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PART Ⅰ．PATHOLOGIC PHYSIOLOGY1

CHAPTER 1 Pathologic Physiology＆By WILLIAM A．SODEMAN3

ETIOLOGY OF DISEASE3

Primary Factors3

Secondary Factors4

BODY RESPONSES TO ETIOLOGIC AGENTS5

REFERENCES6

PART Ⅱ．GENETICS AND DISEASE7

CHAPTER 2 Genetics and Disease＆By BENJAMIN R．GENDEL9

INTRODUCTION9

THE PHYSICAL BASIS OF INHERITANCE9

Genes9

Chromosomes10

Mitosis and Meiosis10

Determination of Sex12

Nondisjunction12

Hereditary Variations12

MECHANISMS OF INHERITANCE14

Dominant Inheritance15

Recessive Inheritance16

Intermediate Inheritance or Incomplete Dominance17

Sex-Linked Inheritance18

Sex-Influenced Inheritance19

TYPES OF GENETIC DISEASES20

The Mutant Gene and Mechanisms of Gene Action20

Lethals20

Morphologic-Embryologic Defects20

Inborn Errors of Metabolism21

Abiotrophic Disturbances26

Immunologic Disturbances26

Susceptibility to Infectious Diseases27

Detoxification of Drugs27

Chromosomal Accidents29

Klinefelter＇s Syndrome29

Turner＇s Syndrome30

Mongolism31

Miscellaneous Conditions31

REFERENCES32

PART Ⅲ．METABOLISM AND THE ENDOCRINE GLANDS33

CHAPTER 3 Nutritional Factors;Protein and Fat Metabolism＆By WILLIAM A．SODEMAN35

INTRODUCTION35

PROTEINS38

Protein Deficiency41

FATS43

CALORIES45

General Metabolism45

Obesity47

Caloric Deficiency48

VITAMINS49

Vitamin A50

The Vitamin B Complex51

Ascorbic Acid(Vitamin C)58

Vitamin D and Calcium61

Vitamin E63

Vitamin K63

Hypervitaminoses64

MINERALS65

Magnesium66

Cobalt66

Copper66

Iodine66

Fluorine67

Iron67

REFERENCES68

CHAPTER 4 Carbohydrate Metabolism＆By HENRY T．RICKETTS AND MAURICE E．KRAHL70

THE CHEMISTRY OF CARBOHYDRATE UTILIZATION70

REGULATORY MECHANISMS OF CARBOHYDRATE METABOLISM71

The Pancreas72

Other Endocrine Glands73

PHYSIOLOGIC EFFECTS OF THE ORAL HYPOGLYCEMIC AGENTS74

THE GLUCOSE TOLERANCE TEST75

CLINICAL ABNORMALITIES OF CARBOHYDRATE METABOLISM77

Inborn Metabolic Errors77

Diabetes Mellitus77

Hypoglycemia82

Organic Hypoglycemia82

Functional Hypoglycemia83

REFERENCES84

CHAPTER 5 Water and Electrolyte Balance＆By C．THORPE RAY86

VOLUMES AND COMPOSITION OF BODY FLUIDS88

Measurements of the Volumes of Body Fluids88

Characteristics of Intracellular and Extracellular Fluids89

Exchanges of Fluids between Cellular and Extracellular Spaces90

Exchanges of Fluids between Vascular and Extravascular Spaces91

EXTERNAL EXCHANGES OF FLUIDS—WATER BALANCE93

The Effect of Solute Load on Water Excretion94

The Effect of the Antidiuretic Hormone on Water Excretion95

Turnover of Body Water97

ELECTROLYTIC BALANCE97

Sodium97

Sodium Content of the Body98

Shifts of Sodium Between Compartments98

Sodium Balance99

