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Motor and Integrative Neurophysiology CHAPTER 54 Motor Functions of the Spinal Cord; the Cord Reflexes 673 Organization of the Spinal Cord for Motor Functions 673 Muscle Sensory ReceptorsMuscle Spindles and Golgi Tendon Organs And Their Roles in Muscle Control 675 Receptor Function of the Muscle Spindle 675 Muscle Stretch Reflex 676 Role of the Muscle Spindle in Voluntary Motor Activity 678 Clinical Applications of the Stretch Reflex 678 Golgi Tendon Reflex 679 Function of the Muscle Spindles and Golgi Tendon Organs in Conjunction with Motor Control from Higher Levels of the Brain 680 Flexor Reflex and the Withdrawal Reflexes 680 Crossed Extensor Reflex 681 Reciprocal Inhibition and Reciprocal Innervation 681 Reflexes of Posture and Locomotion 682 Postural and Locomotive Reflexes of the Cord 682 Scratch Reflex 683 Spinal Cord Reflexes That Cause Muscle Spasm 683 Autonomic Reflexes in the Spinal Cord 683 Spinal Cord Transection and Spinal Shock 684 CHAPTER 55 Cortical and Brain Stem Control of Motor Function 685 MOTOR CORTEX AND CORTICOSPINAL TRACT 685 Primary Motor Cortex 685 Premotor Area 686 Supplementary Motor Area 686 Some Specialized Areas of Motor Control Found in the Human Motor Cortex 686 Transmission of Signals from the Motor Cortex to the Muscles 687 Incoming Fiber Pathways to the Motor Cortex 688 Red Nucleus Serves as an Alternative Pathway for Transmitting Cortical Signals to the Spinal Cord 688 Extrapyramidal System 689 Excitation of the Spinal Cord Motor Control Areas by the Primary Motor Cortex and Red Nucleus 689 Role of the Brain Stem in Controlling Motor Function 691 Support of the Body Against Gravity Roles of the Reticular and Vestibular Nuclei 691 Vestibular Sensations and Maintenance of Equilibrium 692 Vestibular Apparatus 692 Function of the Utricle and Saccule in the Maintenance of Static Equilibrium 694 Detection of Head Rotation by the Semicircular Ducts 695 Vestibular Mechanisms for Stabilizing the Eyes 696 Other Factors Concerned with Equilibrium 696 Functions of Brain Stem Nuclei in Controlling Subconscious, Stereotyped Movements 697 CHAPTER 56 Contributions of the Cerebellum and Basal Ganglia to Overall Motor Control 698 Cerebellum and Its Motor Functions 698 Anatomical Functional Areas of the Cerebellum 699 Neuronal Circuit of the Cerebellum 700 Function of the Cerebellum in Overall Motor Control 703 Clinical Abnormalities of the Cerebellum 706 xxviii Table of Contents Basal GangliaTheir Motor Functions 707 Function of the Basal Ganglia in Executing Patterns of Motor ActivityThe Putamen Circuit 708 Role of the Basal Ganglia for Cognitive Control of Sequences of Motor Patterns The Caudate Circuit 709 Function of the Basal Ganglia to Change the Timing and to Scale the Intensity of Movements 709 Functions of Specific Neurotransmitter Substances in the Basal Ganglial System 710 Integration of the Many Parts of the Total Motor Control System 712 Spinal Level 712 Hindbrain Level 712 Motor Cortex Level 712 What Drives Us to Action? 