One of the most exciting achievements in medicine in the past decade has been the elucidation of the structure and physiological characteristics of releasing or inhibiting fac- tors for each of the classical hormones of the anterior pituitary. The treatment of propoxyphene overdose involves: (1) gastric emptying, (2) activated charcoal, and (3) naloxone. 5, May 1984 CONTENTS icientific Articles To Comfort Always: Strategies for Pain Management in Terminal Cancer Linda M. Kohl 283 The Clinical Management of Sore Throat: A Comparison of Three Ambulatory Settings Michael S. Poe 302 Allied Health Professionals An Update on Physician Assistants: The N. The move to reduce medical care costs has accentuated the importance of these efforts. Bodger GF, Jordan WS Jr: d/ness In fhe Home A Study af 25.000 Illnesses in a Group of Cleveland Families- Clevelond, The Press of Wes T- ern Reserve University, 1964 3 Komoroff AL, Aronson MD, Pass TM, Ervin CT, Branch WT Jr: Serologic evidence of chtomydiol and mycoplasmal phoryngitis in adults. Hohn EO: Comporo- live effects of penicillin, aureomycinond terromy- cin on streptococcol tonsililis and phoryngitis. Most health outhorities agree that attention to balanced diet and adequate caloric intake eliminates the need for supplemental vitamins for most people. Market St., Box 487, Hertford 27944 (1986) Vice-Councilor James M. This clinic is the state's only special migrant clinic that operates full-time year- round. Table 1 Federal and State Migrant Clinics Surveyed Federal Tri-County Community Healtti Center, Newton Grove fi/ligrant Family Health Service, Hendersonville State Albemarle North (Camden, Currituck, Pasquotank Counties) Carteret County Healtti Department Greene Health Care, Inc.
The first major breakthrough occurred in 1970 when the laboratories of Guillemin and Schally first isolated and characterized the structure of thyrotropin-releasing hormone or TRH. Ingestions as little as 10.7 mg/kg have caused toxicity; at 35 mg/kg cardiorespiratory arrest has been reported. Hoole 291 Pharmacotherapy Thrombolytic Therapy Ju He Jacobs 296 Medico-Legal Matters Premarital Legal Requirements in North Carolina Louise H. This is leoding to a change in the strategy for managing sore throats, with a relaxation of some of the former vigorous efforts used to diagnose and treat strep throats. No, not necessarily; in most coses, the American diet does not need supple- mentation. The Employment Security Commission estimates that there are 7,125 seasonal work- ers in the clinic's catchment area.
Otto Warburg 1883-1970 Thoughts upon looking at the 1983 commemorative issue of the Postal Service of West Germany in honor of his hun- dredth birthday, by waiter Kempner. Growth Hormone-Releasing Factor (GRF) Because of its potential usefulness in the treatment of dwarfism due to growth hormone deficiency, the isolation of the hypothalamic factor that stimulates growth hormone (GH) secretion by the pituitary has been eagerly awaited. Acetaminophen is the second part of this less-than- dynamic duo. Fat Soluble Vitamins Vitamin A (retinol) is necessary to prevent night blindness and drying of the conjunctiva, the mucous mem- brane that covers the eye. Bleeding is the most common symptom of vitamin K deficiency and it is usually associated with a serious illness. Warren 364 Fine Needle Aspiration Biopsy of the Lung Jan F. Johnsriide 368 Health Care Planning in North Carolina: Migrant Workers Program Michael F. Hayak 371 Society Profile Meet George Moore, Your New Executive Director Patricia K. Fahrner 395 Insulin Can Make Diabetes Worse: The Smoldering Smogyi Effect Linda M. Mack 401 Editorial Changing Perceptions of the End-Stage Renal Disease Program William B. 257 Mc Dowell St., Asheville 28803 Second Vice-President Lawrence M. All five clinics offering evening clinics were able to report numbers served.
There have been no reports in which CRF has been used therapeutically as a means of restoring adrenal function in patients with secondary adrenal insufficiency. von Werder K: Corticotropin-releasing factor A new tool for the differential diagnosis of Cushing's s\Tidrome, J Clin Endocrinol Metab 1983.7.229 11. The seizures should be treated with naloxone initially. S., but one thot could result in death if left untreated. Of the fat-soluble vitamins, vitamin E appears to be one of the least toxic in large amounts, although it is impor- tant to watch for interactions with anticoagulants and iron products. The MFHS and Greene Health Care clinic could not provide breakdown on refertals.
Within weeks following the report of this patient with apparent ectopic GRF secretion, the amino acid structure of the active peptide that had been purified from the patient's tumor was determined.'^ This peptide, referred to as hp GRF because of its origin in the human pancreas, has 40 amino acid residues. Acetaminophen overdose continues to be a big problem in at least two instances: (1) accidental ingestion by pre- school children. Vitamin B-1 or thiamine is re- quired for both carbohydrate metab- olism and nervous system function- ing. Medical Mutual Insurance Company of north Carolina MMIC ... Conclusions Shenkin has described accessibility as one of four char- acteristics upon which a health care program should be evaluated.^ Seven of eleven clinics contacted are located in counties with greater than 2,000 migrant and seasonal farmworkers in 1980.
Based on sequence homologies this GRF is closely related to the glucagon-secretin family of peptides derived from the gut. (2) purposeful ingestion by teenagers and young adults. Beriberi, the thiamine-deficiency state, is rare in the U. but occurs in areas where polished rice is the ma- jor ingredient of the diet. The TCCHC alone serves twenty- Table 3 Breakdown of Referrals Total Referrals Hospitalizations Outpatient Dental Clinic # % of OP # % of OP # % Of OP # % of OP Federal TCCHC 1,636 31.7 367- 7.1 962 18.6 309 6.0 State Albemarle 74 2.3 7 2.2 - 60 18.6 _ Hyde 127 70.6 6 3.3 99 55.0 22 12.2 Nash 5.0 * Includes all known Tiigrant hospitalizations from the TCCHC catchmen area.
