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Using four different psychological tests, namely Spielberger's rating scale [The State-Trait Anxiety Inventory (STAI)], Self-Rating Depression Scale (SDS), Maudsley Personality Inventory (MPI) and Baum test, we investigated the perioperative psychological status of patients undergoing radical mastectomy for breast cancer and compared data with those of patients undergoing total hysterectomy for uterine myoma. Parameters reflecting the psychological status of hysterectomy patients disclosed lower postoperative anxiety, and slight nervousness and persistent depression perioperatively. In contrast, in patients with breast cancer, those with nervousness had persistent anxiety and depression, while those without nervousness showed the same persistent depression as in hysterectomy patients, as well as a high anxiety level postoperatively. Therefore, we speculate that the persistence of depressive mood during the perioperative period is a factor in the psychological disturbance of mastectomy patients with breast cancer, and moreover, they appear markedly apprehensive because of cancer. These results suggest that the persistence of anxiety and depressive mood associated with cancer is a prime factor in the etiology of postoperative psychological disturbance.

Ketone body (3-hydroxy butyric acid) present in the blood was successively examined during surgical operations to ascertain the condition of energy metabolism and its clinical significance. In 10 patients (R group) to whom only the lactated Ringer's solution was infused during the operation, values of 3-hydroxy butyric acid increased remarkably in the 30 minutes after the operation began. In 7 patients (GI group), to whom the lactated Ringer's solution in 5% of glucose was administered, the values also increased in the 30 minutes after the operation was started. However, after the administration of glucose the values decreased, and returned to the normal value with administration of insulin. Furthermore, blood sugar readings which were examined at the same time increased significantly immediately after the beginning of the operation in both groups. Insulin readings showed considerably low values during the operation in R group. The readings of free fatty acid tended to show high values in R group, while they tended to decrease after the dose of glucose in GI group. With regard to epinephrine and norepinephrine readings, both groups showed significantly high values 30 minutes after the start of operation.

In order to study the changes of the psychological status during perioperative period, we performed four different psychological tests, Spielberger's rating scale "The State-Trait Anxiety Inventory (STAI)", Self-rating Depression Scale (SDS), Maudsley Personality Inventory (MPI) and Baum test, in 63 patients who received simple total hysterectomy for myoma of uterus. The anxiety ratings showed a significant decrease postoperatively. On the contrary, the SDS index that expresses the level of depressive mood showed no significant change during perioperative period. Moreover the patients who had shown a tendency of nervousness in MPI kept the high level of the SDS index during perioperative period than the other patients who had not shown a tendency of nervousness in MPI. In Baum test, more than 75% of patients manifested psychologic fragility or lability. These results suggest that depressive mood affects strictly the psychological status in postoperative period more than anxiety. We presume that the depressive mood during perioperative period is responsible for the postoperative psychological disturbance.