Evidence before this study: Acute appendicitis is the most common general surgical emergency in children. Its diagnosis remains challenging and children presenting with acute right iliac fossa (RIF) pain may be admitted for clinical observation or undergo normal appendicectomy (removal of a histologically normal appendix). A search for external validation studies of risk prediction models for acute appendicitis in children was performed on MEDLINE and Web of Science on 12 January 2017 using the search terms ["appendicitis" OR "appendectomy" OR "appendicectomy"] AND ["score" OR "model" OR "nomogram" OR "scoring"]. Studies validating prediction models aimed at differentiating acute appendicitis from all other causes of RIF pain were included. No date restrictions were applied. Validation studies were most commonly performed for the Alvarado, Appendicitis Inflammatory Response Score (AIRS), and Paediatric Appendicitis Score (PAS) models. Most validation studies were based on retrospective, single centre, or small cohorts, and findings regarding model performance were inconsistent. There was no high quality evidence to guide selection of the optimum model and threshold cutoff for identification of low-risk children in the UK and Ireland. Added value of this study: Most children admitted to hospital with RIF pain do not undergo surgery. When children do undergo appendicectomy, removal of a normal appendix (normal appendicectomy) is common, occurring in around 1 in 6 children. The Shera score is able to identify a large low-risk group of children who present with acute RIF pain but do not have acute appendicitis (specificity 44%). This low-risk group has an overall 1 in 30 risk of acute appendicitis and a 1 in 270 risk of perforated appendicitis. The Shera score is unable to achieve a sufficiently high positive predictive value to select a high-risk group who should proceed directly to surgery. Current diagnostic performance of ultrasound is also too poor to select children for surgery. Implications of all the available evidence: Routine pre-operative risk scoring could inform shared decision making by doctors, children, and parents by supporting safe selection of lowrisk patients for ambulatory management, reducing unnecessary admissions and normal appendicectomy. Hospitals should ensure seven-day-a-week availability of ultrasound for medium and high-risk patients. Ultrasound should be performed by operators trained to assess for acute appendicitis in children. For children in whom diagnostic uncertainty remains following ultrasound, magnetic resonance imaging (MRI) or low-dose computed tomography (CT) are second-line investigations.

Convergence excess esotropia has been treated with bifocals, miotics, medial rectus recession(s), fadenoperation, or a combination of these. However, comparatively few studies on the sensory status of these patients exist. We present the sensory findings in 31 children treated surgically. Age at surgery (years) 5*7 (range 2-5 to 9 0) 6-8 (range 5*5 to [7][8] Age at end of follow-up 8-1 (range 5-0 to 12-0) 9-6 (range 8-0 to 15 0)Preop. near deviation (PD) 35 6 (range 25 to >45) 32-0 (range 25 to >45) Postop. near stereoacuity (arc')

A case of mycosis fungoides with bilateral intraocular involvement is reported. The diagnosis was established with the aid of a vitreous biopsy. Intraocular involvement, though rare, may be an early sign of extracutaneous disease.

A case with a severe midline craniofacial defect, comprising a midline cleft lip and palate with a sphenoethmoidal encephalocele, hypertelorism, bilateral dysplastic optic discs and agenesis of the corpus callosum is described. The optic discs are consistent with the spectrum of appearances seen in the Morning Glory Disc Anomaly (MGDA). This anomaly is usually a uniocular problem that may be rarely associated with craniofacial abnormalities. Despite this range of abnormalities this child was developing well with a specific motor delay at the age of eight months. Cases with similar midline craniofacial abnormalities from the literature are reviewed. This condition appears to be a distinct entity within the spectrum of frontonasal dysplasia.

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