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Background: Meconium ileus is a common cause of intestinal obstruction in neonates that different surgical methods have been described for its management such as Santulli and loop ileostomy. Aim: To evaluate and compare clinical efficacy of Santulli and loop ileostomy in neonates with meconium ileus. Methods: In this retrospective study, 58 patients with meconium ileus were evaluated. After analyses of hospital records, 53 patients with completed hospital records were included. Demographic information, surgery parameters and postoperative complications were extracted from the hospital records or calling parents. Results: Skin excoriation (21.4% vs. 84%, p<0.001), ostomy prolapsed (0 vs. 28%, p=0.003), and surgical site infection (7.1% vs. 28%, p=0.044) was significantly lower in Santulli ileostomy group. Furthermore, ileostomy output in first week (70.53±15.11 ml vs. 144.6±19.99 ml, p<0.001) and in 4th week (2.14±4.98 ml vs. 18.4±17.95 ml, p<0.001) was significantly lower in Santulli ileostomy group as compared to loop ileostomy group. Finally, hospital stay in Santulli ileostomy group was 12±2.34 and in loop ileostomy 14.24±1.47 days (p<0.001). Conclusion: Santulli ileostomy is better than loop ileostomy due to significant less frequency of surgical site infection, skin excoriation, prolapse of ostomy, ileostomy volume output and hospitalization time.

Aim: The aim of this study was to compare post-operative C-reactive protein (CRP) between cases which underwent open appendectomy and laparoscopic appendectomy. Material and methods: This study was conducted on patients admitted for appendectomy in Imam Khomeini and Razi hospitals. Patients with perforated and gangrenous appendicitis, another pathological condition, renal failure, liver failure, history of taking drugs that interact with C-reactive protein (CRP), and pregnancy were excluded from this study. Cases were divided into children (5-15 years) and adults (16-65 years). Patients were randomly selected for open or laparoscopic appendectomy. SPSS version 16.0 (SPSS Inc, Chicago, IL, USA) was used for data analysis. T-test was used for comparison. Pearson and Spearman tests were used for correlation analysis. Results: There were no significant differences between CRP levels after laparoscopy in children vs. adult cases (p-value > 0.05, t-test). There was no significant difference between children and adults in pre-op CRP. There were significant differences between children and adults for 12 h and 24 h level of CRP after laparoscopic appendectomy (p < 0.05, t-test). Mean level of CRP in adults was significantly higher than children (p < 0.05, t-test). Level of CRP, 12 h after the procedure, was significantly higher in open appendectomy compared to laparoscopic surgery in adult cases (p = 0.09, t-test). In cases with body mass index (BMI) < 25 kg/m 2 , there was no significant difference between level of CRP before and after open or laparoscopic surgery. In cases with BMI ≥ 25 kg/m 2 , there was no significant difference between level of CRP of open and laparoscopic surgery (p > 0.05, t-test). Duration of surgery had no effect on level of CRP (p > 0.05, t-test). Conclusions: There was no significant difference between level of CRP after open and laparoscopic appendectomy, except in adult women. Level of CRP, 12 h and 24 h after surgery, was significantly higher in adult cases than children.

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2Intussusception is a curious anatomic condition characterized by the invagination of one segment of the gastrointestinal tract into the lumen of an adjacent segment. once initiated, additional intestinal telescopes into the distal segment, causing the invaginated intestine to propagate distally within the bowel lumen. the aim of the study was to evaluate the clinical manifestation, etiology,and outcome of intussuception at atypical ages. material and methods. This retrospective study was carried out on patients aged <6 mo or >2 yr with intussusception. Duration of study was from March, 20, 1997 to March, 20, 2008. The places of study were Imam Khomeini and Abuzar referrals hospital. Cases were classified according to age and sex. According to age, patients were <6 mo, 2-10 years, 10-18, and more than 18 years. Age, sex, history, chief complaint, clinical manifestation, sonographic findings, duration of clinical manifestation, method of treatment, outcome, duration of hospital staying, and ICU admission were studied. Data were analyzed with SPSS ver 16 (Chicago, IL, USA)and Epi-info. Results. In this study, 36 cases with diagnosis of intussusception at atypical ages, <6 mo or >2 yr, were included. From all cases, 21 cases (58.3%) were 2 through 10 years and male: female ratio was 2.26:1. Ten cases (27.8%) had history of medical condition. Eighty percent (29 cases) had abdominal pain and 20 cases (58.3%) had vomiting. Abdominal mass was found in 14 cases (38.8%). Sonography was done for 30 (83.3%) of cases and suggesting intussuception in 25 (69.4%) of cases. Intussuception was reduced by hand and performed appendectomy for 10 cases (27.8%). Bowel resection was done for 19 cases (52.8%) and radiological reduction was done for 2 cases (5.6%). Eighteen (50%) cases had anemia. Twenty-five cases admitted to ICU. one (2.8%) patient died (a 65 year old woman). Appendicitis is the most common well defined injury associated with intussusception. conclusion. This study showed that with advancing age, incidence of intussusception will be decreased. As age increasing, rate of bowel resection will be increased. All cases with appendectomy and reduction by hand had hospital staying 3-10 days. The results of this study was similar to other studies. The most widely used diagnostic procedure for intussusception was sonography.