Factors Which Influence Sodium Excretion by the Kidneys99

Clinical Examples of Disorders in Sodium Balance100

Chloride104

The Chloride Content of the Body104

Chloride Balance104

Factors Influencing Renal Excretion of Chloride105

Clinical Examples of Disorders in Chloride Balance105

Potassium105

Potassium Content of the Body106

Shifts of Potassium between Compartments106

Potassium Balance107

Factors Which Influence Renal Excretion of Potassium108

Clinical Examples of Disorders in Potassium Balance108

CALCIUM AND MAGNESIUM113

Calcium113

Magnesium114

ACID-BASE EQUILIBRIUM115

Mechanisms of Production of Alkalosis and Acidosis116

Respiratory Acidosis116

Respiratory Alkalosis117

Metabolic Acidosis117

Metabolic Alkalosis119

REFERENCES120

CHAPTER 6 Endocrine Glands＆By EDWARD C．REIFENSTEIN,JR．122

GENERAL CONSIDERATIONS122

Definitions122

General Outline of Hormone Relations122

Classification of Hormone Actions123

Objectives of Hormone Therapy124

Natural versus Artificial”Hormones＂125

The Hormone Content of the Glands125

Intermediary Metabolism in Disease126

RESUME OF GLANDULAR PHYSIOLOGY126

Hypothalamus126

Anterior Pituitary127

Posterior Pituitary128

Ovary129

Testis130

Adrenal Cortex130

Adrenal Medulla132

Thyroid133

Parathyroids133

Pancreas134

Placenta135

DYNAMIC PHYSIOLOGY OF THE HORMONES136

PATHOLOGIC PHYSIOLOGY OF THE MAIN ENDOCRINE ABNORMALITIES142

Hypothalamic Precocity143

Fr？hlich＇s Syndrome143

Adolescent Mammoplasia144

Hypothalamic or Psychogenic Amenorrhea144

Acromegaly146

Panhypopituitarism(Simmonds＇ Cachexia,Sheehan＇s Syndrome,Pituitary Dwarfism)149

Pituitary Amenorrhea151

Cushing＇s Syndrome151

Primary Hyperaldosteronism(Conn＇s Syndrome)154

Primary Hypoaldosteronism155

Adaptation Syndrome155

Disorders of Adaptation;Effects of Pituitary Adrenocorticotropic Hormone and of Adrenal Cortical Steroid Hormones in Nonendocrine Disorders156

Addison＇s Disease and Adrenal Cortical Insufficiency159

Adrenogenital Syndrome160

Adrenal Androgen Hyperfunction Syndromes(Stein-Leventhal Syndrome;Large,Pale Ovary Syndrome)161

Pheochromocytoma163

Diabetes Insipidus163

Menopause and the Menopausal Syndrome164

Postmenopausal and Senile Osteoporosis165

Gonadal Dysgenesis(Ovarian Agenesis,Turner＇s Syndrome,Ovarian Short-Stature Syndrome,Functional Prepuberal Castration)167

Amenorrhea168

Dysfunctional Uterine Bleeding(Metropathia Hemorrhagica)170

Presumptive Test for Pregnancy172

Dysmenorrhea and Endometriosis172

Premenstrual Tension175

Anorexia Nervosa175

Arrhenoblastoma176

Granulosa Tumors,Theca Cell Tumors,and Luteomas176

Hypoleydigism176

Hypospermatogenesis177

Seminiferous Tubule Dysgenesis(Gynecomastia-and-Small-Testes Syndrome,Klinefelter＇s Syndrome)178

