쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

Simultaneous Gas Chromatography-Mass Spectrometric Determination of Total and Individual Phthalic Esters Utilizing Alkaline Hydrolysis and Silyl Derivatization Technique

Kim, Min-Seon,Li, Dong-Hao,Shim, Won-Joon,Oh, Jae-Ryoung,Park, Jong-Man Korean Chemical Society 2007 Bulletin of the Korean Chemical Society Vol.28 No.3

Environmentally important phthalic esters have been analyzed by GC-MS in terms of individual phthalic esters or total phthalic esters directly or after derivatization. Derivatization improves the chromatographic characteristics of the highly polar phthalic esters. This study focused on the GC-MS determination of the total phthalic esters and the individual phthalic esters simultaneously. The phthalic esters were hydrolyzed to phthalate and corresponding alcohols in 1 M NaOH solution at 90 oC for 30 min followed by extraction with ethyl acetate after acidifcation. The phthalic acid and alcohols were simultaneously silyl derivatized using bis(trimethylsilyl)trifluoroacetamide (BSTFA) to their corresponding silyl ester and ethers in the mixture of 60% acetone and 40% ethyl acetate at room temperature within 30 min. Because of the high reactivity of BSTFA with the phthalic acid and alcohols effective silyl derivatization was possible simultaneously. GC-MS analysis of the silyl derivatives of phthalic acid and alcohols was performed. The total phthalic ester content was estimated from the analytical result of phthalic silyl ester, while the individual phthalic ester was quantified from the analytical results of alcoholic silyl ethers. This technique was applied to spiked tab water and real seawater samples from the Lake Shihwa in Korea. The results were checked against the results from the direct GC-MS analysis of the phthalic esters and reasonable recoveries with high sensitivity were achieved. The recoveries were higher than 75% with low relative standard deviation (below 10%).

간질환환자의 위내용물 배출시간에 관한 연구

함준수(Joon Soo Hahm),이동후(Dong Hoo Lee),박경남(Kyung Nam Park),이민호(Min Ho Lee),이종철(Jong Chul Rhee),기춘석(Choon Suck Kee),유대현(Dae Hyun Yoo) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.2

N/A Gastric emptying time(GET) is influenced by several factors, such as neura), hormonal and composi- tion and physiochemical properties of food. The patients with delayed GET have some upper gastrointestinal symptoms such as recurrent nausea, vomiting, postprandia! Bloating, anorexia, and iveight loss. And also, almost of acute hepatitis and a part of chronic ]iver disease patients have similar symptoms of the patients with delayed GET. Therefore We performed GET measurement in liver disease patients to identify the relationship between nonspecific upper gastrointestinal symp- toms and gastric emptying function. The resu]ts are as followings; 1) Total ]iver disease patients are 28 in number, composed of acute hepatitis 3, chronic hepatitis 18, liver cirrhosis 7. 2) The GET(T1/2) of liver disease patients was delayed significantly than that of the normal volunteers. (Mean+SE;120.8+6.6 vs 89.4+5.9 mins.) 3) The GET of the symptomatic patients (N = 20 ) ivas 128.3+6.8 mins (Mean+SE), and that of the asymptomatic patients (N =8) was 101.8+13.2 mins. The symptomatic patients have delayed GET in 10 patients and asymptomatic patients have delayed GET in 3. 4) The GET of the patients who have elevated serum transaminase level higher than twice of normal is delayed significantly than that of the patients who have serum transaminase level lower than twice of normal. (Mean+SE; 143.4+2.6 vs 110.0+7.4 mins.)