713 CHAPTER 57 Cerebral Cortex, Intellectual Functions of the Brain, Learning and Memory 714 Physiologic Anatomy of the Cerebral Cortex 714 Functions of Specific Cortical Areas 715 Association Areas 716 Comprehensive Interpretative Function of the Posterior Superior Temporal Lobe Wernickes Area (a General Interpretative Area) 718 Functions of the Parieto-occipitotemporal Cortex in the Nondominant Hemisphere 719 Higher Intellectual Functions of the Prefrontal Association Areas 719 Function of the Brain in CommunicationLanguage Input and Language Output 720 Function of the Corpus Callosum and Anterior Commissure to Transfer Thoughts, Memories, Training, and Other Information Between the Two Cerebral Hemispheres 722 Thoughts, Consciousness, and Memory 723 MemoryRoles of Synaptic Facilitation and Synaptic Inhibition 723 Short-Term Memory 724 Intermediate Long-Term Memory 724 Long-Term Memory 725 Consolidation of Memory 725 CHAPTER 58 Behavioral and Motivational Mechanisms of the BrainThe Limbic System and the Hypothalamus 728 Activating-Driving Systems of the Brain 728 Control of Cerebral Activity by Continuous Excitatory Signals from the Brain Stem 728 Neurohormonal Control of Brain Activity 730 Limbic System 731 Functional Anatomy of the Limbic System; Key Position of the Hypothalamus 731 Hypothalamus, a Major Control Headquarters for the Limbic System 732 Vegetative and Endocrine Control Functions of the Hypothalamus 733 Behavioral Functions of the Hypothalamus and Associated Limbic Structures 734 Reward and Punishment Function of the Limbic System 735 Importance of Reward or Punishment in Behavior 736 Specific Functions of Other Parts of the Limbic System 736 Functions of the Hippocampus 736 Functions of the Amygdala 737 Function of the Limbic Cortex 738 CHAPTER 59 States of Brain ActivitySleep, Brain Waves, Epilepsy, Psychoses 739 Sleep 739 Slow-Wave Sleep 739 REM Sleep (Paradoxical Sleep, Desynchronized Sleep) 740 Basic Theories of Sleep 740 Physiologic Effects of Sleep 741 Brain Waves 741 Origin of Brain Waves 742 Effect of Varying Levels of Cerebral Activity on the Frequency of the EEG 743 Changes in the EEG at Different Stages of Wakefulness and Sleep 743 Epilepsy 743 Grand Mal Epilepsy 743 Petit Mal Epilepsy 744 Focal Epilepsy 744 Psychotic Behavior and Dementia Roles of Specific Neurotransmitter Systems 745 Depression and Manic-Depressive PsychosesDecreased Activity of the Norepinephrine and Serotonin Neurotransmitter Systems 745 SchizophreniaPossible Exaggerated Function of Part of the Dopamine System 745 Alzheimers DiseaseAmyloid Plaques and Depressed Memory 746 CHAPTER 60 The Autonomic Nervous System and the Adrenal Medulla 748 General Organization of the Autonomic Nervous System 748 Physiologic Anatomy of the Sympathetic Nervous System 748 Preganglionic and Postganglionic Sympathetic Neurons 748 Physiologic Anatomy of the Parasympathetic Nervous System 750 Basic Characteristics of Sympathetic and Parasympathetic Function 750 Cholinergic and Adrenergic Fibers Secretion of Acetylcholine or Norepinephrine 750 Receptors on the Effector Organs 752 Table of Contents xxix Excitatory and Inhibitory Actions of Sympathetic and Parasympathetic Stimulation 753 Effects of Sympathetic and Parasympathetic Stimulation on Specific Organs 753 Function of the Adrenal Medullae 755 Relation of Stimulus Rate to Degree of Sympathetic and Parasympathetic Effect 756 Sympathetic and Parasympathetic Tone 756 Denervation Supersensitivity of Sympathetic and Parasympathetic Organs after Denervation 756 Autonomic Reflexes 757 Stimulation of Discrete Organs in Some Instances and Mass Stimulation in Other Instances by the Sympathetic and Parasympathetic Systems 757 Alarm or Stress Response of the Sympathetic Nervous System 758 Medullary, Pontine, and Mesencephalic Control of the Autonomic Nervous System 758 Pharmacology of the Autonomic Nervous System 759 Drugs That Act on Adrenergic Effector