به جمع مشترکان مگیران بپیوندید!

تنها با پرداخت 70 هزارتومان حق اشتراک سالانه به متن مقالات دسترسی داشته باشید و 100 مقاله را بدون هزینه دیگری دریافت کنید.

برای پرداخت حق اشتراک اگر عضو هستید وارد شوید در غیر این صورت حساب کاربری جدید ایجاد کنید

عضویت

جستجوی مقالات مرتبط با کلیدواژه "ileus" در نشریات گروه "پزشکی"

  • J. Yang, Y. Zhu, F. Wang*
    Background
    To analyze the value of quantitative parameters of Computed Tomograph (CT) abdominal fat in predicting postoperative intestinal obstruction for gastric cancer.
    Materials and Methods
    A retrospective analysis was conducted on 120 gastric cancer patients treated between January 2017 and December 2021. These patients were divided into two groups: an observation group with postoperative intestinal obstruction (28 patients) and a control group without (92 patients). CT scans were used to measure the Subcutaneous Fat Area (SFA) and Visceral Fat Area(VFA), calculate the SFA-VFA difference, and the VFA/SFA ratio. The receiver operating curve (ROC) was employed to evaluate the predictive efficacy of these CT measurements.
    Results
    The observation group exhibited significantly lower VFA and SFA compared to the control group (P < 0.05), while the differences in VFA/SFA ratio and SFA-VFA were not statistically significant. The area under the ROC curve (AUC) for the combined VFA and SFA in predicting postoperative intestinal obstruction was 0.902, with a 95% confidence interval of 0.859 to 0.956. This combined measure showed higher sensitivity (96.02%) and comparable specificity (85.24%) than single measurements. Logistic regression analysis identified diabetes, malnutrition, C-Reactive Protein (CRP) levels, VFA, and SFA as risk factors for postoperative intestinal obstruction (P < 0.05).
    Conclusion
    The combined quantitative assessment of VFA and SFA using abdominal CT improves the sensitivity of predicting postoperative intestinal obstruction in gastric cancer patients. This complication is multifactorial, emphasizing the importance of a comprehensive approach in the clinical evaluation and management of these patients.
    Keywords: Abdominal CT, Fat Quantitative Parameters, Gastric Cancer, Ileus
  • عاطفه یاس، الهه منصوری قزل حصاری، رباب لطیف نژاد رودسری*
    مقدمه

    کارآزمایی های بالینی از مطالعات با ارزش در حیطه علوم پزشکی بوده و نقش موثری در پیشگیری و درمان بیماری ها دارند. جهت دستیابی به شواهد معتبر در زمینه روش های غیردارویی موثر بر ایلیوس پس از سزارین، مطالعه حاضر با هدف ارزیابی نقادانه کارآزمایی های بالینی منتشر شده در زمینه ی تاثیر روش های غیر دارویی بر ایلیوس پس از زایمان سزارین طراحی و اجرا شد.

    مواد و روش کار

    در این مرور انتقادی، کارآزمایی های بالینی غیر دارویی در زمینه ایلیوس پس از زایمان سزارین در پایگاه های  اطلاعاتی,Pubmed, Web of science, scopus, Embase, ProQuest   SID , Magiran, Iranmedex با کلمات کلیدی: زایمان سزارین، ایلیوس، حرکات روده، عبور گاز، دفع مدفوع ، عملکرد روده و روش های غیر دارویی و Cesarean delivery, ileus, bowel movements, passing gas, defecation, bowel function and non-pharmacological methods  از تاریخ 1/1/ 2011 تا 2023/9/25 جستجو شدند. بررسی کیفیت مقالات از چک لیست کانسورت درمان های غیردارویی 2017 که شامل: 6 بخش، 25 سوال و 44 گویه صورت گرفت. برای تجزیه و تحلیل توصیفی داده ها از نرم افزار  SPSS2019 استفاده شد.

    یافته ها

    در مجموع23 مقاله مورد ارزیابی نقادانه قرار گرفت. روش های غیر دارویی با تعداد نه مقاله در ارتباط با جویدن آدامس (40%)، پنج مقاله در زمینه تغذیه زودرس بعد جراحی سزارین (21%)، سه مقاله در ارتباط با طب فشاری (13%)، دو مقاله در ارتباط با نوشیدن قهوه (9%)، یک مقاله در مورد انجام ورزش (4/5%) و سه مقاله در زمینه گیاهان دارویی (13%) به دست آمد. درصد انطباق مقالات با معیارهای ابزار کانسورت، 60 درصد و میانگین امتیاز آن ها 4/4± 27 و دامنه امتیاز مقالات 33-14 بود. بیشترین نقص در بخش های نتایج و روش کار بود.

    نتیجه گیری

    کیفیت کارآزمایی های بالینی در زمینه تاثیر روش های غیر دارویی بر ایلیوس پس از زایمان سزارین در 10 سال اخیر در حد متوسط بود که نیازمند توجه بیشتر و  آشنایی نویسندگان با چک لیست ه ای استاندارد گزارش دهی مطالعات است. داوران مجلات نیز جهت ارزیابی نقادانه مقالات، استفاده از چک لیست های بین المللی گزارش مقالات را مد نظر قرار دهند.

    کلید واژگان: زایمان سزارین, ایلئوس, حرکات روده, عبور گاز, دفع مدفوع, روش های غیر دارویی, عملکرد روده
    Atefeh Yas, Elahe Mansouri Ghezelhesari, Robab Latifnejad Roudsari*

    Objective (s): 

    This study aimed to critically evaluate published clinical trials on the effect of non-pharmacological approaches on post-cesarean ileus.