The most direct route by which this influence might be exerted is by means of the nerve fibers or blood vessels of the hypophysial stalk. The adverse effects of propoxyphene include vertigo. Bowman Gray School of Medicine, Winston-Salem 27103, drowsiness, nausea and vomiting; less commonly, delu- sions, visual hallucinations, dysphonia, disorientation, abdominal pain and constipation can occur. Because our knowledge about strep throats and rheumatic fever is in o state of great flux, there is no con- sensus about the only way to manage sore throats. 6 Doctors Pk., Statonsburg Rd., Greenville 27834 (1985) Vice-Councilor Charles L. These centers are the TCCHC in Newton Grove and the Migrant Family Health Service (MFHS) in Henderson- ville.
r¥-i HE long-suspected connection between the brain and X the endocrine system and the search for hypothalamic hormones was begun nearly forty years ago, when Geof- frey Harris of Cambridge University reviewed the available evidence and came to a compelling conclusion: There is much experimental and clinical evidence that the hypothalamus is functionally linked with anterior pituitary activity. So far the drug is only available in oral form and is extremely damaging to veins if injected IV by the "serious" addict. Bolles 304 Features for Patients The Patient Has a Sore Throat. Terms such as "cost-effectiveness analysis" and "cost-benefit analysis" ore being used to describe efforts to develop the best treatment at the least possible cost. 310 Glenwood Ave., Kinston 28501 (1985) Third District R. In addition to county health departments, two locally administered migrant health centers receive funding from the federal government's Public Health Service, Depart- ment of Health and Human Services, the Office of Migrant Health of the Bureau of Health Care Delivery and Assist- ance.
In this article we will review the current knowledge relating to the two most recently discovered factors, corti- cotropin-releasing factor, or CRF, and growth hormone- releasing factor, or GRF. Activated charcoal works quite nicely here to bind the ingested propoxyphene remaining after gastric emptying. The time and mone\' I sav by working with Southern National i a big help. References 1- Gognon R, De Lozier J, Mc Lemore T: The National Ambulatory Medical Care Survey, Urited States, 1979 Summory, U. Deponmen T of Heol Th and Human Services, Public Heolth Service, Publ. Holmberg SD, Faich GA: Streptococcol phoryngitis and ocute rheumottc fever in Rhode Island. Again, very few of these people will derive much benefit from such therapy. Raleigh 27611 Councilors and Vice-Councilors — 1984-1985 First District Robert E. The TCCHC utilizes two nurse practitioners and one full-time physician while * Personal aommunication with Ms. This paper presents the results of a survey of eleven migrant health care programs in the state.
The names of the known factors and some of their major effects are summarized in table 1 . The use of gastric emptying in propoxyphene overdose can be very tricky; because of the propensity for coma, seizures and respiratory depression soon after an overdose, very "cautious" gastric lavage would seem to be the wiser course. NC Itsit TIRES "It's not easy these days for the small businessman to keep his inde pendence. NC SOUTHERN NATIONAL BANM \m can tc U \ c \ ant \ otir busixics: aans BB (te i NJorth Carolina 4EDICAL JOURNAL )r doctors and their patients lover illustration by Ernest Craige, M. In this climate the patient must remain in close communication with primary care physicians, so that mutually satisfactory management of sore throats in 1984 can be attained. Pediatrics 1953,11:7-13, 5 Report of the Eighty-Sixth Ross Conference on Pediatric Research, Monogement of Phoryngitis in on Era of Declining Rheumotrc Fever, 1984 6. Another segment of the American public seeks vitamin therapy for re- lief or cure of such i I Inesses as cancer, heart disease, and arthritis. The MFHS serves mainly Henderson, Polk, Burke, Haywood, and Rutherford counties, and migrants from northern South Carolina. As in many migrant clinics, nurse practi- tioners provide a majority of the care. (Greene County) Hyde County Health Department Nash County Health Department Prospect Hill Clinic (Caswell, Alamance Counties) Surry County Health Department Wilson County Health Department Yadkin County Health Department the MFHS employs three nurse practitioners and one part- time physician.
" Since all three peptides had identical sequences from their N-terminus, it was postulated that 11 ■. MJMtt JUtl M \im Ull JMII] L i JU hp GRF-40 and hp GRF-37 were biologically active frag- ments of hp GRF-44.'* Although not yet proven, there is increasing evidence that pancreatic GRF is structurally identical with hypo- thalamic GRF. Shizume K: Effects of bilateral adrenalectomy on immunoreactive corticotropin-releasing factor in the rat median eminence and intermediate-posterior pituitary. Liddle GW: The Adrenals in Textbook of Endocrinology (ed, RH Williams) 6th edition. Without a good history, the diagnosis of acetaminophen toxicity IS a very difficult one clinically and consists of about 3 phases. Psychosis, permanent neurologic damage and even death can result if this syn- drome is left untreated. Postmaster: Send address changes to North Carolina Medical Society, 222 N Person St.. "Medical Mutual was the right co mpany t hen a nd it is the right com pan y now. Further extensions of this theme are outreach programs and the suggestion of mobile clinics that travel to migrant camps.' With a defined migrant service mandate, federal pro- grams can better predict, plan, and utilize their facilities and staff to serve large numbers of migrants.