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At that time, CT scans of the cranium, thorax, and abdomen, along with bone scan, were negative for tumor metastasis. He had a diagnosis of nonmetastatic proximal tibial osteosarcoma and was treated with nine cycles of high-dose IV methotrexate, IV ifosfamide, and IV adriamycin followed by surgical resection. After surgery, the patient received 11 more cycles of the same drug regimen. Serial follow-up included CT scans of the thorax and abdomen together with bone scintigraphy every 3 months. CT and bone scans remained clear until 20 months after the primary diagnosis, when a CT scan of the chest showed two nodules, 5 mm in diameter, in the posterior basal segment of the left lung and lateral basal segment of the right consistent with metastatic tumor. The patient underwent resections of these pulmonary nodules via a thoracotomy. After pulmonary metastasectomy, he received five courses of chemotherapy with ifosfamide plus mesna. Unfortunately, the patient was lost to follow-up for 8 months. canadian pharmacy

At the subsequent presentation, the patient was cachectic, dyspneic, and cyanotic on physical examination. His oral temperature was 38.2°C; pulse rate, 125 beats/min; and respiratory rate, 32 breaths/min.
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