    Methods

    Non-pharmacological clinical trials on ileus after cesarean delivery were searched in Pubmed, Web of science, Scopus, Embase, ProQuest, SID, Magiran, Iranmedex databases. The key words: Cesarean Delivery, Ileus, Bowel Movements, Passing Gas, Defecation, Bowel Function and Non-Pharmacological Methods were used from 1/1/2011 to 9/25/2023.The Studies were evaluated by the CONSORT checklist of non-pharmacological interventions consisting of six sections, 25 questions and 44 items. SPSS2019 software was used for descriptive data analysis.

    Results

    A total of 23 articles were critically evaluated. The following non-pharmacological methods were found: nine articles related to chewing gum (40%), five articles related to premature feeding after cesarean section (21%), three articles related to acupressure (13%), two articles related to drinking coffee (9%), one article on exercise (4.5%) and three articles on medicinal plants (13%). The compliance percentage of the articles with Consort criteria was 60% and their mean score was 27±4.4 ranging from 14 to 33. The most discrepancies were in the results and method sections.

    Conclusion

    The quality of clinical trials on non-pharmacological methods on ileus after cesarean delivery in the last 10 years was intermediate, which suggest the need for more attention by investigators using the standard checklists for reporting studies.

    Keywords: Cesarean delivery, Ileus, Bowel movements, Bowel function, Passing gas, Defecation, non-Pharmacological approaches
  • Mitra Ahmadi, Mohammadreza Mirkarimi, Shabnam Khanifar, Hazhir Javaherizadeh *, Mohsen Ali Samir
    Background

     Cystic fibrosis (CF) stands as the most common chronic multisystem and fatal inherited disease.

    Objectives

     The present study aimed to assess the clinical presentation and laboratory findings in children with CF.

    Methods

     This retrospective cross-sectional study reviewed the records of CF patients over a 2-year period beginning in 2018. The diagnosis of CF was confirmed based on clinical manifestations, sweat chloride tests, or genetic studies. Children aged ≥ 2 years were included; nevertheless, patients without sweat chloride tests or genetic studies were excluded. This study recorded demographic features, gastrointestinal manifestations, vitamin D levels, and the number of hospital admissions. A pediatric gastroenterologist conducted fecal elastase and stool fat analyses to evaluate pancreatic insufficiency. Vitamin D levels < 30 ng/mL were considered vitamin D insufficiency; however, levels < 20 ng/mL indicated a vitamin D deficiency. A P-value < 0.05 was considered statistically significant.

    Results

     This study included 59 children (37 male and 22 female) in the study. Low weight, height, and body mass index (BMI) percentiles (< 5) were most frequently observed. Approximately 86.4% of the patients had consanguineous parents, and 40.7% had affected siblings. Failure to thrive (FTT) (49.2%) and recurrent respiratory infections (45.8%) were the most common clinical presentations. A majority (57.7%) of the patients were diagnosed before the age of 1 year. The mean number of admissions in the past 2 years was 3, and 58% of the cases reported gastrointestinal symptoms. A significant correlation was observed between vitamin D levels and the number of hospital admissions (Pearson coefficient = 0.298, P = 0.042).

    Conclusions

     In this study, there was a high prevalence of vitamin D insufficiency and FTT in children with CF. Additionally, there was a significant correlation between vitamin D levels and the number of hospital admissions over a 2-year period.

    Keywords: Cystic Fibrosis, Vitamin D, Ileus, Inflammatory Markers, Pancreas
  • Nathan Strugnell, Jamie Young *, Elizabeth Williams, Bernhard Riedel
    Background

    Colorectal cancer is a major cause of morbidity and mortality in Australia. Following colorectal cancer surgery, although systemic opioids are often first-line analgesia, they may be associated with various adverse effects. Intrathecal morphine (ITM) has been shown to provide good analgesia with a safe side effect profile. This study assessed whether ITM alongside patient-controlled analgesia (PCA) reduces the incidence of immediate postoperative adverse effects and post-discharge outcomes compared to PCA alone following colorectal cancer surgery.

    Methods

    In this retrospective cohort study, data from 260 patients undergoing colorectal cancer surgery during 2014-2018 at Peter MacCallum Cancer Centre was extracted from a clinical database and medical records. Immediate postoperative outcomes included pruritus, postoperative ileus, and time to mobilisation. Post-discharge outcomes encompassed chronic postoperative pain and long-term opioid consumption. Cancer recurrence was an exploratory endpoint. Comparative analysis was undertaken for ITM with PCA (the ITM group) compared to PCA alone (the PCA group), overall and after stratification into laparoscopy versus laparotomy procedures.

    Results

    In total, 260 patients were included in this study (160 in the ITM group and 100 in the PCA group). The ITM group trended toward a lower incidence of postoperative ileus, lower incidence of chronic pain, and opioid use at three and six months but not at twelve months.

    Conclusion

    Based on the findings, the ITM group trended toward reductions in postoperative ileus, chronic pain, and opioid use at three and six months.

    Keywords: Morphine, Patient-controlled analgesia, Anesthesia, Ileus, Colorectal surgery, Colorectalneoplasms
  • نیره قمیان، مجید خادم رضائیان، زهرا بهنام رسولی*، مصطفی زمرشیدی
    مقدمه

    ایلیوس پس از عمل منجر به ناراحتی بیمار، طولانی شدن مدت بستری و تحمیل هزینه به سیستم بهداشتی می شود. در تعداد کمی از مطالعات از نقش احتمالی مصرف قهوه در کاهش بروز ایلیوس حمایت شده است. مطالعه حاضر با هدف بررسی تاثیر مصرف قهوه در مقایسه با رژیم تغذیه ای معمول بر بهبود عملکرد روده پس از هیسترکتومی ابدومینال انجام گرفت.

