A multicentre study of computer aided diagnosis for patients with acute abdominal pain was performed in eight centres with over 250 participating doctors and 16737 patients. Performance in diagnosis and decision making was compared over two periods: a test period (when a small computer system was provided to aid diagnosis) and a baseline period (before the system was installed). The two periods were well matched for type of case and rate of accrual.The system proved reliable and was used in 75-1% of possible cases. User reaction was broadly favourable. During the test period improvements were noted in diagnosis, decision making, and patient outcome. Initial diagnostic accuracy rose from 45-6% to 65 3%. The negative laparotomy rate fell by almost half, as did the perforation rate among patients with appendicitis (from 23.7% to 11-5%). The bad management error rate fell from 0-9% to 0-2%, and the observed mortality fell by 22-0%. The savings made were estimated as amounting to 278 laparotomies and 8516 bed nights during the trial period-equivalent throughout the National Health Service to annual savings in resources worth over £20m and direct cost savings of over £5m.Computer aided diagnosis is a useful system for improving diagnosis and encouraging better clinical practice.

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The tape-measure is frequently used by the medical profession to assess muscle function following injury. It is assumed that increasing limb girth is reflected by increasing muscle power and strength; but this assumption is empirical and may not in practice be justified. The relationship between thigh circumference and muscle strength and power, measured as the torque produced on an isokinetic dynamometer, was assessed in 64 subjects--24 non-injured sportsmen and 40 injured sportsmen. The correlation between the torque produced at the knee by the knee extensors and flexors and the thigh circumference at three levels was not significant in either group. Comparison of the injured with the non-injured limb also failed to show any correlation. By contrast, in eight subjects, repeated measurements over a six to eight month period showed a significant relationship between change in thigh circumference and change in quadriceps power. It is concluded that a single measurement of circumference at the same point in both thighs of a subject with unilateral injury should not be used as an assessment of muscle function. Serial measurements, however, at the 4 and 10 cm levels may be of value as an index of quadriceps power. Reasons for this are discussed.

A review of one thousand injuries due to Rugby Football is reported. There is a high incidence of fracture (15.7%) and head injury of various types (14.0%) in this series although only four adults required immediate hospital admission for the head injury.

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