OrgansSympathomimetic Drugs 759 Drugs That Act on Cholinergic Effector Organs 759 Drugs That Stimulate or Block Sympathetic and Parasympathetic Postganglionic Neurons 759 CHAPTER 61 Cerebral Blood Flow, Cerebrospinal Fluid, and Brain Metabolism 761 Cerebral Blood Flow 761 Normal Rate of Cerebral Blood Flow 761 Regulation of Cerebral Blood Flow 761 Cerebral Microcirculation 763 Cerebral Stroke Occurs When Cerebral Blood Vessels are Blocked 763 Cerebrospinal Fluid System 763 Cushioning Function of the Cerebrospinal Fluid 763 Formation, Flow, and Absorption of Cerebrospinal Fluid 764 Cerebrospinal Fluid Pressure 765 Obstruction to Flow of Cerebrospinal Fluid Can Cause Hydrocephalus 766 BloodCerebrospinal Fluid and Blood-Brain Barriers 766 Brain Edema 766 Brain Metabolism 767 UNIT XII Gastrointestinal Physiology CHAPTER 62 General Principles of Gastrointestinal FunctionMotility, Nervous Control, and Blood Circulation 771 General Principles of Gastrointestinal Motility 771 Physiological Anatomy of the Gastrointestinal Wall 771 Neural Control of Gastrointestinal FunctionEnteric Nervous System 773 Differences Between the Myenteric and Submucosal Plexuses 774 Types of Neurotransmitters Secreted by Enteric Neurons 775 Hormonal Control of Gastrointestinal Motility 776 Functional Types of Movements in the Gastrointestinal Tract 776 Propulsive MovementsPeristalsis 776 Mixing Movements 777 Gastrointestinal Blood Flow Splanchnic Circulation 777 Anatomy of the Gastrointestinal Blood Supply 778 Effect of Gut Activity and Metabolic Factors on Gastrointestinal Blood Flow 778 Nervous Control of Gastrointestinal Blood Flow 779 CHAPTER 63 Propulsion and Mixing of Food in the Alimentary Tract 781 Ingestion of Food 781 Mastication (Chewing) 781 Swallowing (Deglutition) 782 Motor Functions of the Stomach 784 Storage Function of the Stomach 784 Mixing and Propulsion Of Food in the StomachThe Basic Electrical Rhythm of the Stomach Wall 784 Stomach Emptying 785 Regulation of Stomach Emptying 785 Movements of the Small Intestine 786 Mixing Contractions (Segmentation Contractions) 786 Propulsive Movements 787 Function of the Ileocecal Valve 788 Movements of the Colon 788 Defecation 789 Other Autonomic Reflexes That Affect Bowel Activity 790 CHAPTER 64 Secretory Functions of the Alimentary Tract 791 General Principles of Alimentary Tract Secretion 791 Anatomical Types of Glands 791 Basic Mechanisms of Stimulation of the Alimentary Tract Glands 791 Basic Mechanism of Secretion by Glandular Cells 791 Lubricating and Protective Properties of Mucus, and Importance of Mucus in the Gastrointestinal Tract 793 Secretion of Saliva 793 Nervous Regulation of Salivary Secretion 794 Esophageal Secretion 795 xxx Table of Contents Gastric Secretion 794 Characteristics of the Gastric Secretions 794 Pyloric GlandsSecretion of Mucus and Gastrin 797 Surface Mucous Cells 797 Stimulation of Gastric Acid Secretion 797 Regulation of Pepsinogen Secretion 798 Inhibition of Gastric Secretion by Other Post-Stomach Intestinal Factors 798 Chemical Composition of Gastrin And Other Gastrointestinal Hormones 799 Pancreatic Secretion 799 Pancreatic Digestive Enzymes 799 Secretion of Bicarbonate Ions 800 Regulation of Pancreatic Secretion 800 Secretion of Bile by the Liver; Functions of the Biliary Tree 802 Physiologic Anatomy of Biliary Secretion 802 Function of Bile Salts in Fat Digestion and Absorption 804 Liver Secretion of Cholesterol and Gallstone Formation 804 Secretions of the Small Intestine 805 