Cryptorchidism179

Male＂Climacteric＂181

Teratoma,Chorio-epithelioma,and Choriocarcinoma181

Leydig Cell Tumor182

Cretinism and Myxedema(Hypothyroidism)182

Thyrotoxicosis(Hyperthyroidism)182

Exophthalmic Goiter(Graves＇ Disease)184

Simple Goiter185

Thyroiditis185

Hypoparathyroidism185

Pseudohypoparathyroidism186

Hyperparathyroidism186

Diabetes Mellitus188

Hyperinsulinism188

Pregnancy Toxemia Complicating Diabetes Mellitus189

Recurrent and Theatened Abortion190

Postpartum Breast Manifestations191

Endocrine Therapy for Neoplastic Disease192

SUMMARY192

REFERENCES193

PART Ⅳ．INFECTION AND ALLERGY195

CHAPTER 7 Factors Affecting Infections＆By GEORGE T．HARRELL,JR．197

FACTORS CONCERNED IN THE NUMBER OF INFECTING ORGANISMS198

Sources of Infection198

Agents of Disease199

Portal of Entry201

Transmission by Vectors201

Growth in the Body202

FACTORS CONCERNED IN THE VIRULENCE OF THE INFECTING ORGANISM204

Primary and Secondary Infections204

Conditions Necessary for Infection205

Routes of Spread205

Increase in Virulence206

Reduction in Virulence207

Variations in Strains208

FACTORS CONCERNED IN RESISTANCE209

Nonspecific Factors210

Specific Resistance214

REFERENCES214

CHAPTER 8 Effects of Infection＆By GEORGE T．HARRELL,JR．215

INFLAMMATION AND FEVER215

DAMAGE TO ORGANS216

Direct or Immediate Effects216

Indirect or Long-Term Effects221

The Lungs221

The Kidneys222

The Heart223

Effects Not Accompanied by Anatomic Change224

Circulatory Disturbances224

Chills224

Rash225

Central Circulatory Failure225

Peripheral Circulatory Failure226

Disturbances of Venous Circulation230

Disturbances of the Lymphatic Circulation232

INDIRECT EFFECTS ASSOCIATED WITH DISTANT INFECTION232

REFERENCES233

CHAPTER 9 Recovery from Infection＆By GEORGE T．HARRELL,JR．235

IMMUNITY235

Application to Diagnosis236

Circulating Antibodies237

Cellular Antibodies239

Criterion of Cure240

Response to Reinfections241

Harmful Effects242

SUPPORTIVE THERAPY243

Rest243

Diet244

Vitamins245

Fluids247

Minerals248

Measures to Decrease Metabolism248

Measures to Support the Circulation249

REFERENCES250

CHAPTER 10 Alteration of the Course of an Infection＆By GEORGE T．HARRELL,JR．251

PREVENTION251

Control of Environment251

Active Immunization253

Passive Immunization254

CHEMOTHERAPY255

Antiseptics258

Sulfonamides259

Antibiotics260

Other Chemotherapeutic Agents261

Toxic Effects262

IMMUNE THERAPY263

Hypersensitivity Reactions265

OTHER MEASURES265

Physical Therapy265

Biologic Therapy266

Desensitization266

Breakdown of Granulomas267

Inhibition of Antigen-Antibody Reactions267

REFERENCES268

CHAPTER 11 Allergy＆By ROBERT A．COOKE AND WILLIAM B．SHERMAN269

INTRODUCTION269

ANAPHYLAXIS IN EXPERIMENTAL ANIMALS270

Arthus Phenomenon272

ANAPHYLAXIS IN MAN272

Serum Sickness273

CLINICAL ALLERGIES274

Allergies with Immediate Wheal Reactions274

Late Reactions to Food Allergens278

Asthma,Rhinitis and Urticaria Due to Infection278

Delayed and Immediate Reactions to Infective Agents279

Allergic Dermatitis281

Drug Allergies282

EFFECTS OF CORTISONE AND CORTICOTROPIN ON ALLERGIC REACTIONS283

REFERENCES283

PART Ⅴ．PHYSICAL,TOXIC AND CHEMICAL AGENTS285

CHAPTER 12 Physical and Toxic Agents＆By WILLIAM BEAN287

INTRODUCTION287

ENVIRONMENTAL TEMPERATURE288

Heat288

Source of Heat288

Heat Load288

The Basic Heat Equation289

Acclimatization290

Syncope293

Upper Environmental Limits293

Disease Due to Effect of Heat294

Cold296

Source of Cold296

Acclimatization297

Effects of Cold297

Treatment299

AEROMEDICINE300

Syndromes Produced by Free Gas301

MECHANICAL AND HYDRAULIC FACTORS306

Missile Injury306

Blast306

Motion Sickness and Seasickness307

Gravity and Acceleration307

RADIUM,ROENTGEN RAYS,RADIOACTIVE SUBSTANCES AND ATOMIC FACTORS308

ELECTRICAL INJURIES312

MAN IN SPACE:A NEW DIMENSION313

CONCLUDING REMARKS317

REFERENCES318

CHAPTER 13 Chemical Agents and Disease＆By JOHN H．FOULGER320

INTRODUCTION320

GENERAL DISCUSSION OF THE ACTION OF CHEMICALS321

ROUTES OF ENTRY OF CHEMICALS324

Inhalation of Chemicals324

Absorption through the Skin327

Absorption by the Gastrointestinal Tract328

SYMPTOMATOLOGY ASSOCIATED WITH TOXIC CHEMICAL AGENTS328

Symptoms Arising from Irritation and Damage at the Site of Entrance328

Symptoms Arising from Action at the Site of Excretion329

Results of Selective Action of Chemicals on Metabolic Processes,Enzyme Systems and Other Cellular Functions330

