INTRODUCTION Clinical assessment outweighs the use of investigations in the diagnosis of acute appendicitis. Nevertheless, white cell count (WCC) and C-reactive protein (CRP) are regularly measured in patients with suspected appendicitis. The aim of this study was to assess the utility of these markers in patients presenting with acute lower abdominal pain. PATIENTS AND METHODS WCC and CRP were measured prospectively in 98 patients presenting with lower abdominal pain, and the results were correlated with each patient's outcome. RESULTS No patients with WCC and CRP both in the normal range had acute appendicitis. Raised WCC and CRP were poor positive predictors of appendicitis, both alone and in combination, and correlated poorly with the development of complications. CONCLUSIONS This result may have important clinical and economic implications. We suggest that patients experiencing lower abdominal pain, with normal WCC and CRP values, are unlikely to have acute appendicitis and can be safely sent home.

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Ir ead with interest the article by Robinson et al. which audited the use of two parentconsent for childhood circumcision on religious or ritual grounds. This paper raises more general questions about the consent of children for asurgical procedure for non-therapeutic reasons. The Hippocratic oath states 'I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone'. Performing ac ircumcision is associated with well-documented complications: postoperative bleeding, wound infection, meatal

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