The orbito-ventromedial undercutting (Hirose) is a modified form of psychosurgical operations. This small restricted lesion of the subcortical white matter of orbito-ventromedial quadrants was found to produce the maximum therapeutic effect on the emotional aspects of the mental disorder that failed to respond to various kinds of non-surgical treatments. Twenty-three cases of mental disorder performed by the orbito-ventromedial undercutting a case of schizophrenia, a case of atypical schizophrenia, 2 case of manic-depressive psychosis, 5 cases of depression, a case of involutional melancholia, 2 cases of involutional psychosis, 2 cases of epilepsy, 3 cases of obsessive-compulsive neurosis, a case of anxiety neurosis, a case of hypochondriacal state, 2 cases of pastencephalitic behavior disorder, a case of psychopathic personality and a case of mental dificiency, were studied on the daily excretion of urinary 17-OHCS, adrenocortical function and its reserve capacity, and diurnal rhythm of urinary 17-OHCS, compared with the mental symptoms befor and after the operation.
1) Before the operation, the urinary 17-OHCS showed normal level in all cases. The pattern of the excretion of urinary 17-OHCS was found to relate to fluctuation of emotion. However, no specific pattern was observed between the cases tested.
2) In all cases, a peak was observed in excretion curve of 17-OHCS during 2 to 3 weeks after the operation. The peak was assumed to be based on the non-specific reaction to the surgical intervention itself. Another peak was observed in 3 cases out of 23 and it was related to the mental and somatic symptoms which would be ascribed to the frontal lobe lesion.
3) After 2 to 3 weeks of the operation, the excretion of 17-OHCS was stabilized, suggesting that it depends on the emotional stability after the operation. The pattern of the excretion curve were classified into the following three groups as compared with those obtained before the operation:(i) the elevated group (3 cases), (ii) the decreased group (9 cases), (iii) the unchanged group (11 cases).
4) ACTH-Z test was performed in 7 cases before and after the operation. The response to ACTH showed normal record.
5) Before the operation, a case of schizophrenia showed the irregular diurnal rhythm of 17-OHCS, while cases of obsessive-compulsive neurosis and mental deficiency showed the almost normal rhythm. In the case of depression, the highest peak of diurnal rhythm of 17-OHCS appeared rather in the afternoon, corresponding to the daily fluctuation of mood.
6) After the operation, diurnal rhythm of 17-OHCS in the case of depression was normalized. It seems to correspond to disappearance of the daily fluctuation of mood.
7) The interrelation of the results of the endocrinological measurements to the emotional changes befor and after the operation for mental disorder was discussed.

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