EVIDENCES OF ABSORPTION OF CHEMICALS331

Early Results of Absorption of Chemicals331

Changes in Blood Pressure333

Pulse Rates335

Changes in Low Frequency Cardiac Vibrations335

Electrocardiographic Changes336

Other Physiologic Changes337

MECHANISMS OF ACTION OF FOREIGN CHEMICALS337

REFERENCES339

PART Ⅵ．CIRCULATORY SYSTEM341

CHAPTER 14 Hemodynamics:The Blood Vessels＆By W．A．SODEMAN343

GENERAL HEMODYNAMICS343

The Effects of Elasticity344

Arteriosclerosis344

Changes in Velocity and Pressure346

Arterial Pulse349

Means of Recording and Studying the Pulse349

Venous Pulse353

EVIDENCES OF PERIPHERAL VASCULAR DISEASE354

Pain355

Skin Color357

Skin Temperature359

Oscillometric Index360

Visualization of Vessels360

BLOOD PRESSURE361

Arterial Blood Pressure362

Measurement362

Factors Maintaining Pulse Pressure366

Arterial Hypertension370

Hypotension376

Syncope377

Shock380

Venous Pressure383

Measurement385

Elevation of Venous Pressure386

Reduction in Venous Pressure387

Disturbances in Venous Circulation388

CAPILLARIES389

BLOOD VELOCITY AND CIRCULATION TIME390

Circulation Time391

Circulation Rate392

THE LESSER CIRCULATION392

THE LYMPHATICS392

THE EFFECT OF PREGNANCY ON THE CIRCULATION393

REFERENCES393

CHAPTER 15 Dynamics and Circulation of Heart Muscles;Cardiac Reserve;Heart Pain;The Cardiac Cycle＆By J．T．ROBERTS395

CARDIAC DYNAMICS395

Structure of the Heart395

Sino-Atrioventricular System399

Muscle Fibers401

Dynamic Properties of Cardiac Muscle403

CIRCULATION IN THE HEART408

Coronary Arteriosclerosis414

Coronary Blood Flow415

CARDIAC RESERVE420

Measurement423

CARDIAC PAIN AND CARDIAC NERVES424

THE CARDIAC CYCLE428

Dynamic Interval of Atrial Systole429

Inflów Phase of Atrial Systole430

Isometric Ventricular Contraction430

Isotonic Ventricular Contraction with Maximum Ejection Phase430

Ventricular Contraction with Reduced Ejection Phase431

Protodiastolic Phase of Diastole431

Isometric Relaxation Phase of Diastole432

Rapid Inflow or Rapid Filling Phase of Ventricular Diastole432

Diastasis Phase433

Abnormalities of Cardiac Rate and Rhythm433

CARDIAC SOUNDS,MURMURS AND THRILLS441

REFERENCES447

CHAPTER 16 The Electrocardiogram＆By F．D．JOHNSTON449

STANDARD LEADS453

SPREAD OF ACTIVATION WAVE459

UNIPOLAR EXTREMITY LEADS462

PRECORDIAL LEADS463

T WAVES AND VENTRICULAR GRADIENT468

REFERENCES470

CHAPTER 17 Cardiac Output;Hypertrophy and Dilatation;Valvular Diseases;Congenital Defects;Pericardial Diseases;Extracardiac Factors＆By EDGAR HULL472

