• 대한소아치과학회지
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• 제26권3호
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• pp.486-491
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• 1999

부갑상선기능저하증은 혈장내 칼슘 농도에 반응해 분비되는 부갑상선 호르몬의 분비가 비정상적으로 감소된 상태를 의미한다. 이에 반해 가정부갑상선기능저하증은 부갑상선의 기능은 정상이나 뇨세관과 파골세포등의 말단기관들이 부갑상선 호르몬에 반응하지 않는 질환이며, 원인은 이들 호르몬이 결합하는 수용체 성분인 Guanin protein을 결정하는 GS gene의 돌연변이에 의한다. 부갑상선기능저하증은 평균 8-9세에 발병하며 대부분이 20세 이전에 호발하게 되는데, 이 질환에 이환된 경우 특징적으로 뇌, 호르몬 기관, 연골세포등에 존재하는 GS gene의 돌연변이로 인해 성장 및 발육부전, 둥근 얼굴, 비만, 허리만곡증, 외골증등이 생기며, 조기 골단 폐쇄로 인한 중수골 및 중족골의 왜소증 등이 나타난다. 그리고 공통적으로 갑상선 자극 호르몬, 생식 호르몬, glucagon 등의 다수 호르몬에 대해서도 반응하지 않는다. 이들의 치과적 소견의 특징은, 법랑질의 형성부전과 맹출 지연이 가장 일반적이고 치배의 무형성, 치배결손, 짧고 이형성된 치근과 넓어진 치수강, 왜소치, 치수내 석회화, 부정교합 등도 자주 보고되고 있다. 가성부갑상선기능저하증으로 진단된 본 증례 환아의 구강내 소견으로는 전반적으로 짧고 미발육된 영구치 치근과 소구치 및 대구치의 맹출지연과 미맹출, 제 1, 2 소구치와 제 2 대구치의 형성 부전양상이 보이고 있다. 이에 저자는 연세대학교 치과병원 소아치과에 내원한 가성부갑상선기능저하증 환자를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 생명과학회지
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• 제26권11호
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• pp.1345-1354
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• 2016

원형탈모증은 흔하게 발병하고 두피와 전신에 모발의 탈락을 일으키는 모낭조직 특이 자가면역질환이다. 모낭은 자체적으로 면역체계와 내분비 환경을 가지고 각 모발주기 단계에 따라 다른 면역 상태를 나타내는 특이한 기관이다. 성장기 모낭의 면역특권의 파괴는 모낭상피 MHC class I 발현과 자가반응성 CD8+T세포에 대한 자가항원 발현을 유도하는 자가면역의 공격을 일으키고 원형탈모증을 유발한다. 임상적 실험적 연구에 의하면, 심리적 스트레스도 모낭 면역/호르몬 체계에 영향을 미쳐 원형탈모증의 유도에 관여할 수 있다고 지적한다. 원형탈모증의 핵심적인 병리기전은 면역특권 수호자(ACTH, ${\alpha}-MSH$와 $TGF-{\beta}$ 등), 자연살해세포그룹 2D-양성(NKG2D+) 세포(NK 세포와 CD8+T 세포 등)와 스트레스 호르몬(CRH와 substance P)과 관련되어 있다. 효과적인 치료법은 여전히 요구되고 있다. 앞으로 치료목표 중의 하나는 스트레스를 포함한 모낭 면역특권을 개선하는 것일 것이다. 최근 연구는 건선, 아토피피부염, 류마티스 관절염 같은 다른 자가면역질환에서 사용되는 JAK억제제와 면역조절제, Tregs, 혈소판풍부혈장요법, 스타틴과 프로스타글란딘 유사제가 원형탈모증에 효과적이라고 보고하였다. 본 논문은 모낭주위 내분비/면역과 관련된 발병기전에 대한 새로운 이해와 원형탈모증의 새로운 치료법에 대해 고찰하였다.

