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At the end of the second month of this treatment, bone pain had improved but he developed a slight fever (38°C) and exertional dyspnea. On admission, his general condition was good. Crepitations were heard in both lungs. A chest roentgenogram showed metastases on fifth and sixth right ribs and small opacities of an interstitial type spread throughout both lungs. A few days after admission this patients respiratory assessment was suddenly interrupted by the occurrence of thromboembolic disease with diffuse chest pain, increased dyspnea, signs of right ventricular failure and left lower limb phlebitis. Systemic blood pressure was normal. Chest roentgenogram displayed a blunted right costo-phrenic angle, an elevated right diaphragm; Pa02 was 45 mm Hg and PaC02, 25 mm Hg on room air. The thromboembolism was confirmed by pulmonary angiography which showed multiple pulmonary emboli; deep vein thrombosis of the left leg was obvious on phlebography film. Treatment ED by Viagra Australia Pharmacy was commenced with heparin and a filter was placed in the inferior vena cava
through the right femoral vein.

Fifteen days later, all thromboembolic signs had subsided. Clinically, and while still on nilutamide, he remained breathless with crepitations audible in both lungs. A chest x-ray film showed an interstitial process throughout both lungs, a similar appearance to that seen prior to thromboembolism. Peripheral blood cell count was 9,250 with 70.4 percent neutrophils, 2.3 percent eosinophils, 20.9 percent lymphocytes and 6.4 percent monocytes; ESR was increased to 60 mm at first hour. Pulmonary function tests showed results consistent with a restrictive syndrome (vital capacity: 76 percent predicted) with Pa0 of 60 mm Hg on room air and an alveolo-arterial oxygen gradient greatly increased to 54 mm Hg. Gas-diffusing capacity was decreased to 0.8 mmol/minAPa/L (normal value: 1.9 to 2.4). All tests of sputum and serum for bacterial, viral or fungal infection were negative. Tuberculin skin test was negative. Serum IgE level was normal as were serum levels of C3 and C4 complement fractions and circulating immune complexes. A search for rheumatoid factor, cryoglobulin and antinuclear antibodies was negative. A migration inhibition test on peripheral blood leukocytes in the presence of different concentrations of nilutamide showed an inhibition of 31.3 percent at the 72nd hour of a cell culture containing 10 p.g nilutamide/ml; with the same concentration, no significant inhibition (10 percent) was observed in a healthy control.

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