and hearing from doctor, teacher, and health visitor and assessment of test results. Even though this was clearly a very handicapped group not more than a third were reported as having been referred by 7 years for speech therapy. It would have been interesting to have considered these children under aetiological headings, but the absence of specialized tests to assist differential diagnosis inevitably led to the bracketing of many different conditions under the heading of marked speech defect. These included true language disorders and dysarthrias of every type, as well as late-resolving developmental phonetic substitutions which would normally have disappeared spontaneously by the age of 7 years. Nevertheless, when considered as a group these children did manifest a number of important sociobiological characteristics. These children, more often males, came from a poorer social background and were of later birth order than controls. Apart from aetiological considerations such findings help to define the type of child worthy of further investigations of their speech problems. The children more often showed other disabilities, such as visual defect or squint, emphasizing the need for searching for other handicaps. They were more often rated as being clumsy by their teachers, perhaps indicating that a proportion might be associated with neurodevelopmental dysfunction. Perinatal factors were sought, but apart from the tendency for these children to be born before term abnormalities of pregnancy or labour were not found to be significantly more common than in controls.Over On the evidence available from these results there can be no question that children with speech defects at 7 years need and should be urgently provided with expert treatment and followup by speech therapists, not working in isolation but in conjunction with paediatricians, psychologists, psychiatrists, teachers, and parents.We should like to thank the local authority medical officers and teachers without whose help this investigation would not have been possible. We should also like to thank the National Children's Bureau, who mounted the National Child Development Study, and also Mr.
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