Secretion of Mucus by Brunners Glands in the Duodenum 805 Secretion of Intestinal Digestive Juices by the Crypts of Lieberkuhn 805 Regulation of Small Intestine Secretion Local Stimuli 806 Secretions of the Large Intestine 806 CHAPTER 65 Digestion and Absorption in the Gastrointestinal Tract 808 Digestion of the Various Foods by Hydrolysis 808 Digestion of Carbohydrates 809 Digestion of Proteins 810 Digestion of Fats 811 Basic Principles of Gastrointestinal Absorption 812 Anatomical Basis of Absorption 812 Absorption in the Small Intestine 813 Absorption of Water 814 Absorption of Ions 814 Absorption of Nutrients 815 Absorption in the Large Intestine: Formation of Feces 817 CHAPTER 66 Physiology of Gastrointestinal Disorders 819 Disorders of Swallowing and of the Esophagus 819 Disorders of the Stomach 819 Peptic Ulcer 820 Specific Causes of Peptic Ulcer in the Human Being 821 Disorders of the Small Intestine 821 Abnormal Digestion of Food in the Small IntestinePancreatic Failure 821 Malabsorption by the Small Intestine MucosaSprue 822 Disorders of the Large Intestine 822 Constipation 822 Diarrhea 822 Paralysis of Defecation in Spinal Cord Injuries 823 General Disorders of the Gastrointestinal Tract 823 Vomiting 823 Nausea 824 Gastrointestinal Obstruction 824 UNIT XIII Metabolism and Temperature Regulation CHAPTER 67 Metabolism of Carbohydrates, and Formation of Adenosine Triphosphate 829 Release of Energy from Foods, and the Concept of Free Energy 829 Role of Adenosine Triphosphate in Metabolism 829 Central Role of Glucose in Carbohydrate Metabolism 830 Transport of Glucose Through the Cell Membrane 831 Insulin Increases Facilitated Diffusion of Glucose 831 Phosphorylation of Glucose 831 Glycogen Is Stored in Liver and Muscle 831 GlycogenesisThe Process of Glycogen Formation 832 Removal of Stored Glycogen Glycogenolysis 832 Release of Energy from the Glucose Molecule by the Glycolytic Pathway 832 Summary of ATP Formation During the Breakdown of Glucose 836 Control of Energy Release from Stored Glycogen When the Body Needs Additional Energy 836 Anaerobic Release of EnergyAnaerobic Glycolysis 836 Release of Energy from Glucose by the Pentose Phosphate Pathway 837 Glucose Conversion to Glycogen or Fat 838 Formation of Carbohydrates from Proteins and FatsGluconeogenesis 838 Blood Glucose 839 CHAPTER 68 Lipid Metabolism 840 Transport of Lipids in the Body Fluids 840 Transport of Triglycerides and Other Lipids from the Gastrointestinal Tract by LymphThe Chylomicrons 840 Removal of the Chylomicrons from the Blood 841 Free Fatty Acids Are Transported in the Blood in Combination with Albumin 841 Table of Contents xxxi LipoproteinsTheir Special Function in Transporting Cholesterol and Phospholipids 841 Fat Deposits 842 Adipose Tissue 842 Liver Lipids 842 Use of Triglycerides for Energy: Formation of Adenosine Triphosphate 842 Formation of Acetoacetic Acid in the Liver and Its Transport in the Blood 844 Synthesis of Triglycerides from Carbohydrates 844 Synthesis of Triglycerides from Proteins 845 Regulation of Energy Release from Triglycerides 846 Obesity 846 Phospholipids and Cholesterol 846 Phospholipids 846 Cholesterol 847 Cellular Structural Functions of Phospholipids and Cholesterol Especially for Membranes 848 Atherosclerosis 848 Basic Causes of AtherosclerosisThe Roles of Cholesterol and Lipoproteins 850 Other Major Risk Factors for Atherosclerosis 850 Prevention of Atherosclerosis 850 CHAPTER 69 Protein Metabolism 852 Basic Properties 852 Amino