    روش کار

    این مطالعه کارآزمایی بالینی تصادفی دو سو کور در سال 1400-1399 بر روی 40 بیمار کاندید هیسترکتومی به دلیل بیماری خوش خیم رحمی که به بیمارستان امام رضا (ع) مشهد مراجعه کرده بودند، انجام شد. افراد به دو گروه تقسیم شدند که از روز بعد از عمل به فاصله زمانی هر 6 ساعت تا 3 نوبت، در گروه مداخله میزان 100 میلی لیتر قهوه و در گروه کنترل میزان 100 میلی لیتر رنگ مجاز خوراکی و اسانس شبیه قهوه مصرف شد. پیامد اولیه، بررسی زمان اولین دفع گاز و پیامدهای ثانویه، بررسی زمان اولین صدای روده ای، اولین اجابت مزاج و میزان بروز ایلیوس بعد از عمل بود. تجزیه و تحلیل داده ها با استفاده از نرم افزار آماری SPSS (نسخه 27) انجام شد. میزان p کمتر از 05/0 معنی دار در نظر گرفته شد.

    یافته ها

    در مقایسه زمان اولین صدای روده ای (02/0=p)، اولین دفع گاز (007/0=p) و اولین اجابت مزاج (001/0>p) بین دو گروه مداخله و کنترل تفاوت آماری معناداری وجود داشت. هیچ موردی از ایلیوس شدید مشاهده نشد. در مقایسه بین عدم بروز ایلیوس با مجموع موارد ایلیوس خفیف و متوسط تفاوت بین دو گروه معنادار بود (047/0=p). مقایسه مدت زمان بستری بین دو گروه معنادار نبود (24/0=p).

    نتیجه گیری

    در مقایسه زمان اولین صدای روده ای، اولین دفع گاز، اولین اجابت مزاج و بروز ایلیوس بین دو گروه مداخله و کنترل تفاوت آماری معناداری وجود داشت. چنین به نظر می رسد که مصرف قهوه پس از عمل هیسترکتومی ابدومینال موجب تسریع شروع حرکات روده ای و کاهش بروز ایلیوس می شود.

    کلید واژگان: ایلئوس, قهوه, هیسترکتومی
    Nayereh Ghomian, Majid Khadem Rezaiyan, Zahra Behnam Rassouli *, Mostafa Zemorshidi
    Introduction

    Postoperative ileus causes patient discomfort, prolonged hospitalization and extra costs on health system. Few studies support the possible role of coffee consumption in reducing the incidence of ileus. The present study was performed aimed to investigate the role of coffee consumption in comparison with routine diet on improving intestinal function after abdominal hysterectomy.

    Methods

    This randomized double-blind clinical trial study was performed in 2020-2021 on 40 patients candidate for hysterectomy due to benign uterine disease who had referred to Imam Reza hospital in Mashhad. The patients were divided into two groups and from the day after surgery, every 6 hours for three times, patients in intervention group consumed 100 ml of coffee and patients in control group consumed 100 ml of food coloring and essence similar to coffee. The primary outcome was the time of first gas passing and secondary outcomes were the time of first bowel sound, first defecation and incidence of postoperative ileus. Data were analyzed by SPSS 27 software (version 27). P< 0.05 was considered statistically significant.

    Results

    There was a statistically significant difference between the two groups in comparing the time of first bowel sound (P=0.02), first gas passing (P=0.007) and first defecation (P<0.00). There was no case of severe ileus in participants. In comparison between the absence of ileus with the sum of mild and moderate ileus cases, the difference between two groups was significant (P=0.047). Comparison of hospitalization period was not significant between the two groups (P=0.24).

    Conclusion

    There was a statistically significant difference between the intervention and control groups in comparing the time of first bowel sound, first gas passing, first defecation and incidence of ileus. It seems that coffee consumption after abdominal hysterectomy accelerates the onset of intestinal movements and reduces the incidence of ileus.

    Keywords: Coffee, Hysterectomy, Ileus
  • Ebrahim Khadem, Mahboobeh Shirazi, Leila Janani, Roja Rahimi, Parastoo Amiri, Fereshteh Ghorat
    Objective

    Postoperative ileus (POI) is a common complication after surgery that requires a multifactorial therapeutic approach. This study aims to assess the effect of topical chamomile oil on postoperative bowel activity after cesarian section.

    Methods

    This randomized controlled trial was carried out in 2015 at Chamran Hospital in Iran. A block randomization list was generated for 142 parturient divided into three groups. In the intervention group (arm A) (n = 47), chamomile oil was applied topically on abdominal region after the stability of the patient. Placebo group (arm B) (n = 47) received placebo oil and control group (arm C) (n = 48) had no intervention. A recovery program was used after surgery for all participants. The primary outcome was time to first flatus. Secondary outcomes were time to bowel sounds, defecation, return of appetite, hospital stay, and rate of nausea and vomiting, abdominal pain.

    Findings

    Times to first flatus were significantly shorter in Group A (arm A vs. B, P < 0.001 and arm A vs. C, P < 0.001). In addition, time to first bowel sounds (arm A vs. B, P < 0.001 and arm A vs. C, P < 0.001) and return of appetite (arm A vs. B, P < 0.001 and arm A vs. C, P < 0.001) were significantly shorter in arm A. The times from surgery to first defecation were shorter in Group A versus B and C. However, there were no statistically significant differences between three groups.

    Conclusion

    These results suggest that topical chamomile oil has a potential therapeutic effect on gastrointestinal motility and can reduce the duration of POI.

