BACKGROUND/AIMS: To evaluate the usefulness and safety of treating disseminated intravascular coagulation (DIC) complicating cholangitis primarily with antithrombin (AT) and thrombomodulin (rTM). METHODS: A DIC treatment algorithm was determined on the basis of plasma AT III levels at the time of DIC diagnosis and DIC score changes on treatment day 3. Laboratory data and DIC scores were assessed prospectively at 2-day intervals. RESULTS: DIC reversal rates >75% were attained on day 7. In the DIC reversal group, statistically significant differences from baseline were observed in interleukin-6 and C-reactive protein levels within 5 days. Patients with no DIC score improvements after treatment with AT alone experienced slow improvement on a subsequent combination therapy with rTM. Although a subgroup with biliary drainage showed greater improvement in DIC scores than did the nondrainage subgroup, the mean DIC score showed improvement even in the nondrainage subgroup alone. Gastric cancer bleeding that was treated conservatively occurred in one patient. As for day 28 outcomes, three patients died from concurrent malignancies. CONCLUSIONS: Although this algorithm was found to be useful and safe for DIC patients with cholangitis, it may be better to administer rTM and AT simultaneously from day 1 if the plasma AT III level is less than 70%.
Antithrombin III ; Antithrombins ; C-Reactive Protein ; Cholangitis ; Dacarbazine ; Disseminated Intravascular Coagulation ; Drainage ; Hemorrhage ; Humans ; Interleukin-6 ; Plasma ; Prospective Studies ; Stomach Neoplasms ; Thrombomodulin

Many papers on medical education emphasize the idea that obtaining structure through the practice of Oral Case Presentations (OCPs) is essential and efficient to brush up presentation skills. However, psychological resistance to giving a public presentation is an obstacle in learning OCPs. The aim of this survey is to evaluate the educational effect of our teaching method using a playful learning approach for presentation. This study was conducted by using an anonymous self-administered questionnaire for medical students during their clinical clerkship. One hundred twenty eight students participated in this survey.　Didactics and small group discussions took place during the first week of clerkship, and participants were asked to give presentations about their original theme during the second week. Questionnaires were distributed before and after the end of each session. The results showed that psychological resistance to presentations decreased, positive feelings increased, and students became more aware of the purpose, place, and subject of their presentations. Each parameter statistically improved at each phase. A playful learning approach is effective in teaching presentations, including OCPs.