THE OUTPUT OF THE HEART472

Methods of Estimation472

The Fick Principle472

The Dye Dilution Principle474

Dye Injection Method474

Physical Methods474

Expression of the Cardiac Output477

Normal Cardiac Output477

Abnormalities of Cardiac Output Not Related to Cardiovascular Disease477

The Cardiac Output in Cardiovascular Abnormalities478

Cardiac Arrhythmias479

Valvular Disease480

Heart Failure480

Myocardial Infarction481

Pericardial Disease481

Vascular Fistulas and Septal Defects481

HYPERTROPHY AND DILATATION OF THE HEART481

Ventricular Dilatation and Hypertrophy481

Dilatation481

Hypertrophy483

Hypertrophy and Dilatation of the Atria486

VALVULAR DISEASE OF THE HEART487

General Considerations487

Mitral Valve Disease488

Mitral Insufficiency488

Mitral Stenosis490

Mitral Insufficiency and Stenosis493

Cardiac Catheterization in Mitral Disease493

Surgery of the Mitral Valve496

Disease of the Aortic Valve496

Aortic Stenosis496

Aortic Insufficiency500

Aortic Stenosis and Insufficiency503

Tricuspid Valve Disease503

Tricuspid Insufficiency504

Tricuspid Stenosis504

Tricuspid Insufficiency and Stenosis505

Pulmonary Valve Disease505

Cardiac Catheterization in Pulmonary Stenosis507

Surgery for Pulmonary Stenosis507

Combined Valvular Disease507

CONGENITAL CARDIOVASCULAR DEFECTS508

Atrial Septal Defect509

Anomalous Pulmonary Veins512

Pulmonary Hypertension in Atrial Septum Defects514

Right-to-Left Shunting in Atrial Septal Defect514

Pulmonary Stenosis with Patent Atrial Septum515

Ostium Primum Deficit515

Lutembacher＇s Complex515

Ventricular Septal Defect516

Pulmonary Hypertension in Ventricular Septal Defect517

Right-to-Left Shunting in Ventricular Septal Defect518

Ventricular Septal Defect with Pulmonary Stenosis(Tetralogy of Fallot)519

Patent Ductus Arteriosus520

Coarctation of the Aorta521

Pulse Pressures,Systolic Pressures,Pulse Forms523

Mean Pressures524

Diastolic Pressures525

Cardiac Catheterization in the Study of Congenital Heart Disease526

Data Obtainable by Comparative Oxygen Content of Blood Samples526

Intracardiac and Pulmonary Arterial Pressures in Congenital Defects530

Dye Injection Techniques in the Study of Congenital Anomalies530

Gas Inhalation531

Surgery for Congenital Cardiovascular Defects532

Corrective Surgery532

Palliative Surgery533

PERICARDIAL DISEASE534

Hemopericardium534

Pericardial Effusion534

Constrictive Pericarditis534

Pulsus Paradoxus and Inspiratory Distention of the Neck Veins537

Cardiac Catheterization in Constrictive Pericarditis538

EXTRACARDIAC CONDITIONS AFFECTING FUNCTION OF THE HEART538

Hypertension539

Hypotension539

Anemia539

Hyperthyroidism539

Hypothyroidism540

Pulmonary Disease540

Pulmonary Embolism and Thrombosis;Primary Pulmonary Hypertension540

Fever541

Infectious,Metabolic and Toxic States541

REFERENCES542

CHAPTER 18 Cardiac Failure and Function Tests＆By JOHN S．LA DUE551

CARDIAC DECOMPENSATION551

Mechanisms of Congestive Heart Failure553

Pathologic554

Metabolic555

Hemodynamic556

Mechanism of Compensation561

Manifestations of Left-Sided Heart Failure566

Dyspnea566

Pulmonary Edema568

Hydrothorax568

Vital Capacity568

Circulation Time568

Other Findings569

Right-Sided Heart Failure569

Blood Volume569

Edema571

Cyanosis573

Treatment of Congestive Heart Failure573

ANGINA PECTORIS,CORONARY INSUFFICIENCY AND MYOCARDIAL INFARCTION576

Angina Pectoris577

Coronary Insufficiency(Myocardial Ischemia)578

Myocardial Infarction579

CARDIAC FUNCTION TESTS581

Introduction581

Anoxemia Test582

Standard Exercise Test583

Master＇s and Donoso＇s Criteria584

Vital Capacity585

Oxygen Debt586

REFERENCES587

PART Ⅶ．RESPIRATORY SYSTEM589

CHAPTER 19 Pulmonary Ventilation and Respiration;Tests of Respiratory Function＆By JOHN H．SEABURY591