    Keywords: Cesarian section, complementary therapies, defecation, flatulence, ileus, Matricaria, surgery
  • Mohsen Rajabnia *, Mahsa Mohammadi, Danial Dehbandi

    Gallstone ileus is a rare cause of mechanical small bowel obstruction due to gallstone impaction within the lumen of the small intestine after passing through biliary enteric fistula. We report a case of gallstone ileus that was diagnosed with Rigler's triad (small bowel obstruction, ectopic gallstone, pneumobilia) in abdominal contrast-enhanced CT scan that is less than 30% of the patients.Key words: Gall stone, Ileus, small bowel obstruction, pneumobilia, Rigler's triad.

    Keywords: Gall stone, Ileus, small bowel obstruction, pneumobilia, Rigler's tria
  • Omid Sadeghpour, Zeinab Hamzehgardeshi, Farnaz Sohrabvand, Seyde Sedighe
    Objective

    To investigate the effect of the Carumcarvi (BuniumpersicumBoiss) plant, a gas solvent, on resumption of bowel motility after caesarean section.

    Materials and methods

    A randomized controlled trial was done on a group of 98 women undergoing elective caesarean section under general anesthesia in a university hospital. Patients in the intervention group (Group A) drank 10 ml of a syrup containing 8 g of BuniumpersicumBoiss in 20 ml of syrup 6 to 7 hours after surgery. The control group (Group B) comprised 10 patients who drank 10 ml of placebo syrup 6 to 7 hours after surgery. Demographic characteristics, time to first hearing of normal intestinal sounds, time to first flatus, time to first bowel movement, and length of hospital stay were compared between the two groups.

    Results

    Compared with the control group, the intervention group had a significantly shorter mean time to hearing the first intestinal sounds (10.66 ± 2.38 vs. 19.54 ± 3.85 h), mean time to first flatus (13.91 ± 3.73 vs. 24.82 ± 5.83 h), mean time to first bowel movement (19.31 ± 4.63 vs. 30.70 ± 10.21 h), and mean length of hospitalization (31.70 ± 7.70 vs. 49.20 ± 10.16 h) (p < 0.05). No patients developed serious side effects associated with consumption of the syrup.

    Conclusion

    The use of a gas solvent such as BuniumpersicumBoiss after caesarean section can speed the resumption of postoperative bowel motility.

