[A Case Report of Gastric Cancer with Positive Peritoneal Lavage Cytology and Metachronous Schnitzler's Metastasis Treated with Multimodality Therapy].

A69 -year-old male patient with type 3 gastric cancer in pyloric antrum underwent distal gastrectomy with regional lymphadenectomy. Serosal infiltration of cancer tissue was found in the anterior wall of antrum, and the evaluation of peritoneal lavage cytology were positive. Pathological analysis showed the tumor was mainly consist of moderately tubular adenocarcinoma and strongly positive for HER2 stain. Postoperatively, combined therapy of capecitabine and trastuzumab was carried out, but cisplatin was excluded because of the patient's rejection. However, nine months after drug withdrawal, singular tumor located at left anterior side of rectum was detected by abdominal CT scan. Colonoscopy revealed its mucosal invasion and the result of biopsy was metastasis of gastric cancer, also known as Schnitzler's metastasis. Local radiation therapy aimed at the tumor was performed, followed by capecitabine and oxaliplatin therapy for 18 months. After the therapy, Schnitzler's metastatic lesion was disappeared and biopsy from colonic mucosa revealed there was no tumor tissue left. The patient has been in good health 5 years after surgery. This case suggests that multimodality therapy including radiation and chemotherapy might improve survival of gastric cancer patient with positive peritoneal lavage cytology and metachronous metastasis.

A case of rectal villous tumor with shortness of breath in a 70-year-old woman-Uncommon symptom of McKittrick-Wheelock syndrome.

Diagnosis of McKittrick-Wheelock syndrome (MWS) is sometimes difficult because the symptoms are sometimes nonspecific. Physician should be considered MWS in case of severe hyponatremia and hypokalemia are accompanied by prolonged mucous diarrhea.

Inter-professional and inter-departmental alcoholism rehabilitation program.

A 3-month alcoholism rehabilitation program at psychiatric hospitals is common in Japan for patients with alcohol use disorder (AUD). However, many AUD patients are often hospitalized for the treatment of digestive disorders due to alcohol-related liver diseases and pancreatitis. In this sense, AUD patients need to be better supported by professionals and departments in general hospitals. Here we analyzed the problems in alcohol-related medical care in Japan and examined the measures to be taken at general hospitals.