Acids 852 Transport and Storage of Amino Acids 854 Blood Amino Acids 854 Storage of Amino Acids as Proteins in the Cells 854 Functional Roles of the Plasma Proteins 855 Essential and Nonessential Amino Acids 855 Obligatory Degradation of Proteins 857 Hormonal Regulation of Protein Metabolism 857 CHAPTER 70 The Liver as an Organ 859 Physiologic Anatomy of the Liver 859 Hepatic Vascular and Lymph Systems 859 Blood Flows Through the Liver from the Portal Vein and Hepatic Artery 860 The Liver Functions as a Blood Reservoir 860 The Liver Has Very High Lymph Flow 860 Regulation of Liver MassRegeneration 860 Hepatic Macrophage System Serves a Blood-Cleansing Function 861 Metabolic Functions of the Liver 861 Carbohydrate Metabolism 861 Fat Metabolism 861 Protein Metabolism 862 Other Metabolic Functions of the Liver 862 Measurement of Bilirubin in the Bile as a Clinical Diagnostic Tool 862 JaundiceExcess Bilirubin in the Extracellular Fluid 863 CHAPTER 71 Dietary Balances; Regulation of Feeding; Obesity and Starvation; Vitamins and Minerals 865 Energy Intake and Output Are Balanced Under Steady-State Conditions 865 Dietary Balances 865 Energy Available in Foods 865 Methods for Determining Metabolic Utilization of Proteins, Carbohydrates, and Fats 866 Regulation of Food Intake and Energy Storage 865 Neural Centers Regulate Food Intake 867 Factors That Regulate Quantity of Food Intake 870 Obesity 872 Decreased Physical Activity and Abnormal Feeding Regulation as Causes of Obesity 872 Treatment of Obesity 873 Inanition, Anorexia, and Cachexia 874 Starvation 874 Vitamins 875 Vitamin A 875 Thiamine (Vitamin B1) 875 Niacin 876 Riboflavin (Vitamin B2) 876 Vitamin B12 876 Folic Acid (Pteroylglutamic Acid) 877 Pyridoxine (Vitamin B6) 877 Pantothenic Acid 877 Ascorbic Acid (Vitamin C) 877 Vitamin D 878 Vitamin E 878 Vitamin K 878 Mineral Metabolism 878 CHAPTER 72 Energetics and Metabolic Rate 881 Adenosine Triphosphate (ATP) Functions as an Energy Currency in Metabolism 881 Phosphocreatine Functions as an Accessory Storage Depot for Energy and as an ATP Buffer 882 Anaerobic Versus Aerobic Energy 882 Summary of Energy Utilization by the Cells 883 Control of Energy Release in the Cell 884 Metabolic Rate 884 Measurement of the Whole-Body Metabolic Rate 885 Energy MetabolismFactors That Influence Energy Output 885 Overall Energy Requirements for Daily Activities 885 Basal Metabolic Rate (BMR)The Minimum Energy Expenditure for the Body to Exist 886 Energy Used for Physical Activities 887 Energy Used for Processing Food Thermogenic Effect of Food 887 Energy Used for Nonshivering ThermogenesisRole of Sympathetic Stimulation 887 xxxii Table of Contents CHAPTER 73 Body Temperature, Temperature Regulation, and Fever 889 Normal Body Temperatures 889 Body Temperature Is Controlled by Balancing Heat Production Against Heat Loss 889 Heat Production 889 Heat Loss 890 Regulation of Body TemperatureRole of the Hypothalamus 894 Neuronal Effector Mechanisms That Decrease or Increase Body Temperature 895 Concept of a Set-Point for Temperature Control 896 Behavioral Control of Body Temperature 897 Abnormalities of Body Temperature Regulation 898 Fever 898 Exposure of the Body to Extreme Cold 900 UNIT XIV Endocrinology and Reproduction CHAPTER 74 Introduction to Endocrinology 905 Coordination of Body Functions by Chemical Messengers 905 Chemical Structure and Synthesis of Hormones 906 Hormone Secretion, Transport, and Clearance from the Blood 908 Feedback Control of Hormone