대장내시경검사의 전처치로서 항콜린제 사용에 관한 연구 : 전향적, 이중맹검법으로

박경남,한동수,이민호,최호순,박준용,손주현,이오영,함준수,전용철,송승찬,기춘석,윤병철,이종희 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Background: Use of antispasmodic medication prior to colonoscopy is controversial but someone believes antispasmodic may improve visualization of colonic mucosa and ease colonoscope insertion. So, we designed a study to assess the effect of premedication with the antispasmodic, hyoscine-N-butyl bromide(Buscopan') on the performance of colonoscopy. Methods: This study was prospective, double blinded, randomized, controlled study, One hundred three consecutive patients were randomized to receive intravenous buscopan lml(n=52) or placebo(n=51) combined with our standard initial medication(me- peridine 50 mg and midazolam 2 mg). Insertion of colonoscopy was timed, and 100 mm visual analogue scales (VAS) were used for asscssing difficulty of procedure, colonic motility, frequency of positional change, frequency of external compression, difficulty of assistance and degree of discomfort experienced by the patients. Results: There were no significant differences of intubation time between buscopan group(mean time, 7.23 min., range 2~15) and placebo group(7.07 min., range 3-25), (p=0.83) and withdrawal time between buscopan group (6.46 min., range 2-22) and placebo group(6.76 min., range 2 25), (p=0.69). Also, there was no significant differences in intubation time between males and females(buscopan; males 7.00 min., females 7.60 min., p=0.34, placebo; males 7.0~5 min., females 7.08 min., p 0.44). The VAS scores checked by endoscopist(p=0.29), assistant(p=0.32) and patient (p=0.15) were not significantly different in both groups. There were no significant differences in intubation time, VAS scores nf endoscopist, assistant, and patients. Conclusion: Premedication with intravenous bu.opan has no advantage on colonoscopy procedure. Use of antispasmodic medication prior to colonoscopy was not considered as recommendable agent.

Comparative evaluation of the algorithms for parametric mapping of the novel myocardial PET imaging agent ¹⁸ F-FPTP

Kim, Ji Who,Seo, Seongho,Kim, Hyeon Sik,Kim, Dong-Yeon,Lee, Ho-Young,Kang, Keon Wook,Lee, Dong Soo,Bom, Hee-Seung,Min, Jung-Joon,Lee, Jae Sung Springer Japan 2017 Annals of nuclear medicine Vol.31 No.6

<P><B>Objective</B></P><P>(<SUP>18</SUP>F-fluoropentyl)triphenylphosphonium salt (<SUP>18</SUP>F-FPTP) is a new promising myocardial PET imaging tracer. It shows high accumulation in cardiomyocytes and rapid clearance from liver. We performed compartmental analysis of <SUP>18</SUP>F-FPTP PET images in rat and evaluated two linear analyses: linear least-squares (LLS) and a basis function method (BFM) for generating parametric images. The minimum dynamic scan duration for kinetic analysis was also investigated and computer simulation undertaken.</P><P><B>Methods</B></P><P><SUP>18</SUP>F-FPTP dynamic PET (18 min) and CT images were acquired from rats with myocardial infarction (MI) (<I>n</I> = 12). Regions of interest (ROIs) were on the left ventricle, normal myocardium, and MI region. Two-compartment (<I>K</I><SUB>1</SUB> and <I>k</I><SUB>2</SUB>; 2C2P) and three-compartment (<I>K</I><SUB>1</SUB>–<I>k</I><SUB>3</SUB>; 3C3P) models with irreversible uptake were compared for goodness-of-fit. Partial volume and spillover correction terms (<I>V</I><SUB><I>a</I></SUB> and <I>α</I> = 1 − <I>V</I><SUB><I>a</I></SUB>) were also incorporated. LLS and BFM were applied to ROI- and voxel-based kinetic parameter estimations. Results were compared with the standard ROI-based nonlinear least-squares (NLS) results of the corresponding compartment model. A simulation explored statistical properties of the estimation methods.</P><P><B>Results</B></P><P>The 2C2P model was most suitable for describing <SUP>18</SUP>F-FPTP kinetics. Average <I>K</I><SUB>1</SUB>, <I>k</I><SUB>2</SUB>, and <I>V</I><SUB><I>a</I></SUB> values were, respectively, 6.8 (ml/min/g), 1.1 (min<SUP>−1</SUP>), and 0.44 in normal myocardium and 1.4 (ml/min/g), 1.1 (min<SUP>−1</SUP>), and 0.32, in MI tissue. Ten minutes of data was sufficient for the estimation. LLS and BFM estimations correlated well with NLS values for the ROI level (<I>K</I><SUB>1</SUB>: <I>y</I> = 1.06<I>x</I> + 0.13, <I>r</I><SUP><I>2</I></SUP> = 0.96 and <I>y</I> = 1.13<I>x</I> + 0.08, <I>r</I><SUP><I>2</I></SUP> = 0.97) and voxel level (<I>K</I><SUB>1</SUB>: <I>y</I> = 1.22<I>x</I> − 0.30, <I>r</I><SUP><I>2</I></SUP> = 0.90 and <I>y</I> = 1.26<I>x</I> + 0.00, <I>r</I><SUP><I>2</I></SUP> = 0.92). Regional distribution of kinetic parametric images (<I>αK</I><SUB>1</SUB>, <I>K</I><SUB>1</SUB>, <I>k</I><SUB>2</SUB>, <I>V</I><SUB>a</SUB>) was physiologically relevant. LLS and BFM showed more robust characteristics than NLS in the simulation.</P><P><B>Conclusions</B></P><P>Fast kinetics and highly specific uptake of <SUP>18</SUP>F-FPTP by myocardium enabled quantitative analysis with the 2C2P model using only the initial 10 min of data. LLS and BFM were feasible for estimating voxel-wise parameters. These two methods will be useful for quantitative evaluation of <SUP>18</SUP>F-FPTP distribution in myocardium and in further studies with different conditions, disease models, and species.</P><P><B>Electronic supplementary material</B></P><P>The online version of this article (doi:10.1007/s12149-017-1171-6) contains supplementary material, which is available to authorized users.</P>