• Radiation Oncology Journal
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• 제29권3호
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• pp.156-163
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• 2011

Purpose: To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. Materials and Methods: We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-five patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. Results: Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia, acromegaly, and Cushing's disease). Amenorrhea was abated in 7 of 10 patients, galactorrhea in 8 of 8 patients, acromegaly in 7 of 11 patients, Cushing's disease in 4 of 4 patients. Long-term complication was observed in 4 patients; 3 patients with cerebrovascular accident, 1 patient developed dementia. Of these patients, 3 of 4 received more than 60 Gy of irradiation. Conclusion: EBRT is highly effective in preventing recurrence and reducing mass effect of non-secreting adenoma. Effort to improve tumor control of secreting adenoma is required. Careful long-term follow-up is required when relatively high dose is applied. Modern radiosurgery or proton RT may be options to decrease late complications.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6673-6679
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• 2015

Background: Male breast cancer is a rare neoplasm, and its treatments are based on those of female breast cancer. This study aimed to analyze 20 years of male breast cancer clinical characteristics and treatment results from the Middle Black Sea Region of Turkey. Materials and Methods: A retrospective analysis of 16 male breast cancer patients treated in our tertiary hospital between 1994 and 2014 was performed. Epidemiologic data, tumor characteristics, and treatments were recorded and compared with 466 female breast cancer ((premenopausal; n = 230) + (postmenopausal n = 236)) patients. The 5-year disease-free and overall survival rates were calculated. Results: Male breast cancer constituted 0.1% of all malignant neoplasms in both sexes, 0.2% of all malignant neoplasms in males, and 0.7% of all breast cancers. The mean patient age in this study was $59.8{\pm}9.5$ (39-74) years. The mean time between first symptom and diagnosis was $32.4{\pm}5.3$ (3-60) months. Histology revealed infiltrative ductal carcinoma in 81.3% of patients. The most common detected molecular subtype was luminal A, in 12 (75%) patients. Estrogen receptor rate (93.8%) in male breast cancer patients was significantly higher than that in female breast cancer (70.8% in all females, p = 0.003; 68.2% in postmenopausal females, p = 0.002) patients. Most of the tumors (56.3%) were grade 2. Tumor stage was T4 in 50% of males. The majority (56.3%) of the patients were stage III at diagnosis. Surgery, chemotherapy, radiotherapy and endocrine-therapy were applied to 62.5%, 62.5%, 81.2% and 73.3%, respectively. Loco-regional failure did not occur in any of the cases. All recurrences were metastastic. The 5-year disease-free and overall survival rates in male breast cancer patients were 58% and 68%, respectively. Conclusions: Tumors found in male breast cancer patients were similar in size to tumors found in females, but they advanced to T4 stage more rapidly because of the lack of breast parenchymal tissues. The rate of estrogen receptor expression tended to be higher in male breast cancer patients than in female breast cancer patients. Metastasis is the most important problem in initially non-metastatic male breast cancer patients.

• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.463-468
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• 2015

Pulmonary Langerhans cell histiocytosis is an uncommon diffuse cystic lung disease in adults. In rare cases, it can involve extrapulmonary organs and lead to endocrine abnormalities such as central diabetes insipidus. A 42-year-old man presented with polyphagia and polydipsia, as well as a dry cough and dyspnea on exertion. Magnetic resonance imaging of the hypothalamic-pituitary system failed to show the posterior pituitary, which is a typical finding in patients with central diabetes insipidus. This condition was confirmed by a water deprivation test, and the patient was also found to have type 2 diabetes mellitus. Computed tomographic scanning of the lungs revealed multiple, irregularly shaped cystic lesions and small nodules bilaterally, with sparing of the costophrenic angles. Lung biopsy through video-assisted thoracoscopic surgery revealed pulmonary Langerhans cell histiocytosis. On a follow-up visit, only 1 year after the patient had quit smoking, clinical and radiological improvement was significant. Here, we report an uncommon case of pulmonary Langerhans cell histiocytosis that simultaneously presented with diabetes insipidus and diabetes mellitus.

• Endocrinology and Metabolism
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• 제33권4호
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• pp.459-465
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• 2018

Background: Differentiated thyroid carcinoma (DTC) shows a very good prognosis, but older patients have a higher recurrence rate and those show poor prognosis than younger patients. The aim of this study was to determine the clinical outcomes of thyroid cancer patients who experienced recurrence in old age according to the treatment strategy used. Methods: This retrospective observational cohort study was conducted at Asan Medical Center, Seoul, Korea. Among DTC patients with no evidence of disease after initial treatment, we enrolled 86 patients who experienced recurrence at an age >65 years from 1994 to 2012. Sixty-nine patients had local recurrence and 17 patients showed distant metastasis. Results: The mean age of patients at recurrence was 72 years. Patients were followed up for a median of 4.1 years after recurrence. Sixty-three of the 69 patients with local recurrence received additional treatment, while the other six received conservative care. The cancer-specific mortality rate was 15.5% in the local recurrence group. Airway problems were the main cause of death in patients who did not receive further treatment for local recurrence. Among the 17 patients with distant metastasis, 10 underwent specific treatment for metastasis and seven received only supportive management. Seven of those 17 patients died, and the cancer-specific mortality rate was 35% in the distant metastasis group. Conclusion: The overall cancer-specific mortality rate was 20% in DTC patients in whom recurrence was first detected at an age >65 years. Mortality due to uncontrolled local disease occurred frequently in patients who did not receive definitive management for recurrence.

