Methods for the quantitative estimation of plasma cortisol concentration have been devised by Nelson and Samuels (1), Silber and Porter (2), and Peterson and Wyngaarden (3) who used the sulfuric acid-induced fluorescence developed by Sweat (4). Together with urinary procedures (5, 6) these techniques have been employed to determine the secretion of cortisol by the adrenal in normal and pathological conditions (7-9) and to evaluate the factors involved in the "removal" of cortisol from the plasma in surgery (10-13) and liver disease (14-16).Although a considerable amount of work has been done in isolating and identifying such urinary metabolites of cortisol as THF8 and THE (17-22) and their interconversions (23-25), much less has been done to relate the quantitative transformations of these urinary metabolites from cortisol under normal and pathological conditions. In 1953, deCourcy, Bush, Gray, and Lunnon (26) reported daily excretion values for two chromatographically separated urinary steroids corresponding in migration rates to THF and THE, in 10 1 This work was suported in part by a grant from the Atomic Energy Commission. It was sponsored and supported in part by the Subcommittee on Metabolism in Trauma, Advisory Committee on Metabolism, Office of the Surgeon General, Department of the Army, through a contract (DA-49-MD472) with Harvard University.The assistance of Winthrop Laboratories, Inc., and The Upjohn Co. is gratefully acknowledged.2 Present address: The Medical College of St. Bartholomew's Hospital, London. 3 Compounds referred to are the following: THF, tetrahydrocortisol (3a,11p,17a,21-tetrahydroxypregnan-20-one ); allo-THF (3a,1 1,l17a,21-tetrahydroxyallopregnan-20-one); THE, tetrahydrocortisone (3a,17a,21-trihydroxypregnan-11,20-dione); F, cortisol (llfi,17a,21-trihydroxypregnan-3,20-dione); E, cortisone (17a,21-dihydroxypregnan-3,11,20-trione).normal men. The mean values were 212 tg. per 24 hours for THF and 1.5 mg. per 24 hours for THE, giving a ratio for THF: THE of 0.14. Romanoff, Seelye, Rodriquez, and Pincus (27) have recently published quantitative data on the excretion of THF and THE combined with allo-THF (28, 29) in one group of normal men and in a group of schizophrenic men. There was no essential difference in the ratio of THF:(THE plus allo-THF) between the two groups of men, and the ratio was reported as approximately 1: 2. Cope and Hurlock (30) published data on the excretion of urinary THF and THE in several normal and surgical cases. Their results indicated increased excretion of these metabolites after surgery but did not show any other definite pattern of alteration of the metabolism of cortisol, although they state that "a tendency can be observed for tetrahydro-compound F excretion to rise more than does tetrahydrocortisone." In a preliminary report, Gold, Macfarlane, and Moore (31) showed that the relative proportions of the two urinary cortisol metabolites, THF and THE, were related to situations of "stress" and adrenocorticotropin (ACTH) administration. It is the purpo...

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Summary: In a consecutive series of 70 patients with carcinoma of the rectum, 42 had operable tumours and in these the histology of the initial biopsy was compared with that of the excised specimen. In 9 of the 42 patients the histological grading of the original biopsy was different from that of the final specimen; in 3 the carcinoma was missed despite repeated preoperative biopsies; and in 5, errors were -made in the diagnosis of carcinoma in polyps. In 5 of 7 cases of poorly differentiated carcinoma the initial biopsies indicated moderate differentiation: there was therefore a 70% inaccuracy in the preoperative diagnosis of poorly differentiated carcinoma of the rectum. The implications of this inaccuracy for the surgery of rectal cancer are discussed.

JOURNALIn general, in each group of those who had abnormal faecal chemical fat the faecal radioactivity determination was abnormal in about 75%, while the blood peak radioactivity was abnormal in only about 50%. On the other hand, in nearly each group, of those who had normal faecal chemical fat, nearly 80% had a normal faecal radioactivity, while the blood peak radioactivity was normal in nearly 85%.Of the two 1311 triolein determinations the faecal radioactivity determination was found to be a much better index of the presence of steatorrhoea than the blood peak radioactivity test. When both studies were carried out the index of accuracy was increased.If a patient has normal blood peak and faecal radioactivity values after the 1311 triolein meals, the chances of his being normal are about 85 to 95%, while the chance of his having steatorrhoea (false negative) are about 15 to 25Y%. On the other hand, if both values are abnormal the chances of his being normal are about 10% (false positive), while the chances of his having steatorrhoea are about 75%.Administration of the 13II-labelled triolein does not afford an adequate quantitation of steatorrhoea, as does the faecal chemical balance study.Although the 1311 triolein studies are good, simple exploratory tests in the detection of steatorrhoea, particularly if both faecal and blood peak radioactivity are determined, show by our results that 13'I triolein is not as sensitive an index of accuracy in the detection of steatorrhoea as is the faecal chemical fat determination. However, if facilities for metabolic balance studies are not available, then because of its simplicity the triolein test (using both blood peak and faecal radioactivity determination) may be used as a diagnostic aid in the detection of steatorrhoea, provided its limitations are fully appreciated.It is also recommended that, in a given patient, if both blood peak and faecal radioactivity are abnormal, that patient should have faecal chemical balance studies to establish the diagnosis definitely and for the quantitative estimation of steatorrhoea.We thank Dr. Hyman Menduke, Ph.D., for his aid in the statistical analysis.