Excretion patterns of 17-ketosteroids and 17-hydroxycorticosteroids in surgical stress

Quantitative determinations of urinary 17-ketosteroids (17-KS) and 17-hydroxycorticosteroids (17-OHCS) were made in 17 males and 8 females before and for 7 days following moderate to major surgery.

The operation caused a marked rise in the excretion of total 17-OHCS. On the other hand, a significant decrease in the excretion of the total 17-KS was found following surgery. The postoperative decrease resulted from a significant decrease in the excretion of C19O2- 17-KS, since the urinary C19O3-17-KS remained almost unchanged following the operation. The postoperative decrease was shown to be of a higher degree in males since the decrease in the excretion of aetiocholanolone and androsterone was more marked in males than in females. Contrary to this, the excretion of both C19O3-17-KS and C19O2-17-KS increased following ACTH injection. From the result, it seems justifiable to assume that the secretion of androgen from the testes may decrease rapidly following operation. It was also demonstrated that the ratio of aetiocholanolone to androsterone increased postoperatively as did the ratio of THF to alloTHF. Furthermore, the ratios of THE to THF and E to F were found to be significantly decreased following surgery.

Plasma testosterone levels following surgical stress in male patients

Plasma testosterone levels were determined by the competitive protein binding method of Mayes & Nugent (1968) with slight modifications, in 20 male patients in whom moderate or major surgery had been performed. Preoperative (control) and postoperative blood samples were obtained at 8 a. m. except for immediate postoperative samples. There was a significant decrease in the plasma levels of testosterone immediately and 2 days after moderate and major surgery. The level of testosterone returned toward the control level on the sixth postoperative day after moderate surgery, while after major surgery, the decreased plasma testosterone was maintained for at least 6 days. It is suggested that testicular secretion of testosterone seems to decrease during the postoperative period.

Synthesis and cycloaddition reactions of 2-(2-thienyl)aziridines

The synthesis of several new 2-(2-thienyl)aziridines and an examination of their cycloaddition with olefinic and acetylenic dipolarophiles is described.

Effects of surgery on plasma levels of cortisol, corticosterone and non-protein-bound-cortisol

The diurnal variation in plasma cortisol, corticosterone and non-protein-bound cortisol was investigated using altogether 991 plasma samples obtained from preoperative chronically ill (control) subjects and patients during and following major surgery. A fluorimetric method using an elution chromatography on Amberlite IRC-50 and the equilibrium dialysis method were used for the determinations.

The diurnal variation in plasma cortisol of the preoperative control subjects reached a peak (17.3 μg/100 ml) at 6 a.m. and declined to the lowest level (2.3 μg/100 ml) between 10 p.m. and midnight. The maximum value in the levels of corticosterone (0.6 μg/100 ml) was observed at 6 a.m. Surgery caused a steep rise in plasma cortisol showing a maximum value (30.0 μg/100 ml) 2 to 4 hours after the end of the operation. Although the average of the morning levels of plasma cortisol returned to the control levels within 4 to 5 days, the evening levels returned on the 6th day after the operation. The response of plasma corticosterone in the surgery group was found to parallel the change in plasma cortisol. However, the increase in the corticosterone concentration was significantly higher than that of cortisol.

The percentage of non-protein-bound cortisol in the plasma of the preoperative control subjects was found to be 2.5 to 3.3 per cent at 6 and 8 a.m. and 1.5 per cent at midnight, while the percentage remained almost unchanged (about 2%) at 10 a.m., 12 a.m. and 6 p.m. The percentage increased significantly during and for 4 days following the operation, concomitant with the increase in the levels of plasma cortisol. It is suggested that stressful situations are associated with markedly increased plasma levels of biologically active cortisol.