• 한국노년학
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• 제29권2호
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• pp.645-656
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• 2009

본 연구는 의료기관 가정간호사업 현황을 총체적으로 파악하여, 의료기관 가정간호사업 활성화와 노인장기요양보험제도 도입 이후 세 가지 유형의 가정방문 간호사업을 효율적으로 기능역할 정립하는데 필요한 기초자료를 생성하기 위함이다. 건강보험심사평가원의 2006년 의료기관 가정간호 급여청구자료를 2차 분석하고, 전국 75개 의료기관 가정간호사업소의 사업현황을 횡단적 조사 분석하였다. 2006년 전체 의료기관 가정간호 이용자 중 65세 이상 노인은 20,343명(전체 대상자의 64.0%), 급여 청구는 98,822건(전체 청구의 70.1%), 방문은 333,889건(전체 방문의 76.8%)이었다. 이용자의 진단명은 뇌졸중 23.6%, 뇌졸중을 제외한 심장 등 순환기질환이 17.7%로 전체 청구 중 41.3%가 뇌졸중을 비롯한 순환기질환에 의한 것이었다. 다음은 당뇨 등 내분비계질환 10.4%, 신생물 9.7% 순이었다. 2006년 일 년간 노인대상 의료기관 가정간호 총 진료비는 13,247,992,290원(전체의 70.5%), 가정간호비용은 6,544,430,760원(전체의 72.2%)이었다. 2006년 일 년간 의료기관 가정간호 서비스 이용 노인 일인당 평균 총 진료비는 646,262원, 가정간호비용은 319,476원, 총 방문건수는 15.3건이었다. 의료기관 가정간호사업은 보건소 방문보건사업과 중재 종류는 유사하나, 보건소 방문보건사업에서는 수행되지 않는 헤마토크릿(16.8%), 혈색소(15.6%), 적혈구 침강속도(5.6%), 경피적산소분압(0.1%) 등 임상검사와 흡입배농 및 배액(0.7%), 약물저류 관장(0.1%) 및 가스관장(0.01%)등 특수처치가 수행되었다. 건강보험 급여한도 월 8회를 초과하여 전액본인부담금으로 의료기관 가정간호를 이용한 노인은 질환별로 욕창 7.0%, 암 5.4%, 당뇨 2.5%, 고혈압 1.1%, 뇌졸중 0.9%였다. 따라서, 이러한 서비스 차이를 반영하여 세 가지 유형의 가정방문 간호사업간 기능역할을 설정하고, 서비스 이용을 활성화하기 위해서 보험급여를 확대할 필요가 있다.

• 한국직업건강간호학회지
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• 제4권호
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• pp.58-83
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• 1995

