We evaluated the medium-term results of combined Chiari pelvic and femoral osteotomies performed at the Manchester Children's Hospitals between the years 1985 and 1994. The indications for these osteotomies were either hip dislocation or subluxation in children with neuromuscular disease. We clinically and radiologically evaluated 20 hips in 18 patients treated for hip subluxation and dislocation with Chiari osteotomy. The average post-operative clinical follow-up period was 11.32 years (range 10.1-12.9). The mean age at the time of surgery was 7.3 years (range 3.1-13.2 years). Clinically, 9 hips had a 'Good' outcome, 10 were "Fair" and 1 was "Poor" according to Osterkamp criteria. At last follow-up, radiologically the mean Sharp's angle improved from 51° to 44° (p = 0.09), the mean Centre-Edge angle improved from -16° to 18° (p = 0.067), the mean Migration Index improved from 59 to 29 % (p = 0.011), the mean femoral neck-shaft angle from 160° to 117° (p < 0.0001) and the Severin criteria improved from an average grade of 4.5-2.9 (p < 0.0001). Our results compared to previous studies confirm that combined femoral and Chiari osteotomies provide a favourable outcome both clinically and radiologically at least 10 years following surgery. Accepting that the numbers are small, we report no statistical difference in the mean age at the time of operation when comparing the children with an eventual 'good' outcome and those with an eventual 'fair' or 'poor' outcome.

We have read with interest the article entitled ''Transoral thyroid and parathyroid surgery' ' [1]. This article describes a new minimally invasive surgical approach to the thyroid and parathyroid glands. It appears that the purpose of the study was to (1) demonstrate the feasibility of a transluminal endoscopic approach to thyroid and parathyroid surgery; (2) describe a new minimally invasive technique which has improved cosmetic results; and (3) promote a minimally invasive technique to thyroid surgery that offers minimal disruption to surrounding tissues and structures.The article focused on a proof of concept through surgery on porcine and human cadavers and also on live porcine subjects. It sites the embryological and anatomical similarities between pigs and humans when justifying their use of porcine subjects. The results in these subjects appears to be promising. However, the article failed to address a number of important questions regarding the feasibility of translating this impressive work into a procedure that can be widely adopted by endocrine surgeons.If we understand the article correctly, the technique can be described as minimally invasive surgery (MIS) because of the use of a potential anatomical space previously described by Newell [2]. However, as with other MIS techniques used on the thyroid, the size of the incision is limited [3]. In this case, it appears that the incision is limited to approximately 10 mm in length, somewhat smaller than current MIS methods. As such, this will limit the size of any thyroidectomy to approximately 20 ml in volume, consequently reducing the range of pathologies on which the technique can be employed. This may be particularly significant for tumour resection where the actual tumour extends beyond the capsule of the thyroid gland.Another problem with this technique is the potential for infection. The oral cavity and pharynx are unclean spaces. They cannot be cleaned and therefore pose a significant infection risk. It is likely that due to this infection risk antibiotic cover will be required in all cases, something not routinely required in current minimally invasive thyroid surgery.A further problem, common to most endoscopic procedures, is the necessity to clean the camera of debris and fluids to ensure an adequate view of the surgical site. In the case of a transluminal approach, there is the risk of trauma to surrounding tissues and structures due to repeated insertion and removal of the instrument for cleaning [4,5].The article also suggests the possibility of using CO 2 gas as a means of creating a surgical space. We acknowledge that this was not actually employed by the authors and we would caution against its use due to the potential risk creating a pneumomediastinum.Although we have highlighted some areas for consideration by the authors, we would like to congratulate the team on their endeavours and look forward to seeing how their work is developed. Disclosures G. Galatà and M. Hannan have no conflicts of interest or financial ties to disclose. Refer...

This article is taken from a presentation made by two young people who were part of the 'Looked After Children in Education' (LACE) research study. The article describes aspects of the research process of a qualitative and participatory research study. It explores the experiences of two young people involved in the research (in particular the research training, developing the research tool and conducting the eldwork) and gives their re ections on how their involvement bene ted the research process and the research participants in particular. It also highlights limitations of the process, which could be overcome in the future. The two young people in consultation with the LACE researcher worded this presentation.The Looked After Children in Education (LACE) research project is unique, as it involves young people in the design, decision-making process, eldwork and data analysis stages of the project. It was formally set up in December 2000 after recruiting a number of young people as researchers who themselves had experienced care while being in education.The LACE project is a collaborative research project between three organisations: Save the Children, First Key Northern Ireland and the Voice of Young People in Care. Due to a number and variety of complex reasons, these organisations decided to undertake research on the educational experiences of young people 'looked after' in care. There was a concern that there was an unacceptably low level of educational achievement among this group and equally worrying was a concern about the kinds of experiences these young people were having in school and/or out of school. The main aim of the research was, therefore, to nd out why young people 'looked after' in care, as a group, were less likely to achieve, and the factors and in uences that hinder and promote achievement, and to highlight their personal experiences within the school/care environment.The three organisations involved in the research felt that the best way to undertake the research project was to recruit and train a group of young people who had had or were having experience of being 'looked after' in care while attending school. It was felt that young researchers would help to reduce the

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