INTRODUCTION591

ANATOMICO-PHYSIOLOGIC RELATIONS592

Intrathoracic Pressure593

Work of Breathing594

PULMONARY VOLUMINA595

REGULATION OF PULMONARY VENTILATION599

Reflex Control601

Voluntary Control602

PULMONARY RESPIRATION AND ITS REGULATION603

The Circulation in the Lung603

Control of the Pulmonary Circulation605

Regulation of Pulmonary Respiration606

Acid-Base Balance608

Acidosis and Alkalosis610

Anoxia611

Cyanosis613

ABNORMALITIES OF BREATHING614

Quantitative Arrhythmias614

Periodic Breathing615

Qualitative Arrhythmias616

THE CLINICAL EVALUATION OF PULMONARY FUNCTION617

Measurement618

PULMONARY FUNCTION IN DISEASE624

REFERENCES627

CHAPTER 20 Protective Mechanisms of the Lungs;Pulmonary Disease;Pleural Disease＆By JOHN H．KILLOUGH629

INTRODUCTION629

Nasopharynx629

Trachea and Bronchi630

Alveoli631

PROTECTIVE MECHANISMS631

PULMONARY DISEASE634

Bronchial Asthma634

Emphysema635

Eosinophilic Pulmonary Infiltration(Loeffler＇s Syndrome)637

Pulmonary Alveolar Proteinosis638

Congenital Cystic Disease639

Pulmonary Arteriosclerosis639

Pulmonary Embolism640

Pneumoconiosis641

Pulmonary Fibrosis642

Atelectasis642

Tumor of the Lung644

Pulmonary Infections644

Acute Tracheitis and Bronchitis645

Chronic Bronchitis645

Lung Abscess646

Bronchiectasis647

Pneumonia647

Lipid Pneumonia649

Tuberculosis650

Fungus Infections652

Clubbing of Fingers and Toes652

PLEURAL DISORDERS653

Tumors of the Pleura653

Pleuritis653

Empyema654

Epidemic Pleurodynia655

Pneumothorax655

REFERENCES656

PART Ⅷ．DIGESTIVE SYSTEM659

CHAPTER 21 The Esophagus＆By JOSEPH B．KIRSNER AND WALTER L．PALMER661

MECHANISM OF ESOPHAGEAL PAIN661

FUNCTIONAL DISORDERS OF THE ESOPHAGUS662

Spasm of Functional Origin662

Achalasia(Cardiospasm;Megaesophagus)662

Anatomic Features662

Pathogenesis663

Symptoms664

ORGANIC DISEASES OF THE ESOPHAGUS665

Plummer-Vinson Syndrome665

Lower Esophageal Ring665

Non-specific Esophagitis666

Peptic Esophagitis666

Peptic Ulcer of the Esophagus666

MECHANICAL OBSTRUCTION667

Benign Stricture667

Carcinoma of Esophagus668

Esophageal Varices669

Esophageal Diverticula669

Pulsion Diverticula669

Traction Diverticula670

Diaphragmatic Hernia670

Symptoms672

REFERENCES673

CHAPTER 22 The Stomach＆By JOSEPH B．KIRSNER AND WALTER L．PALMER674

ANATOMIC VARIATIONS674

CONGENITAL ANOMALIES674

Hypertrophic Stenosis of the Pylorus674

Diverticula675

SENSORY DISTURBANCES675

Appetite and Hunger675

Vomiting676

Nausea676

Belching676

MOTOR DISTURBANCES677

SECRETORY DISTURBANCES677

Physiologic Considerations677

PATHOLOGIC DISTURBANCES IN GASTRIC SECRETION679

MECHANISM OF PAIN681

Location of Pain682

Pain in Gastric Carcinoma682

Transmission of Pain682

Pain in Gastric Crises of Tabes Dorsalis683

CHRONIC NONSPECIFIC GASTRITIS683

BENIGN GASTRIC TUMORS685

CARCINOMA OF THE STOMACH685

Symptoms687

PEPTIC ULCER688

Pathogenesis688

Symptoms690

REFERENCES692

CHAPTER 23 The Small Intestine＆By LEON SCHIFF694

ANATOMICO-PHYSIOLOGIC CONSIDERATIONS694

Motility694

Innervation695

Secretions696

SYMPTOMATOLOGY OF SMALL INTESTINAL DISEASE697

EFFECTS OF DISEASE OF THE SMALL INTESTINE＂ ON DISTURBANCES IN SMALL BOWEL FUNCTION:MECHANISMS OF SYMPTOM PRODUCTION701

Intestinal Obstruction701

Diverticula707

Enteritis708