    Keywords: Ileus, Caesarean Section, Bunium Persicum Boiss, Traditional Persian Medicine
  • Mohammad Moshiri, Zahra Ataee, Parastoo Rahimi, Elham Ansari, Leila Etemad *
    Ileus is a very rare complication of methamphetamine (MET) intoxication. We herein report a 15-year-old non-addict girl who ingested about 5 gr of MET. She suffered from bowel obstruction manifestations. She was treated by intravenous metoclopramide and erythromycin. On next morning, she became restlessness with tachycardia and sweeting that was treated by intravenous diazepam. Abdominal-pelvic computerized tomography (CT) scan confirmed generalize dilatation in small intestine and more prominent in colon with no ischemia or mechanical obstruction. It also showed some hyperdense collections in ascending colon, sigmoid and rectum. MET was detected in her urine. On the third day, the bowel obstruction signs resolved. On fourth day, the prokinetic drugs were discontinued and whole bowel irrigation by polyethylene-glycol was performed. She passed the drug packages, and was discharged in well condition on fifth day. MET intoxication can induce ileus, specially, in the higher doses of MET and physicians should mention this rare MET presentation.
    Keywords: Amphetamine, Catecholamine, Gastrointestinal, Ileus
  • Konstantinos A Paschos *_Anestis Chatzigeorgiadis
    Bezoars are rare conditions of mechanical intestinal occlusion. Among the various types of bezoars, phytobezoars and trichobezoars are the most common types. Symptoms are usually indistinguishable from other more common entities; therefore, it may be difficult to reach a correct diagnosis. Computed tomography (CT) scan is the preferred diagnostic method. Treatment may include surgery, lavage with Coca-Cola or hydrolytic solutions, and endoscopic mechanical or electrical disintegration. The present case report aimed to describe an uncommon symptomatic double phytobezoar (ileal and gastric), which was successfully treated surgically and endoscopically. The patient, an 83-year-old woman, was admitted to the General Hospital of Drama (Drama, Greece) after suffering from abdominal pain for 3 days. Physical examination revealed abdominal distention and pain mainly in the right quadrants. The CT scan revealed an intestinal phytobezoar which was subsequently removed surgically with a longitudinal enterotomy. On the third postoperative day, the patient presented jaundice and a new CT scan showed a second phytobezoar impacted into the duodenal bulb, which was missed during the initial diagnosis. The gastric phytobezoar was fragmented endoscopically using a polypectomy snare with high flow electric current (70-80 Watts) and its pieces were removed orally. The patient had no complications during the hospital stay and was discharged on the eighth postoperative day. Three months later, the follow-up gastroduodenoscopy and CT scan revealed no signs or symptoms of any gastrointestinal mass. The present case report is the first presentation of a double gastrointestinal phytobezoar that caused ileus and temporary jaundice. Moreover, a successful single-session mechanical-electrical fragmentation of a large gastric phytobezoar is described for the first time.
    Keywords: Bezoar, Gastroscopy, Ileus, Jaundice, Small Bowel Obstruction
  • Oktay Aydin, G?khan Karaca, Gülçin Ayd?n, Ca?atay Erden Daphan, Faruk Pehlivanl?*
    Retroperitoneal and horseshoe abscesses are particularly important because of the anatomic characteristics and the clinical differences between treatment approaches. There are several challenges in treating perirectal and retroperitoneal abscess, the most important of which are partial recovery, high recurrence rates, and continence problems. A 65-yearold male patient underwent laparotomy at an external center with a diagnosis of ileus. Although no intraoperative pathology was detected, ileus persisted postoperatively, and the patient was referred to our clinic where he was diagnosed with a complicated horseshoe abscess, 9 cm in diameter and displaying retroperitoneal extension. Perirectal abscess drainage was performed, and the patient was discharged on the 5th day after the treatment. To the best of our knowledge, there have not been any previously reported cases of ileus caused by retroperitoneal abscess as a complication of horseshoe abscess. The case presented in this paper represents a rare complication, thereby contributing to the literature which remains to be explored.
    Keywords: Retroperitoneal abscess, Horseshoe abscess, Ileus, Perirectal abscess.
  • Forouzan Elyasi *, Marzieh Azizi, Mahboobeh Shirzad, Roya Ghasemian, Arash Kazemi, Sabahat Lavvaf
    Introduction
    Neuroleptic malignant syndrome (NMS) is a rare and unpredictable adverse reaction associated with the use of first-generation and second-generation antipsychotics. Atypical antipsychotics may create atypical forms of NMS due to their different pharmacological characteristics. Decreased dopaminergic tone in the brain is coincided with a dysregulation of autonomic nervous system in this syndrome. This paper reports on an NMS case, in which current views and symptoms that occurred during the course of the disease were rare symptoms that are not usually found in NMS.
    Case Presentation
    The patient was a 43-year-old male with schizoaffective disorder under treatment with clozapine and risperidone. He had lead pipe muscle rigidity, stupor, fever and autonomic dysfunction, increased levels of creatinine phosphokinase, leukocytosis, and microglobulina. Levenson’s criteria is widely accepted for diagnosis of NMS. Six days after admission to the psychosomatic ward, the patient had ileus. Due to lack of response to neomycin and GI rest and embedding NG tube, the patient underwent therapeutic sigmoidoscopy and colonoscopy for decompression.
    Conclusions
    Diagnosis of NMS is largely based on clinical history and the presence of specific clinical symptoms. Antipsychotics polypharmacy increases the NMS risk. Mechanisms underlying the development of ileus in the patient are speculative and multifactorial. Paralytic ileus can be one of the autonomic dysfunctions in NMS. Furthermore, NMS is categorized in differential diagnosis of acute abdomen caused by the pseudo-obstruction. All physicians should be aware of this possibility when faced with patients under treatment with neuroleptics.
