From Minerva's Photo Album

A 38 year old woman was assaulted with a knife while shopping in a supermarket. Her assailant's blade passed through her left nostril, penetrating the posterior pharyngeal wall and becoming embedded close to the transverse process of the second cervical vertebra. An aortogram showed no evidence of injury to the carotid artery. The knife was removed under general anaesthesia, and her recovery from this potentially horrendous injury was uneventful.

Stephen Hamilton, senior house officer, Gerald W Mcgarry, consultant otolaryngologist, Department of Otolaryngology and Head and Neck Surgery, Glasgow Royal Infirmary NHS Trust, Glasgow G31 2ER

The format of the consent form has not altered since the 1950s. However, the degree of trust patients have for their doctors has clearly changed.--

unaid Hanif, registrar in otolaryngology, Adam Frosh, registrar in otolaryngology, Department of Otolaryngology, West Middlesex University Hospital, Isleworth, Middlesex TW7 6AF

A 19 year old man attended this accident and emergency clinic for review of burns sustained to both forearms after trying to light a bonfire by squirting petrol on to it. He was initially thought to have developed ascending lymphangitis from infection of the burns, but examination showed that his forearm veins were marked out by sharply defined linear superficial burns. I assumed that this had occurred because his veins were dilated and standing proud of the skin at the time of the flash burns. Venous flow was not interrupted, and he recovered fully with simple burn dressings and without antibiotics.--

Ian Greaves, registrar, Department of Accident and Emergency Medicine, St James's University Hospital, Leeds LS9 7TF

A 52 year old man developed a persistent pharyngocutaneous fistula after total laryngectomy and radiotherapy for laryngeal carcinoma. The fistula required reconstruction with a flap from the left pectoralis major and skin grafting. One year later he presented after developing progressive dysphagia over one week. Endoscopy showed a tight benign stricture where the flap of pectoralis major was, and this was dilated with improvement in symptoms. In addition, the view of the pharynx through the endoscope was partially obscured by prominent matted hair arising from the mucocutaneous flap. The hair follicles on the graft were able to regenerate with normal growth of hair, although they had been exposed to an unnatural environment.

Voi Shim, senior registrar in gastroenterology, Anthony Morris, consultant gastroenterologist, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L7 8XP

An 85 year old woman was referred by a geriatrician for an orthopaedic opinion because she repeatedly suffered anterior dislocation of her left shoulder. An x ray film showed a second shoulder joint. She had fractured her left humerus a year before, but the fracture had not united. A pseudoarthrosis developed as a result of stiffness in the shoulder joint caused by arthritis. This second joint had taken over the function of the shoulder joint.

Babis Karagkevrekis, registrar in orthopaedics, DG Bennett, senior house officer in geriatrics, Cheltenham General Hospital, Cheltenham, Gloucestershire GL53 7AN

A 21 year old student presented to this department two days after taking "ecstasy" (3, 4-methylene -di xymethamphetamine, MDMA). He complained of a sore throat, slight shortness of breath, and pleuritic chest pain. Spontaneous pneumomediastinum and surgical emphysema was confirmed in an x ray film. On review by thoracic surgeons his condition was noted to be improving, and he was discharged to be followed up by his general practitioner. Previous reports of pneumomediastinum with "ecstasy" have been associated with vomiting, which did not apply in this case. A possible explanation is the extreme exertion associated with the recreational use of this drug.--

NL jones, registrar, RJ evans, senior registrar, Department of Accident and Emergency Medicine, Cardiff Royal Infirmary, Cardiff CF2