삼풍 사고 생존자들의 정신과적 증상

이민수,한창수,곽동일,이준상 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.5

1995년 6월 29일 발생한 삼풍 백화점 붕괴사고의 생존자들을 정신과적으로 면담하여 이들의 정신적인 후유증의 여부와 증상의 빈도를 보고자 하였다. 1995년 11월에 안암병원에 내원한 삼풍사고 생존자 중, 정신과적 진찰을 받은 681명의 면담 자료를 대상으로 하여 기술통계 및 빈도분석을 실시하였다. 대상 환자들이 호소하는 증상 중 가장 흔한 증상은 수면장애로 전체환자의 54.2%가 호소하였다. 그 다음으로 두통(31.8%), 예민성(23.3%), 기억나는 상황에서의 심한 고통(24.2%)의 순으로 나타났다. 신체증상 중에는 두통, 흉부 불편감, 사지통, 요통, 소화기계 이상의 순으로 증상을 호소하였다. 위의 결과로 보아 내원 환자의 대부분이 정신과적 증상을 호소하고 있었다. 본 연구에서는 생존자들이 한국의 문화적, 사회적 배경에 따라 서구의 환자들과 다른 양상으로 신체 증상을 호소할 가능성을 고려하였으나, 결과는 서구의 연구결과와 큰 차이를 보이지 않았다. 향후 이 결과를 근거로 하여 외상후에 나타나는 증상들을 한국적 상황에 맞게 분별할 수 있는 자료를 제시할 수 있을 것이다. In order to evaluate psychiatric symptoms in survivors of the Sampoong accident, we interviewed 624 survivors of the accident. The most common complaint of the subjects was sleep disturbance(54.2%). And then, headache(31.8%), irritability and anger(23.3%), intense distress over reminders(24.2%) followed. Common somatic complaints were headache, chest discomfort, extremity pain, backache, and gastrointestinal discomfort. This study revealed that most of the subjects had various psychiatric symptoms after the Sampoong accident.

영아에서 발생한 골수섬유증 1례

최성민,이동석,권경배,김두권,김나연,원유흥,이준희,권영무 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