    Keywords: Antipsychotics, Neuroleptic Malignant Syndrome, Muscle Rigidity, Ileus
  • Reza Jafarzadeh Esfehani, Marzyeh Moosavi Yazd, Ali Jafarzadeh Rsfehani, Samira Foji, Batool Kamalimanesh *
    Background and Aim
    Cesarean section (CS) accounts for 35% of all surgical operations in Iran. Post cesarean ileus is a complication of CS. There are various pharmaceutical and non-pharmaceutical ways for the treatment of this condition. Given the fact that the non-pharmaceutical approaches are better tolerated and often inexpensive, the present study was conducted to evaluate the effect of chewing gum on post cesarean ileus.
    Methods
    This clinical trial was conducted on 93 patients undergoing CS (i.e., elective or urgent CS) at Sabzevar Mobini Hospital, Savzevar, Iran, between July 2013 and September 2014. The study population was selected using convenience sampling technique and assigned into two groups of chewing gum (n=35) and control (n=58) groups. The subjects in the chewing gum group were encouraged to chew gum at defined intervals. Both groups were evaluated for pain, bowel sounds, first defecations, gas passage, and feeling bowel movements. Data analysis was performed in SPSS software, version 21.
    Results
    There was no significant difference between the two groups in terms of the auscultation of first bowel sound, first record of gas passing, and first defecation. The logistic regression models showed that chewing gum was significantly associated with reduced post-operative pain while controlling for surgery duration as a confounding factor (OR: 0.79, 95% CI for OR=0.63, 0.99). However, chewing gum showed no significant relationship with bowel sounds, first defecations, gas passage, and feeling bowel movements.
    Conclusion
    As the findings indicated, the use of chewing gum after CS was ineffective in the reduction of ileus. However, this practice was only capable of mitigating post-operative pain, and therefore can be used as an adjuvant technique for the management of post-operative pain.
    Keywords: Caesarean section, Chewing gum, Ileus
  • امیر درخشان فر، جلال الدین امیری *، امین نیایش
    زمینه و هدف
    ایلئوس یکی از عوارض شایع در بیماران بستری در بیمارستان می باشد و شایعترین علت تاخیر در ترخیص بیمار به دنبال جراحی های شکمی می باشد. مطالعه حاضر با هدف بررسی نتایج حاصل از جویدن آدامس بر روی حرکات دودی دستگاه گوارش بعد از آپاندکتومی طراحی شده است.
    مواد و روش ها
    در این کارآزمایی بالینی، با استفاده از فرمول حجم نمونه مربوط به مقایسه دو میانگین 40 نفر از بیمارانی که در سال های 1394-1393 در مرکز آموزشی درمانی بعثت همدان تحت عمل جراحی آپاندکتومی قرار گرفته بودند، به صورت تصادفی در دو گروه مداخله و کنترل (هر گروه 20 نفر) مداخله مطالعه قرار گرفتند. معیارهای ورود به مطالعه سن بالای 15 سال و عمل جراحی آپاندکتومی و معیارهای خروج از مطالعه داشتن دیابت، هیپوتیروئیدی، هیپوپاراتیروئیدی، اختلال الکترولیت و بیماری-های عضلانی و عصبی واضح و اعتیاد به مواد مخدر بود. روش بیهوشی هر دو گروه بیماران یکسان بود. برای گروه مورد در سه نوبت آدامس ساخت کارخانه و طعم یکسان در بازه های زمانی در چهار، ده و هجده ساعت بعد از به هوش آمدن بیمار (هر نوبت 20 دقیقه)، داده شد. در گروه شاهد اقدامی انجام نگردید. یک ساعت بعد از به هوش آمدن بیمار و ثابت شدن علایم حیاتی، در زمان بستری در بیمارستان در گروه های مورد و شاهد هر دو ساعت صداهای روده، با گوشی پزشکی توسط محقق بررسی شد. پژوهشگر هر دو ساعت دفع گاز و مدفوع را از طریق پرسش از بیمار ارزیابی کرد. داده های جمع آوری شده توسط نرم افزار آماری SPSS ویرایش 17 مورد تجزیه و تحلیل قرار گرفتند و از آمار توصیفی و در موارد مورد نیاز برای بررسی معنی داری ارتباطات از آزمون آماری تی تست استفاده گردید. سطح معنی داری آزمون ها کمتر از 05/0 در نظر گرفته شد.
    یافته ها
    میانگین زمان شنیده شدن اول صدای روده ای در گروه مداخله؛ 17/1±30/3 ساعت و در گروه کنترل 23/1±60/2 ساعت بود، آزمون آماری تفاوت معنی داری را بین دو گروه مداخله و کنترل نشان نداد (073/0 P =). میانگین زمان دفع گاز در گروه مداخله؛ 52/3±90/10 ساعت و در گروه کنترل 90/9±50/17 ساعت بود، که تفاوت معنی داری را بین دو گروه مداخله و کنترل مشاهده گردید (008/0 P =). میانگین زمان دفع مدفوع در گروه مداخله؛ 03/5±40/25 ساعت و در گروه کنترل 98/13±70/37 ساعت بود، که تفاوت معنی داری بین دو گروه مداخله و کنترل مشاهده گردید (001/0 P =). میانگین زمان عدم دریافت تغذیه خوراکی کردن در گروه مداخله؛ 88/4±75/17 ساعت و در گروه کنترل 18/5±50/18 ساعت بود (641/0 P =). میانگین زمان خروج از تخت در گروه مداخله؛ 60/5±85/8 ساعت و در گروه کنترل 29/4±55/10 ساعت بود (28/0 P =).
    نتیجه گیری
    بر اساس نتایج مطالعه حاضر، میانگین زمان دفع گاز و میانگین زمان دفع مدفوع در گروه دریافت کنندگان آدامس به طور قابل توجهی پایین تر از گروه کنترل بوده است. انجام مطالعات تکمیلی و جستجوی راه هایی که بدون پرسش از بیمار از اولین زمان دفع گاز و مدفوع بتوان به اثرات جویدن آدامس در کاهش زمان ایلئوس پی برد، توصیه می گردد.
    کلید واژگان: ایلئوس, جویدن آدامس, آپاندکتومی لاپاراتومی
    Derakhshanfar A., Amiri J. *, Niayesh A
    Introduction &
    Objective
    Ileus is one of the common complications in hospitalized patients as well as it is the most common reason of delay in discharge from the hospital due to abdominal surgeries. Present study with aim of investigating the results of chewing gum on bowel movements of digestive system after appendectomy was designed.
    Materials and Methods
    In this clinical trial using the related sample size formula 40 patients’ means that underwent appendectomy surgery in Besat- Hamedan Medical Center were randomly classified into the intervention and control groups (20 people per group). Inclusion criteria for the study included the age of over 15 and having appendectomy surgery and the exclusion criteria included hypothyroidism, hypo-parathyroid glands, electrolyte disorders, neuro muscular diseases and drug addiction. Method of anesthesia was similar in both groups. For the case group the chewing gum manufactured by the same factory and in the same flavor was prescribed within the four, ten and eighteen hours after the patient's recovery. No treatment was applied to the control group. One hour after the patient’s recovery and stabilization of the vital signs, the bowel sounds were examined by stethoscope by researcher in the case and control groups every two hours. The researcher evaluated flatulence and defecation by asking the patients. The collected data were analyzed by SPSS version 17 and the descriptive statistics were used in the required cases and the t-test was used for the evaluation of significance of the data. The significance level of data is considered lower than 0.05.