Secretion 909 Transport of Hormones in the Blood 909 Clearance of Hormones from the Blood 909 Mechanisms of Action of Hormones 910 Hormone Receptors and Their Activation 910 Intracellular Signaling After Hormone Receptor Activation 910 Second Messenger Mechanisms for Mediating Intracellular Hormonal Functions 912 Hormones That Act Mainly on the Genetic Machinery of the Cell 915 Measurement of Hormone Concentrations in the Blood 915 Radioimmunoassay 915 Enzyme-Linked Immunosorbent Assay (ELISA) 916 CHAPTER 75 Pituitary Hormones and Their Control by the Hypothalamus 918 Pituitary Gland and Its Relation to the Hypothalamus 918 Hypothalamus Controls Pituitary Secretion 919 Hypothalamic-Hypophysial Portal Blood Vessels of the Anterior Pituitary Gland 920 Physiological Functions of Growth Hormone 921 Growth Hormone Promotes Growth of Many Body Tissues 922 Growth Hormone Has Several Metabolic Effects 922 Growth Hormone Stimulates Cartilage and Bone Growth 923 Growth Hormone Exerts Much of Its Effect Through Intermediate Substances Called Somatomedins (Also Called Insulin-Like Growth Factors) 923 Regulation of Growth Hormone Secretion 924 Abnormalities of Growth Hormone Secretion 926 Posterior Pituitary Gland and Its Relation to the Hypothalamus 927 Chemical Structures of ADH and Oxytocin 928 Physiological Functions of ADH 928 Oxytocic Hormone 929 CHAPTER 76 Thyroid Metabolic Hormones 931 Synthesis and Secretion of the Thyroid Metabolic Hormones 931 Iodine Is Required for Formation of Thyroxine 931 Iodide Pump (Iodide Trapping) 932 Thyroglobulin, and Chemistry of Thyroxine and Triiodothyronine Formation 932 Release of Thyroxine and Triiodothyronine from the Thyroid Gland 933 Transport of Thyroxine and Triiodothyronine to Tissues 934 Physiologic Functions of the Thyroid Hormones 934 Thyroid Hormones Increase the Transcription of Large Numbers of Genes 934 Thyroid Hormones Increase Cellular Metabolic Activity 934 Effect of Thyroid Hormone on Growth 936 Effects of Thyroid Hormone on Specific Bodily Mechanisms 936 Regulation of Thyroid Hormone Secretion 938 Anterior Pituitary Secretion of TSH Is Regulated by Thyrotropin-Releasing Hormone from the Hypothalamus 938 Feedback Effect of Thyroid Hormone to Decrease Anterior Pituitary Secretion of TSH 939 Diseases of the Thyroid 940 Hyperthyroidism 940 Symptoms of Hyperthyroidism 940 Hypothyroidism 941 Cretinism 942 CHAPTER 77 Adrenocortical Hormones 944 Synthesis and Secretion of Adrenocortical Hormones 944 Functions of the Mineralocorticoids-Aldosterone 947 Renal and Circulatory Effects of Aldosterone 948 Aldosterone Stimulates Sodium and Potassium Transport in Sweat Glands, Salivary Glands, and Intestinal Epithelial Cells 949 Table of Contents xxxiii Cellular Mechanism of Aldosterone Action 950 Possible Nongenomic Actions of Aldosterone and Other Steroid Hormones 950 Regulation of Aldosterone Secretion 950 Functions of the Glucocorticoids 950 Effects of Cortisol on Carbohydrate Metabolism 951 Effects of Cortisol on Protein Metabolism 952 Effects of Cortisol on Fat Metabolism 952 Cortisol Is Important in Resisting Stress and Inflammation 952 Other Effects of Cortisol 954 Cellular Mechanism of Cortisol Action 954 Regulation of Cortisol Secretion by Adrenocorticotropic Hormone from the Pituitary Gland 955 Adrenal Androgens 957 Abnormalities of Adrenocortical Secretion 957 Hypoadrenalism-Addisons Disease 957 Hyperadrenalism-Cushings Syndrome 958 Primary Aldosteronism (Conns Syndrome) 959 Adrenogenital Syndrome 959 