Sprue and Spruelike Syndromes(Malabsorption Syndromes)710

Blind Loop Syndrome720

Massive Intestinal Resection720

Irradiation Effects721

＂Protein-Losing Gastroenteropathy＂721

REFERENCES722

CHAPTER 24 ？e Large Intestine＆By LEON SCHIFF729

Functions730

SYMPTOMS AND SlGNS OF COLONIC DISEASE734

Constipation735

Diarrhea737

DISEASES OF THE COLON AND THE MECHANISM OF SYMPTOM PRODUCTION738

Irritable Colon738

Ulcerative Colitis739

Lymphopathia Venereum743

Amebiasis743

Shigella Infections744

Diverticula744

Tumors and Polyps745

REFERENCES747

CHAPTER 25 The Liver＆By FRANZ J．INGELFINGER750

CHANGES IN HEPATIC STRUCTURE750

Vascular Congestion750

Parenchymatous Disorders751

Biliary Disorders754

Intrahepatic754

Extrahepatic754

Fatty Liver and the Relation of Nutrition to Structural Changes755

Disorders of Hepatic Blood Flow757

Pain Sensation763

CHANGES IN HEPATIC FUNCTION764

Correlation of Structure and Function764

Enzyme Systems765

Jaundice767

Bile Constituents Other Than Bilirubin773

Carbohydrate Metabolism774

Nitrogen Metabolism776

Lipid Metabolism780

Vitamin Metabolism783

Fat-Soluble Vitamins782

Water-Soluble Vitamins783

Inactivation and Detoxification784

EFFECTS OF HEPATIC DISEASE ON OTHER ORGANS786

Spleen786

Blood786

Kidney787

Bones787

Gastrointestinal Tract788

Central Nervous System788

Cardiovascular System788

MANIFESTATIONS PRODUCED BY MULTIPLE FACTORS789

Edema and Ascites789

Hepatic Coma791

Liver Failure792

REFERENCES792

CHAPTER 26 The Gallbladder and Pancreas＆By FRANZ GOLDSTEIN795

THE GALLBLADDER795

THE PANCREAS801

REFERENCES807

PART Ⅸ．URINARY TRACT809

CHAPTER 27 The Kidney＆By A．C．CORCORAN811

EXCRETORY FUNCTION811

Renal Blood Flow811

Glomerular Filtration812

Proximal Tubule814

Clearance817

The Loop of Henle818

Ion Exchange:Acidification820

Stop-Flow Technique822

Diuresis and Diuretics822

Tests of Excretory Function826

Tests of Rate of Excretion827

Clearance Tests828

Water Tests829

PRESSOR-ANTIPRESSOR(ENDOCRINE) FUNCTIONS831

Erythropoietin833

CLINICAL MANIFESTATIONS OF RENAL DISEASE833

Proteinuria and the Organized Sediment833

Edema of Renal Origin843

FUNCTIONAL PATTERNS IN RENAL DISEASE847

Essential Hypertension847

Renal Hypertensions848

Tubular Dysfunctions850

Renal Failure;Uremia851

REFERENCES856

PART Ⅹ．BLOOD AND SPLEEN859

CHAPTER 28 Disorders of the Blood＆By WILLIAM B．CASTLE861

GENERAL FUNCTIONS OF THE BLOOD861

DISORDERS OF THE ERYTHROCYTES862

Morphology of Erythrocyte Production862

Physiology of Erythrocyte Production865

Biochemistry of Erythrocyte and Hemoglobin Production868

Production Rates of Erythrocytes and Hemoglobin872

Erythrocyte Destruction874

Splenic Functions876

Hemoglobin Catabolism880

Excretion of Bilirubin881

Conservation of Iron883

General Effects of Anemia883

Erythrocyte Characteristics885

Peripheral Blood in Anemia890

Definition and Classification of Anemia891

Anemia of Acute Erythrocyte Loss892

Anemias of Increased Erythrocyte Destruction894

Extrinsic Causes of Increased Erythrocyte Destruction895

Intrinsic Causes of Increased Erythrocyte Destruction901

Anemias of Decreased Erythrocyte Production916

Nutritional Deficiency of Erythropoiesis916

Immediate Deficiency Mechanisms in Pernicious and Related Macrocytic Anemias926

Endocrine Deficiency of Erythropoiesis936