The small scale industries which have less than 30 employees occupy 86.5% of total number of industries in Korea. And though they have higher accident rate and lower environmental condition than big industries, it has been not mandatory to appointing health care manager at factory. So, from 1993, government subsidizes to the health care management of small industries. The purpose of this study is to identify the real feature of health care status in small industries, and to evaluate the level of health care management, before and after the subsidiary program. 65 small plating industries which have been managed by the same health care management support institution in 1993 were selected for study. Of the 65 industries, 3 which have not taken both environmental evaluation and health screening in 1994, and 9 which have closed were excluded from study sample. And the remaining 53 were analyzed by using the results of environmental evaluation and health screening, reported to the Ministry of Labor, before and after the subsidiary program, the analysis was done by the comparison of the two year paired data of the same industry. Over-permissible-limit rate, health screening implementation rate, above grade C rate were calculated and compared. The status of health care management ; 1. Of the sample industries, 96.9% provide protective equipment and 80.0% set up ventilating system. Protective gloves (89.2%) and protective clothing (80.0%) are widely provided, but ear plugs (4.6%) are rarely provided. 21.5% of the protective equipment are well put on, and 40.4% of the ventilating systems function well. 2. In 1993, 35 industries, 53.8% of the sample, checked working environment twice. Over-permissible-limit rates of heavy metal (12.2%), suspended particle (11.1%), noise (5.5%) were high. To put on protective equipment and to set up local ventilating system were pointed out by the examiners. 3. General health screening was done at 63.1% of the sample industries and 35.3% of total workers were examined. Specific health screening was done at 93.8% of the sample industries and 75.4% of workers were examined. 15.5% of workers was provided to be above grade C and to have digestive system disease (43.3%), circulatory disease (18.9%), and hematopoietic disease (14.2%), etc. 4. In 1993, the subsidiary program of health care management was provided in forms of health education, health counseling, and rounding check of working field. And 61.5%, 83.0%, 55.4% of sample industries respectively received it. The average visit per industry was 1.8. Comparisons of the level of occupational health before and after the subsidiary program ; 1. Over-permissible-limit rates of hazardous factors of 1993 and that of 1994 were compared. The rates of suspended particle, noise, organic solvent of 1994 (37.5%, 13.4%, 24.2% respectively) were higher than that of 1993 (25.0%, 6.0%, 6.3% respectively). In the case of acid, there was no difference between the rate of 1993 and that of 1994. Only the rate of heavy metal decreased from 12.9% in 1993 to 3.0% in 1994. 2. General health screening was done at 38.7% of the sample industries in 1993 and at 44.6% in 1994. But the implementation rate of specific health screening decreased from 72.4% in 1993 to 64.6% in 1994. 3. The implementation rate of specific health screening was analyzed by some health factors. The rate of suspended particle increased from 61.8% in 1993 to 91.2% in 1994. But the rates of the others-noise, organic solvent, heavy metal, specific chemical substances-decreased. 4. Above grade C rate in health screening increased from 27.8% in 1993 to 35.5% in 1994. But that of endocrine disorders and pulmonary disease decreased.

• Clinical and Experimental Pediatrics
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• 제45권5호
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• pp.654-658
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• 2002

목 적 : 내분비계와 면역계는 상호 의존적이며 여기에는 부신의 역할 특히 dehydroepiandrosterone(DHEA)와 코티솔 사이의 균형이 중요한 것으로 알려져 있다. 이들은 T 세포 분화 과정 및 이와 관련된 인터루킨들의 유도작용에 길항 효과를 나타낸다. 따라서 저자들은 T 세포 면역 장애와 관련된 가와사끼병에서 부신 안드로겐과 코티솔의 역할을 평가하고자 하였다. 방 법: 2001년 4월부터 8월까지 가와사끼병으로 진단된 14명과 자가면역성질환의 병력이 없는 대조군을 대상으로 혈중 DHEAS와 24시간 동안 채집한 소변에서 유리 코티솔 농도를 방사면역측정법으로 검사하였다. 검체는 면역글로불린과 스테로이드를 투여하기 전에 채취하였으며, 가와사끼병의 임상적 중등도는 Harada 점수와 심초음파에 의한 심혈관계 병변을 근거로 하였다. 결 과 : 1) 환자군은 4개월에서 4세 사이로 평균 연령은 2.3세, 연령 분포는 1세 미만이 3명(21.4%), 1-2세 2명(14.3%), 2-3세 5명(35.7%), 3-4세 4명(28.6%)이었으며, 남녀 비는 1 : 1.3이었다. 2) DHEAS치는 환자군에서 $11.1{\pm}6.0{\mu}g/dL$, 대조군에서 $81.6{\pm}13.3{\mu}g/dL$로 환자군에서 유의하게 감소하였다(P<0.05). 3) 24시간 소변 유리 코티솔(F)치는 환자군에서 $36.9{\pm}21.9{\mu}g/dL$, 대조군에서 $13.6{\pm}5.5{\mu}g/dL$로 환자군에서 유의하게 증가하였다(P<0.05). 4) DHEAS/F 비율은 환자군 $0.33{\pm}0.20$, 대조군 $6.65{\pm}2.56$으로 환자군에서 현저히 감소하였으나(P=0.016), 연령 및 성별에 따른 유의한 차이는 없었다. 5) 가와사끼병에서 임상적 중등도의 지표인 Harada 점수와 DHEAS/F 비율 사이에 통계학적으로 유의한 차이는 보이지 않았으나, 심혈관계 병변(관상동 맥류)이 발생하였던 환아에서 그 비율이 매우 낮았다. 결 론: 가와사끼병에서는 부신호르몬의 균형에 변화가 발생하며, 이것이 가와사끼병의 병인인 T 세포 면역장애와 관련이 있을 것으로 생각되며, 또한 관상 동맥 합병증의 예측인자의 하나로서 DHEAS/F 비율을 이용할 수 있을 것으로 생각된다.