CHAPTER 78 Insulin, Glucagon, and Diabetes Mellitus 961 Insulin and Its Metabolic Effects 961 Effect of Insulin on Carbohydrate Metabolism 963 Effect of Insulin on Fat Metabolism 965 Effect of Insulin on Protein Metabolism and on Growth 966 Mechanisms of Insulin Secretion 967 Control of Insulin Secretion 968 Other Factors That Stimulate Insulin Secretion 969 Role of Insulin (and Other Hormones) in Switching Between Carbohydrate and Lipid Metabolism 969 Glucagon and Its Functions 970 Effects on Glucose Metabolism 970 Regulation of Glucagon Secretion 971 Somatostatin Inhibits Glucagon and Insulin Secretion 971 Summary of Blood Glucose Regulation 971 Diabetes Mellitus 972 Type I DiabetesLack of Insulin Production by Beta Cells of the Pancreas 972 Type II DiabetesResistance to the Metabolic Effects of Insulin 974 Physiology of Diagnosis of Diabetes Mellitus 975 Treatment of Diabetes 976 InsulinomaHyperinsulinism 976 CHAPTER 79 Parathyroid Hormone, Calcitonin, Calcium and Phosphate Metabolism, Vitamin D, Bone, and Teeth 978 Overview of Calcium and Phosphate Regulation in the Extracellular Fluid and Plasma 978 Calcium in the Plasma and Interstitial Fluid 978 Inorganic Phosphate in the Extracellular Fluids 979 Non-Bone Physiologic Effects of Altered Calcium and Phosphate Concentrations in the Body Fluids 979 Absorption and Excretion of Calcium and Phosphate 980 Bone and Its Relation to Extracellular Calcium and Phosphate 980 Precipitation and Absorption of Calcium and Phosphate in BoneEquilibrium with the Extracellular Fluids 981 Calcium Exchange Between Bone and Extracellular Fluid 982 Deposition and Absorption of Bone Remodeling of Bone 982 Vitamin D 983 Actions of Vitamin D 985 Parathyroid Hormone 985 Effect of Parathyroid Hormone on Calcium and Phosphate Concentrations in the Extracellular Fluid 986 Control of Parathyroid Secretion by Calcium Ion Concentration 988 Calcitonin 988 Summary of Control of Calcium Ion Concentration 989 Pathophysiology of Parathyroid Hormone, Vitamin D, and Bone Disease 990 Primary Hyperparathyroidism 990 Secondary Parathyroidism 991 RicketsVitamin D Deficiency 991 OsteoporosisDecreased Bone Matrix 991 Physiology of the Teeth 992 Function of the Different Parts of the Teeth 992 Dentition 993 Mineral Exchange in Teeth 993 Dental Abnormalities 994 CHAPTER 80 Reproductive and Hormonal Functions of the Male (and Function of the Pineal Gland) 996 Physiologic Anatomy of the Male Sexual Organs 996 Spermatogenesis 996 Steps of Spermatogenesis 996 Function of the Seminal Vesicles 999 Function of the Prostate Gland 999 Semen 999 Male Sexual Act 1001 Abnormal Spermatogenesis and Male Fertility 1001 Neuronal Stimulus for Performance of the Male Sexual Act 1001 Stages of the Male Sexual Act 1002 Testosterone and Other Male Sex Hormones 1003 Secretion, Metabolism, and Chemistry of the Male Sex Hormone 1003 Functions of Testosterone 1004 Basic Intracellular Mechanism of Action of Testosterone 1006 xxxiv Table of Contents Control of Male Sexual Functions by Hormones from the Hypothalamus and Anterior Pituitary Gland 1006 Abnormalities of Male Sexual Function 1008 Prostate Gland and Its Abnormalities 1008 Hypogonadism in the Male 1008 Testicular Tumors and Hypergonadism in the Male 1009 Pineal GlandIts Function in Controlling Seasonal Fertility in Some Animals 1009 CHAPTER 81 Female Physiology Before Pregnancy and Female Hormones 1011 Physiologic Anatomy of the Female Sexual Organs 1011 Female Hormonal System 1011 Monthly Ovarian