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Urinary 17-hydroxycorticosteroids were separated and purified with the elution chromatography on Amberlite IRC-50 and quantitatively determined by the Porter-Silber reaction. The simultaneous determination of cortisol and corticosterone in 5 ml of peripheral plasma with the elution chromatography on Amberlite IRC-50 and the fluorometrical method was used as the method which gave the necessary data on reproducibility , recovery, sensitivity and specificity. Percentage of nonprotein-bound cortisol in plasma was determined by the equilibrium dialysis method. Daily urinary excretion of total 17-hydroxycorticosteroids n 17 cases that underwent major surgical operations was examined and they increased significantly following 2-7 days after surgical operation, showing the maximum value (about 15 mg) on the 2nd day. The ratio of THE to THF and E to F decreased significantly , while the ratio of THF to allo THF increased gradually following the operation. The diurnal variation in plasma cortisol and corticosterone of preoperative chronically ill (control) subjects was examined at 2-hour intervals using altogether 504 determinations . The maximum value of plasma cortisol (15--17 ,c2g/ di) was observed at 6 a.m.. The value decreased gradually with the lowest value (about 3 pg/d1) between 10 p.m. and 0 a.m.. Plasma corticosterone l vel was found to be 0.3-0.6 pg/d1 at 6 a.m. and 8 a.m.. However, corticosterone levels were under the influence of the sensitivity of the method used at other times. The diurnal rhythm in percentage of nonprotein-bound cortisol from 140 plasma samples under nonstress conditions was found to be stable showing about 2% except the value at 6 a.m. which showed about 3%. Response of corticoids in 24 cases that underwent major surgical operations , (15 cases of thoracic surgery and 9 cases of abdominal surgery,) was examined. The operation caused a steep rise in plasma cortisol showing the maximum values (25-30 teg/d1) 2 to 4 hours after the end of the operation. Although the average of the morning levels returned to normal within 4 to 5 days, the evening levels returned on the 6th day after the operation. Up to the 5th day after the operation, the postoperative differences between the morning values of plasma cortisol and the values on the evening (postoperative diurnal rhythms) less than 3 pgicll were considerably smaller than the preoperative control rhythms (7-8 pg/d1) except between the morning and the evening of the operation day when the rhythm was reversed.

Clinical Studies on Changes in Urinary 17-hydroxycorticosteroids, Plasma Corsisol and Corticosterone Levels after Major Surgical Operation