Abnormality of the skin of the nose, causing it to become enlarged, reddish-purple and bumpy. The symptoms are often incorrectly attributed to excessive drinking (’whisky nose’)- Rhinophyma is caused by enlargement of the sebaceous glands in the nose, together with an increase in tissue, and as such is a particular form of rosacea. Rhinophyma can be treated with antibiotics, which reduce the redness and some of the swelling. If this does not give satisfactory results a skin specialist or plastic surgeon can reshape the nose by cutting out little strips, or by scraping the skin. Extra rib connected with the lowest vertebra of the neck and fused with the uppermost normal rib (or connected to it by a septum of tissue, often not completely). The condition occurs on one or both sides in 1 per cent of the population. It causes problems in only a very few cases, namely when blood vessels and nerves of the arm, which normally run over the uppermost rib, are trapped because they have to run over the extra rib. The foremost oblique muscle of the neck, which is attached to the first rib, can cause further constriction. Problems usually occur specifically because of an abnormal movement or position of the shoulder. Pressure on the nerves of the arm causes tingling, pain, a dull sensation and loss of strength in the arm. The condition is worsened by poor circulation caused by pressure on the blood vessels. The hand may be cold, and the arm may swell and show signs of cyanosis. Diagnosis is by stimulating the symptoms by asking the patient to carry out a certain sequence of movements. X-rays show the extra rib, and injection of a contrast medium into the veins gives evidence of their constriction when certain movements are made. If symptoms are not severe treatment is by improved posture and diet if the patient is overweight. In serious cases the extra rib can be removed by surgery.