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1/3. Rheumatologic manifestations of malignancy.

    The relationship between rheumatologic syndromes and cancer covers a very broad array of both common and distinctly rare manifestations. This discussion has outlined some of the known relationships that do exist. A high index of suspicion by both the primary care physician and subspecialist will enhance the probability of detecting cancer in the patient who may present with rheumatologic complaints.
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2/3. Clubbed fingers: indicators of serious disease.

    Clubbed fingers were noted by a dentist in a woman patient having respiratory symptoms. He referred her to a physician to be examined for pulmonary disease. Bronchogenic carcinoma was diagnosed.
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3/3. Possible hazard of timed-release aspirin in a patient with pancreatic insufficiency.

    An episode of severe small intestinal hemorrhage occurred in a cystic fibrosis patient having pancreatic insufficiency and receiving timed-release aspirin therapy for disabling hypertrophic pulmonary osteoarthropathy. The increased acidity of small intestinal contents due to decreased bicarbonate secretion observed in patients with pancreatic insufficiency may alter the luminal environment and result in mucosal erosions and/or ulcerations in association with the presence of aspirin. Thus, physicians should be aware of the possibility that timed-release aspirin causes small intestinal hemorrhage in such patients.
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