    Results
    The average time to hear the first bowel sound in experimental group was 3.30 ± 1.17 hours and in control group it was 2.60 ± 1.23 hours. Therefore there was no significant difference (P = 0.073) between the experimental and control groups. The average time to gas-passing in experimental group was10.90 ± 3.52 hours and in control group it was 17.50 ± 9.90 hours that showed a significant difference (P = 0.008) between the experimental and control groups. Average time to defecation in the experimental group was 25.40 ± 5.03 hours and in control group it was 37.70 ± 13.98 hours. Therefore there was a significant difference (P = 0.001) between the experimental and control groups. The average time to receive oral feeding in the experimental group was 17.75 ± 4.88 hours and in control group it was 18.50 ± 5.18 hours (P = 0.641). The average time to leaving the sickbed in the experimental group was 8.85 ± 5.60 hours and in control group it was 10.55 ± 4.29 hours (P = 0.28).
    Conclusions
    According to the results of this study, the average time to gas-passing and defecation in gum recipients group was significantly less than the control group. Complementary studies and finding ways to find out the chewing gum effects on reduction of Ileus time without questioning the patient about the first gas-passing and defecation after surgery was recommended.
    Keywords: Ileus, Gum-Chewing, Laparatomic Appendectomy
  • فرشته قراط*، ابراهیم خادم، محبوبه شیرازی، روجا رحیمی، سودابه بیوس، عالمه خادمی
    مقدمه
    ایلئوس یک پیامد شایع و غیر قابل پیشگیری در جراحی های شکمی است که علاوه بر تاخیر در بهبود بیماران پس از جراحی، هزینه سیستم های مراقبت سلامت را به میزان قابل توجهی افزایش می دهد. علیرغم مطالعات مختلف در سراسر دنیا هنوز پاتوفیزیولوژی دقیق و نیز درمان موثر در این زمینه ناشناخته است. این مطالعه با هدف بررسی علل و درمان ایلئوس پس از جراحی از دیدگاه طب سنتی و مقایسه آن با طب نوین انجام گرفته است.
    روش
    در این مطالعه مروری به بررسی متون در حوزه طب سنتی پرداخته شد. جامعه پژوهش محتوای امهات کتب طب سنتی ایران بوده و نمونه گیری به صورت هدفمند بر اساس میزان وابستگی و ارتباط به مضامین تحت مطالعه با استفاده از نرم افزار نور انجام گردید. جستجوی جامعی دربرگیرنده واژگان کلیدی «ایلاوس»، «قولنج»، «سوء مزاج»، «امعاء»، «کولون» و «حفظ الصحه» در منابع طب سنتی به عمل آمد. همچنین جستجو در منابع طب نوین در بانک های اطلاعاتی Ovid، Sience Direct و PubMed با واژگان کلیدی bowel function، surgery، bowel movement و post-operative ileus به صورت جستجوی منفرد و ترکیبی انجام گردید. داده ها پس از یادداشت برداری به طور دقیق تحت تجزیه و تحلیل محتوایی قرار گرفتند.
    یافته ها
    ایلئوس نوعی کولیک ناشی از انسداد غیر مکانیکی دستگاه گوارش است که به دلیل از بین رفتن موقتی پریستالتیسم روده ای بعد جراحی های شکمی روی می دهد. این عارضه منجر به عوارض متعددی بعد از جراحی و افزایش طول بستری بیمار می گردد. ایلئوس در کتب طب سنتی با عنوان ایلاوس آمده و حکیمان طب سنتی آن را نوعی قولنج شدید دانسته و اسباب و درمان آن را مشابه قولنج ذکر کرده اند. از جمله سبب های ایلئوس در متون طب سنتی سوء مزاج سرد روده هاست که باعث تجمد آن یا تولید ریاح و درد می گردد. همچنین از جمله سایر اسباب آن داروهای سست کننده و بی حس کننده است که باعث بطلان حس روده شده و لذا قوه دافعه از آن سلب می شود و در نتیجه مواد محتبسه در روده دفع نمی شوند.
    بحث و نتیجه گیری
    با بررسی متون طب نوین و طب سنتی به نظر می رسد ایلاوس طب سنتی تطابق کامل با ایلئوس بعد از جراحی نداشته و نیاز به نظریه پردازی در این زمینه وجود دارد. به نظر می رسد با توجه به شرایط حین جراحی، مانند بازشدن شکم و بی حسی موضعی یا بیهوشی عمومی که موجب سردی و بی حسی بدن می گردد، در طی جراحی سوء مزاج سرد امعا ایجاد می شود که تجمد روده ها یا تولید ریاح را به دنبال دارد. بنابراین استفاده از داروهایی که موجب تسخین دستگاه گوارش و تحلیل ریاح شود می تواند در این زمینه موثر باشد.
    کلید واژگان: جراحی, ایلئوس, حرکات رودهای, طب سنتی, طب مکمل, قولنج, درد شکم
    Fereshteh Ghorat*, Ebrahim Khadem, Mahboobeh Shirazi, Roja Rahimi, Soodabeh Bioos, Alemeh Khademi
    Introduction
    Ileus is a common complication of abdominal surgery and it is non-preventable. It not only causes delays in patient recovery, but also significantly increases the cost of health care systems. Despite of the various studies, Pathophysiology and treatment of ileus is unknown. This study aimed to investigate the causes and treatment of post-operative ileus from the viewpoint of traditional medicine and classic medicine.
    Method
    In this review study was investigate the texts in the field of traditional medicine about ileus. Sampling was conducted by dependency and relationship to the subject with "light application". A thorough search with the key words "Ilavoos", "colic", "Sooemezaj", "Amaa", "colon" and "hefzossehe" was conducted in search of the text of traditional medicine, also in databases of classical medicine such as Pub med, Science Direct, Ovid by keywords "post-operative ileus", "bowel movement", "surgery" and "bowel function", single and combined. Data were analyzed following content analysis.
    Results
    Ileus in the books of traditional medicine were consider of Ilavoos And philosophers have considered it a severe colic. The cause of ileus in the context of traditional medicine is very cold mezaj of intestines that causes bloating and pain. As well as the other reason of ileus is anesthetics drugs that destroys the sense of disposal of intestine so the retained materials not pass. Discussion &
    Conclusion
    The literature review of modern medicine and traditional medicine showed that Ilavoos in traditional medicine is not full compliance with post-operative ileus, and it is necessary in this field to a theory. It seems that according to the conditions such as opening of the abdomen during surgery and local or general anesthesia that leads to coldness and numbness of the body during surgery caused cold sooemazaj Amaa that followed dysfunction of intestines or production of gas. Therefore, the use of drugs that cause warming of the gastrointestinal tract can be effective in this regard.