Cycle; Function of the Gonadotropic Hormones 1012 Gonadotropic Hormones and Their Effects on the Ovaries 1012 Ovarian Follicle GrowthThe Follicular Phase of the Ovarian Cycle 1013 Corpus LuteumLuteal Phase of the Ovarian Cycle 1014 Summary 1015 Functions of the Ovarian Hormones Estradiol and Progesterone 1016 Chemistry of the Sex Hormones 1016 Functions of the EstrogensTheir Effects on the Primary and Secondary Female Sex Characteristics 1017 Functions of Progesterone 1018 Monthly Endometrial Cycle and Menstruation 1018 Regulation of the Female Monthly RhythmInterplay Between the Ovarian and Hypothalamic-Pituitary Hormones 1019 Feedback Oscillation of the Hypothalamic-Pituitary-Ovarian System 1021 Puberty and Menarche 1021 Menopause 1022 Abnormalities of Secretion by the Ovaries 1023 Female Sexual Act 1023 Female Fertility 1024 CHAPTER 82 Pregnancy and Lactation 1027 Maturation and Fertilization of the Ovum 1027 Transport of the Fertilized Ovum in the Fallopian Tube 1028 Implantation of the Blastocyst in the Uterus 1029 Early Nutrition of the Embryo 1029 Function of the Placenta 1029 Developmental and Physiologic Anatomy of the Placenta 1029 Hormonal Factors in Pregnancy 1031 Human Chorionic Gonadotropin and Its Effect to Cause Persistence of the Corpus Luteum and to Prevent Menstruation 1032 Secretion of Estrogens by the Placenta 1032 Secretion of Progesterone by the Placenta 1033 Human Chorionic Somatomammotropin 1033 Other Hormonal Factors in Pregnancy 1034 Response of the Mothers Body to Pregnancy 1034 Changes in the Maternal Circulatory System During Pregnancy 1035 Parturition 1036 Increased Uterine Excitability Near Term 1036 Onset of LaborA Positive Feedback Mechanism for Its Initiation 1037 Abdominal Muscle Contractions During Labor 1037 Mechanics of Parturition 1037 Separation and Delivery of the Placenta 1038 Labor Pains 1038 Involution of the Uterus After Parturition 1038 Lactation 1038 Development of the Breasts 1038 Initiation of LactationFunction of Prolactin 1039 Ejection (or Let-Down) Process in Milk SecretionFunction of Oxytocin 1040 Milk Composition and the Metabolic Drain on the Mother Caused by Lactation 1041 CHAPTER 83 Fetal and Neonatal Physiology 1042 Growth and Functional Development of the Fetus 1042 Development of the Organ Systems 1042 Adjustments of the Infant to Extrauterine Life 1044 Onset of Breathing 1044 Circulatory Readjustments at Birth 1045 Nutrition of the Neonate 1047 Special Functional Problems in the Neonate 1047 Respiratory System 1047 Circulation 1047 Fluid Balance, Acid-Base Balance, and Renal Function 1048 Liver Function 1048 Digestion, Absorption, and Metabolism of Energy Foods; and Nutrition 1048 Immunity 1049 Endocrine Problems 1049 Special Problems of Prematurity 1050 Immature Development of the Premature Infant 1050 Instability of the Homeostatic Control Systems in the Premature Infant 1050 Danger of Blindness Caused by Excess Oxygen Therapy in the Premature Infant 1051 Growth and Development of the Child 1051 Behavioral Growth 1052 UNIT XV Sports Physiology CHAPTER 84 Sports Physiology 1055 Muscles in Exercise 1055 Strength, Power, and Endurance of Muscles 1055 Muscle Metabolic Systems in Exercise 1056 Phosphocreatine-Creatine System 1057 Table of Contents xxxv Nutrients Used During Muscle Activity 1059 Body Fluids and Salt in Exercise 1065 Effect of Athletic Training on Muscles and Drugs and Athletes 1065 Muscle Performance 1060 Body Fitness 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