This study was a retrospective audit of patients over 15 years of age who presented to the emergency department of Appendicitis is a common diagnosis, but is by no means a simple one to establish. This retrospective study investigated the value of medical imaging (ultrasonography and/or computed tomography [CT]) for patients with suspected appendicitis. Negative appendicectomy rate and appendiceal perforation with or without medical imaging were used as end points for this investigation.PATIENTS AND METHODS This study retrospectively reviewed all patients admitted in one district general hospital with suspected acute appendicitis. The patient cohort was identified from the Unit Registry and an International Classification of Diseasesbased Review of medical records. The medical records were analysed, and the outcome of patients were followed up. RESULTS Between 12 January 2004 to 27 May 2005, 168 patients' medical records were audited. The negative appendicitis rate was 6.7% and appendiceal perforation rate was 3.2%. Among them, only 20 in-patients (12%) had medical imaging (ultrasonography and/or CT scan) after clinical assessment for suspected acute appendicitis. Medical imaging had a 70% prediction rate for acute appendicitis, 20% false-negative rate, and 10% false-positive rate. Overall, the prediction rate for appendicitis by clinical assessment supplemented by laboratory tests and medical imaging at clinician's discretion was 93.2%.CONCLUSIONS Despite studies advocating routine use of medical imaging for patients with suspected acute appendicitis, this study showed that the clinical evaluation is still paramount to the management of patients with suspected acute appendicitis before considering medical imaging.

We present a rare presentation of testicular seminoma. A 60-year-old man presented with a solitary subcutaneous metastasis to the skull, 4 years after radical orchidectomy and adjuvant prophylatic radiotherapy for stage T1 seminomatous germ cell tumour. The patient was treated with surgical excision of the solitary metastasis, adjuvant radiation therapy and chemotherapy. He has been followed up for two and a half years with no further recurrence.