• 대한간호학회지
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• 제29권6호
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• pp.1455-1468
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• 1999

The purpose of this study was to investigate the objectives and contents of basic medical sciences at department of nursing in college of nursing, and junior college of nursing, thus ultimately providing the basic data to standardize the curriculum of the basic medical sciences in nursing education. Seventy eight professors who were in charge of teaching basic medical sciences to at 22 colleges of nursing/ department of nursing, and 20 junior colleges of nursing responded to the questionnaires that consisted of the questions regarding objectives and contents, of basic medical sciences. Based on the description of objectives, the description related to nursing, nurse, nursing science was cathegorized as on objective applicable to nursing science, the description related to medicine or clinical medicine as medical model, the description without description related to medicine was cathegorized as knowledge acquisition. The number of schools corresponding to each category were summerized in descending order. The objectives of basic medical sciences were categorized by concepts and number of schools corresponding to the categorized concept. The findings of the study are as follows ; 1. The subjects of basic medical science identified were physiology, anatomy, biochemistry, pathology, microbiology, and pharmacology in most colleges of nursing and junior colleges. Two colleges of nursing/department of nursing (9.1%) and 19 junior colleges of nursing(95%) did not offer biochemistry, 1 college of nursing /department of nursing(5%) did not offer pathology & pharmacology. 2 junior colleges of nursing (10%) did not offer pharmacology, 1 junior college of nursing(5%) did not offer pathology. The other 1 junior college of nursing did not offer microbiology. 2. Objectives of physiology were to acquire knowledge and understanding on human function in both 6 (50%) colleges and 5 junior colleges. Objectives of anatomy were to acquire knowledge on human structure in both 4 (57%) colleges and 2 (50%) junior colleges; knowledge applicable to nursing sciences in both 3 (42.8%) colleges and 2 (50%) junior colleges. Objectives of biochemistry was to obtain knowledge and understanding on biochemistry, and understanding of basic concepts about biochemistry. Objectives of pathology were to obtain knowledge and understanding on pathology in both 4 (57.1%) colleges and 5(62.5%) junior colleges. Objectives of microbiology were to acquire knowledge and understanding on microbiology in both 5(83.8%) colleges and 6(85.7%) junior colleges. Objectives of pharmacology were to acquire knowledge on pharmacology in both 7(100%) colleges and 8(100%) junior colleges. 3. Contents of physiology in 19 (100%) schools were membrane transport, digestion, circulation, nervous system and respiration. In 16(84.2%) were kidney and muscle, that in 13(68.4%) were endocrine physiology. In 11(57.9%) were introduction and that in 9(47.4%) were structure and function of cells. Contents of anatomy in 11(100%) schools were skeletal system, muscle system, digestive system, circulatory system, concepts regarding human structure. In 10(90.9%) schools were endocrine system and nervous system, and in 5(45.5%) schools were blood, urinary system and cell. Contents of biochemistry in 6(100%) schools were history of biochemistry, body regulating factor, bioenergy, health and nutrition, nutrition of cell, energy production system. In 5(83.3%) schools were metabolism of protein and carbohydrate and enzyme, and in 3(50%) schools were metabolism of energy and fat. Contents of microbiology in 13(100%) schools were environment and influenc of bacteria, virus, G(-) rods, purulent cocci, G(+) rods. In 10 (76.9%) were immunity, diphtheria, enterobacteria, and in 9(69.2%) were spirochete, rickettsia and clamydia, and that in 6(46.2%) were sterilization and disinfection. Contents of pathology in 14(100%) schools were cell injury and adaptation, inflammation, respiratory diseases, circulatory diseases. In 10(71.4%) were neurological disorders, in 8(57.1%) were immunity and disease, and in 7 (50%) were tumor and progressive changes. Contents of pharmacology in 15(100%) were cardivascular drugs, introduction to pharmacology, hypnotics, analgesics, local anesthetics, an ticonvulsants. In 12(80%) were drugs activity on sympathetic and parasympathetic nervous system, and in 11(73%) were sulfa drugs, antibiotics, drug abuse and addiction.