특발성 골수섬유증은 만성 골수증식성 질환의 하나로 말초혈액도말에서 백적아구증, 부동변형적혈구 눈물방울세포 소견을 보이며, 골수 생검상 망상 섬유와 교원섬유로 구성된 섬유조직이 증가하는 골수의 섬유화 소견을 보이며, 골수외 조혈작용으로 인한 대상적 비장·간장 종대를 특징으로 하는 소아에서는 극히 드문 질환이다. 저자들은 본원에 복부종괴와 안면창백으로 입원하였던 8개월된 남아에서 임상증상, 말초혈액검사, 골수생검에서 특발성 골수섬유증으로 진단되어 Methylprednisolone 대량 정주 요법으로 치료하였으나 진단7개월만에 패혈증과 심부전으로 사망했던 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Idiopathic myelofibrosis is a chronic myeloproliferative disorder characterized by anemia, leukoerythroblastosis, anisopoikilocytosis, tear-drop cell, extramedullary hematopoiesis with hepatosplenomegaly and varying degrees of myelofibrosis of bone marrow. The mean age is about 60 years, and pediatric cases are rare. We experienced a case of idiopathic myelofibrosis in a 8 months old male who was presented with pallor, huge splenomegaly, leukoerythroblastosis in peripheral blood, myelofibrosis in bone marrow biopsy. We presented a case of idiopathic myelofibrosis with brief review of the literatures.

老齡者의 建康을 위한 生活習慣 實態調査

申東敏,長鳳愚,李揆文,金賢俊,金昌範,崔宗洙,崔鍾晥,李鍾珏,金圭碩,趙庚旭,金鍾聲,朴鍾振 平生體育硏究所 論文集 1987 平生體育硏究所 論文集 Vol.2 No.-

With a view to examining the habit and method in which old people maintain and improve their health, we consulted 551 men and 444 women who were over 65 years old, and concluded as follows: 1. Habit of eating It's been revealed that most of the old people keep a regular eating hour, control the quantity of meal or eat a little food, and prefer vegetables to meat. 2. Mental health Old people feel the necessity for mental health and most of them (about 80%) keep good mental health without becoming pessimistic. Their chief concenrs have turned out to be about their sons and daughters and their own health and finance. 3. Managing Good Health It has been revelaed that old people do not possess any special kind of secret to keep good health but taking plenty of rest, regular meal, and proper exercise, and many of them (about 60%) have been shown to eat invigorant food that they can easily get around their living area. 4. Physical Functions It has been revealed that many old people are conscious of some symptoms about their parts of body and about to percent of them suffers from neuralgia. Some measures like medical aid especially for old people need to be taken as soon as possible. As we have found that the health-keeping method of old people consists plenty of rest, proper exercise, and appropriate nutrition, we can conclude that the recreatonal and culture facilities and programs for keeping old people in good health should be developed. It is also necessary to study food that contribute to their health and develop ways to get rid of the stresses to which they are exposed in their daily life. Presides, it is natural that government found an administrative department to deal with these matters effectively.

매실음료 섭취에 따른 혈액화학적 변화 연구

주동엽,정용준,민범일 東新大學校 1999 論文集 Vol.11 No.-

This study was designed to investigate the effect of natural water and maesil drink, Korean traditional drink, after exercise of maximum of gradual load before 20 minute on the treadmill training. I surveyed 6 mail basketball players of university in order to inverstigate the effects on the exercise spot and analysed the relations of blood variations before and after exercise of maximum of gradual load with a treadmill, and 3 minutes, 5minutes, 10minutes after each recovery step. The results were as follows. 1. Total-Cholesterol, Albumin, Triglyceride, Heart Rate were significant difference in the effects of the two drink at the each group and measuring time(P<.05). 2. Glucose, Total-Protein were no difference in the two group, but measuring time were significant difference(P<.05).

두개안면골 골절 및 결손에 있어서 모상건막하 두개골막피판의 적용

황민효,선 욱,김동일,최 준,백세민 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.5

Technological advances in reconstructive surgery have aroused a wide spread reappraisal of anatomy and anatomical concepts. Mamy useful new flaps, such as the fasciocutaneous flap, have been introduced as a result. However subgaleal flaps have not been widely used, and there is little anatomical information published to guide tha surgeon in designing such a flap. The advantages of the subgaleal flaps are multiple pedicle, good vascularity and easier management, support the split and full thickness skin graft, thin and supple, gliding nature and minimal donor morbidity. The subgaleal flap has been used as an isolated flap in a variety of prospective cases such as defects or fractures of cranial floor frontal sinus or orbit, nasal or midface reconstruction, soft tissue contouring in massive facial trauma. We have used the subgaleal pericranial flaps in 3 cases with craniofacial fracutres or deformities and acquired satisfying results.