In Vivo Inactivation of Gentamicin by Carbenicillin and Ticarcillin

COMMENT The unusual feature of this case is the appearance of diffuse osteoblastic metastases in association with gastric carcinoma, especially as an initial feature of the disease. Although increased radiodensity in the axial skeleton is a well-recognized manifestation of osseous metastasis, this pattern is most commonly encountered in patients with prostatic and bladder carcinomas, meduloblastoma, and other CNS tumors, and extraintestinal carcinoid tumors. Despite statements that indicate that gastric carcinoma is the most probable origin of osteoblastic metastases arising from tumors of the GI tract,1 actual reports of such cases are infrequent. In fact, review of available literature indicates that only two other similar cases have been noted,2-3 although the incidence of skeletal metastasis from gastric carcinomas may be as high as 3% to 14%.4 The patient in this report had widespread osteoblastic metastases at the time of initial examination. It was the knowledge of an earlier case that allowed us to raise the possibility of gastric carcinoma in this instance, especially in view of this patient's intestinal symptoms, prior to documentation of malignancy during endoscopy. The roentgenographic findings in the skeleton are certainly consistent with sclerotic metastatic foci, although other causes of increased radiodensity must be considered. Such causes include lymphoma and lymphosarcoma, Paget's disease, myelofibrosis, mastocytosis, fluorosis, renal osteodystrophy, hypoparathyroidism, sarcoidosis, axial osteomalacia, and rare congenital disorders such as osteopetrosis and sclerosteosis.59 In each of these diseases, additional roentgenographic changes are generally present. In our patient, the absence of such changes coupled with historical evidence of GI symptoms and signs allows accurate differ¬ ential diagnosis. We wish to emphasize, then, that gastric carcinoma may indeed be associated with osteoblastic metastases, especial