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17 rectomy as the subjects of study, urinary steroid hormones were measured, and simultaneously the enzyme work and enzyme pattern related to the steroid metabolism, as proposed by Yoshida of our laboratory, were studied. The results may be summarized as follows. 1. Blue tetrazolium and 11-oxy-17-KGS In the cases receiving extended panhysterectomy the levels of these two substances in the urine on the day of operation did not reach so high levels as those in the cases undergoing total hysterectomy, but the values were significantly higher than those before operation, which gradually decreased on 2 to 4 postoperative days later. In the cases of total hysterectomy these values on the day of operation rose to a markedly higher level as compared with those before operation, but they rapidly recovered to preoperative values after two postoperative days and became stabilized deoxy-17-KGS The level of urinary 11-deoxy-17-KGS did not show much change in both extended panh ysterectomy group and total hysterectomy group OHCS As to the level of urinary 17-OHCS, in extended panhysterectomy group some showed a somewhat higher value on the day of operation than that before operation, which gradually in creased from two to 4 postoperative days but recovered rapidly by 6 postoperative days, while some did not show any change on the day of operation but a decreased value on the seco nd postoperative day and recovered to the preoperative level after 4 postoperative days. In the total hysterectomy group the value on the day of operation was markedly higher that before operation in some cases, which rapidly decreased by 2 postoperative days but still higher than the preoperative level, thereafter decreasing gradually, recovered to the preo perative level by 6 postoperative days, while in others the level on the day of operation was somewhat higher than the preoperative level, which gradually increased from 2 to 4 postop erative days, and by 6 postoperative days it rapidly recovered to the preoperative level deoxy-17-KS day of operation to the second postoperative day which recovered to the preoperative level by the 4th postoperative day, while others maintained a low level from the day of operation to the 4th day, recovering to the preoperative level on the 6th postoperative day. operation on the day of operation and recovered to the preoperative level after the second postoperative day which remained stable up to the 6th postoperative day. b) Solvolysate In extended panhysterectomy group there were some who showed no change in the level of solvolysate up to the 6th postoperative day while others who maintained a lower level than that before operation up to the 6th postoperative day. As to the total hysterectomy group there were some showing a higher level on the day of operation which recovered to the preoperative level on the sixth day, while there were others showing no change in the level for two days after operation but showing a higher level on the 4th postoperative day and recovering to the preoperative level on the sixth postoperative day oxy-17-KS there were some who showed a higher level for two postoperative days when compared with the preoperative level, which became stabilized after the 4th postoperative day, while there were some maintaining a stabilized lower level after operation. In the total hysterectomy group some showed a higher value on the operation day than the
18 preoperative level, which decreased gradually after the second postoperative day and recovered to the preoperative level on the 6th day, while others showed a higher level on the day of operation and recovered to the preoperative level on the second postoperative day but showed again a higher level on the 4th and 6th day. b) Solvolysate There could be observed no appreciable change of urinary solvolysate in both estended panhysterectomy group and total hysterectomy group. 6. Pregnanediol As to pregnanediol the level of it on the day of operation was higher than that before operation in both extended panhysterectomy group and total hysterectomy group, and it gradually decreased until the sixth postoperative day when it recovered to the preoperative level. 7. Pregnanetriol Both extended panhysterectomy and total hysterectomy groups showed not any definite ch anges in the level of urinary pregnanetriol. 8. Enzyme work a) 11-Hydroxylated steroids, 17-hydroxylated steroids and 21-hydroxylated steroids. In the total hysterectomy group values of these hydroxylated steroids were markedly hig her on the day of operation than those before operation, but they rapidly decreased after the second postoperative day to recover to the preoperative level. In contrast, in the group of extended panhysterectomy group these values, though they did not reach so high level as in total hysterectomy group, were kept at a high level on the second and fourth postoperative day which finally recovered to the preoperative level on the sixth postoperative day. b) Desmolated steroids As to urinary desmolated steroids in extended panhysterectomy group some showed higher values on the day of operation compared to those before operation, which recovered to the preoperative level on the fourth postoperative day, while otheres who kept showing lower values up to the sixth postoperative day. In total hysterectomy group some had higher values on the day of operation than those before operation, which gradually decreased thereafter until the fourth postoperative day when the level recovered to the preoperative value, while others showed a high level on the day of operation which recovered to the preoperative level on the second postoperative day but again revealing high values on the fourth and sixth postoperative day. 9. Enzyme pattern The ratio of 17-hydroxylated steroids to total steroids was unstabel in extended panhyste rectomy group while it was stable in total hysterectomy group. The ratio of 11-hydroxylated steroids to total steroids in extended panhysterectomy gro up, with exception of one case, was stable in all cases. The ratio of 21-hydroxylated steroids to total steroids proved to be unstable in both ex tended panhysterecotmy group and total hysterectomy group. In both extended panhysterectomy group and total hysterectomy group when compared with the preoperative desmolase pattern the characteristic feature was that there could be observed a low ratio of desmolated steroids to total steroids from the day of operation up to the sixth postoperative day.
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