Toxic Inhibition of Erythropoiesis937

Physical Injury of Erythropoiesis941

Mechanical Interference with Erythropoiesis944

POLYCYTHEMIAS948

Relative Polycythemia948

Secondary Polycythemia948

Polycythemia Vera950

Neoplastic versus Physiologic Control of Erythropoiesis951

General Aspects of Polycythemia Vera954

DISORDERS OF THE LEUKOCYTES955

Leukocyte Characteristics956

Leukocytosis958

Granulocytosis959

Lymphocytosis961

Monocytosis961

Leukopenia962

Agranulocytosis966

Leukemias and Malignant Lymphomas968

Clinical Features972

Treatment977

HEMORRHAGIC DISORDERS981

Extravascular Factors983

Vascular Factors984

Intravascular Factors986

Platelets987

Coagulation Factors993

REFERENCES1004

CHAPTER 29 The Spleen and Reticuloendothelial System＆By CHARLES A．DOAN1013

THE SPLEEN AS A LYMPHATIC ORGAN1014

THE SPLEEN AND ITS MUSCULAR CAPSULE1015

THE SPLEEN AND ITS VASCULAR SINUSES1015

THE SPLEEN AND THE RETICULOENDOTHELIAL SYSTEM OF CELLS1017

THE HYPERSPLENIC CLINICAL SYNDROMES1018

ACCESSORY SPI EENS AND RECURRENT HYPERSPLENISM1026

REFERENCES1028

PART Ⅺ．LOCOMOTOR SYSTEM1031

CHAPTER 30 The Joints＆By RICHARD H．FREYBERG1033

ANATOMY AND PHYSIOLOGY OF JOINTS1033

Articular Cartilage1034

Joint Capsule and Synovium1036

Synovial Fluid1037

Exchange of Substances through the Articular Membrane1038

Functional Alterations Produced by Disease1039

Joints as Units1039

Chemistry of Periarticular Connective Tissue1040

Muscle Function in Relation to Movements of Joints1041

PATHOLOGIC PHYSIOLOGY OF THE LOCOMOTOR SYSTEM1042

Effects of Trauma1042

Neuropathic Joint Disease1044

Specific Infectious Arthritis1045

CHRONIC INFLAMMATIONS OF JOINTS AND RELATED CONNECTIVE TISSUE1046

Rheumatoid Arthritis1047

Other Diffuse Connective Tissue Diseases(Collagen Diseases)1053

Rheumatoid Spondylitis1054

Rheumatic Fever1055

Gouty Arthritis1055

NON-ARTICULAR RHEUMATISM1057

Primary Fibrositis1057

Tenosynovitis and Other Forms of Fibrositis1058

DISEASES OF MUSCLES1058

NERVOUS SYSTEM DISEASE1059

DISEASES OF BONE1059

REFERENCES1060

PART Ⅻ．NERVOUS SYSTEM1063

CHAPTER 31 The Nervous System＆By BERNARD J．ALPERS AND ELLIOTT L．MANCALL1065

INTRODUCTION1065

THE MOTOR SYSTEM1067

The Neuromuscular Junction and Muscle1067

The Neuromuscular Junction1068

The Sarcolemmal Membrane1071

Muscular Contraction1073

Electrodiagnosis in Muscle Disease1077

The Peripheral Neuron1079

Peripheral Nerve1079

Anterior Horn1080

PYRAMIDAL SYSTEM1083

EXTRAPYRAMIDAL SYSTEM1085

THE SENSORY SYSTEM1087

Specificity of Sensory Receptors1087

Posterior Column System1088

Spinothalamic System1089

VESTIBULAR SYSTEM1091

Vertigo1092

Nystagmus1094

CEREBELLUM1095

SPECIAL SENSES1096

Olfaction1096

Vision1097

Hearing1101

Taste1103

THE AUTONOMIC NERVOUS SYSTEM1104

Central Organization of Vegetative Activity1104

The Hypothalamus1104

The Cerebral Cortex1106

The Amygdala1107

Brain Stem Structures1107

Peripheral Organization of Vegetative Activity1108

CONSCIOUSNESS AND HIGHER INTEGRATIVE FUNCTIONS1112

Consciousness1112

Limbic System and Behavior1115

Memory1117

The Body Image1118

Highest Integrative Functions1120

SEIZURES1121

VASCULAR SYSTEM1125

Occlusive Vascular Disease1126

Cerebral Embolism1130

Cerebral Hemorrhage1130

REFERENCES1131

INDEX1135