    Keywords: Surgery, Ileus, Bowel Movements, Traditional Medicine, Alternative Medicine
  • Reza Shariat Moharari, Majid Motalebi, Atabak Najafi, Mohammad Mahdi Zamani, Farsad Imani, Farhad Etezadi, Pejman Pourfakhr, Mohammad Reza Khajavi*
    Background
    Magnesium is an antagonist of (N-methyl D-Aspartate) NMDA receptor and its related canals, and may affect perceived pain.
    Objectives
    The aim of this study was to evaluate the impact of intravenous magnesium on the hemodynamic parameters, analgesic consumption and ileus.Patients and
    Methods
    A randomized, double blind, placebo controlled study was performed. Thirty two patients of ASA I or II, scheduled for major gastrointestinal (GI) surgery, were divided into magnesium and control groups. Magnesium group received a bolus of 40 mg/kg of magnesium sulphate, followed by a continuous perfusion of 10 mg/kg/h for the intraoperative hours. Postoperative analgesia was ensured by Morphine patient–controlled analgesia (PCA). The patients were evaluated by Intraoperative hemodynamic parameters, the postoperative pain by numeral rating scale (NRS), and the total dose of intraoperative and postoperative analgesic consumption. Postoperative hemodynamic, respiratory parameters, physiological gastrointestinal obstruction (ileus), and side effects were also recorded.
    Results
    The study included 14 males and 18 females. Age range of patients was 17 to 55 years old. The average age in the magnesium group was 41.33 ± 10.06 years and45.13 ± 11.74 years in control group. Mean arterial pressure (MAP) of magnesium group decreased during the operation but increased in control group (P < 0.001), and systemic vascular resistance (SVR) of magnesium group decreased during the operation also (P < 0.02) but increased in control group. Postoperative cumulative Morphine consumption in magnesium group, was significantly in lower level (P = 0.026). For NRS, severe pain was significantly lower, in magnesium group, at all intervals of postoperative evaluations, but moderate and mild pain were not lower significantly. Duration of postoperative ileus was 2.3 ± 0.5 days in magnesium group, and 4.2 ± 0.6 days in control group (P = 0.01).
    Conclusions
    Intravenous magnesium reduces postoperative ileus, postoperative severe pain and intra/post operative analgesic requirements in patients after major GI surgery. No side effects of magnesium in these doses were seen, so it seems to be beneficial along with routine general anesthesia in major GI surgeries.
    Keywords: Analgesics, Ileus, Magnesium Sulphate, Pain, Postoperative Period, Vascular Resistance
  • Ali Akbar Abdollahi*, Khadijeh Yazdi, Nasser Behnampour, Mani Niazi
    Background And Objectives
    Postoperative ileus is common after abdominal resection. It causes gas store, distention, nausea, vomiting, and even pain. This study examines the impact of gum chewing as a type of sham feeding on the duration of postoperative ileus.
    Methods
    In this randomized control trial study, 70 patients in two groups (each group n=35) underwent abdominal resection. The A group chewed sugarless gum three times (each time 20 minutes) in 4,10, and 18 hours after discharge on operation room. Both groups were matched in terms of demographics, intraoperative and postoperative care data. The data resending the first passage of flatus, defecation and bowel sound in every two hours for each patient were completed in questioning. With esthetes cop muse ring each two hours. T-test was used for comparison of the means.
    Findings
    The initial bowel sound began at 3±1.3 and 2.8± 1.3 hours after operation in the gum and control groups, respectively. No significant difference was found between the two groups. Furthermore, gas passing has been reported at 18.3±10.5 and 36.28±12.6 hours after operation in gum and control group respectively. The first defecation was an accident at 36.8±21.7 and 69.5±19.2 hours after operation in gum and control groups, respectively (P=0.001).
    Conclusions
    This study indicates that gum-chewing in the immediate postoperative period helps to enhance movement of intestines and facilitates recovery from ileus following abdominal resection. This inexpensive and well-tolerated treatment also results in earlier hospital discharge.
    Keywords: Gum, chewing, Mastication, Postoperative care, Ileus, Abdominal resection, Defecation
  • Reza Shariat Moharari, Majid Motalebi, Atabak Najafi, Mohammad Mahdi Zamani, Farsad Imani, Farhad Etezadi, Pejman Pourfakhr, Mohammad Reza Khajavi
    Background
    Magnesium is an antagonist of (N-methyl D-Aspartate) NMDA receptor and its related canals, and may affect perceived pain..
    Objectives
    The aim of this study was to evaluate the impact of intravenous magnesium on the hemodynamic parameters, analgesic consumption and ileus..Patients and
    Methods
    A randomized, double blind, placebo controlled study was performed. Thirty two patients of ASA I or II, scheduled for major gastrointestinal (GI) surgery, were divided into magnesium and control groups. Magnesium group received a bolus of 40 mg/kg of magnesium sulphate, followed by a continuous perfusion of 10 mg/kg/h for the intraoperative hours. Postoperative analgesia was ensured by Morphine patient–controlled analgesia (PCA). The patients were evaluated by Intraoperative hemodynamic parameters, the postoperative pain by numeral rating scale (NRS), and the total dose of intraoperative and postoperative analgesic consumption. Postoperative hemodynamic, respiratory parameters, physiological gastrointestinal obstruction (ileus), and side effects were also recorded..
    Results
    The study included 14 males and 18 females. Age range of patients was 17 to 55 years old. The average age in the magnesium group was 41.33 ± 10.06 years and45.13 ± 11.74 years in control group. Mean arterial pressure (MAP) of magnesium group decreased during the operation but increased in control group (P < 0.001), and systemic vascular resistance (SVR) of magnesium group decreased during the operation also (P < 0.02) but increased in control group. Postoperative cumulative Morphine consumption in magnesium group, was significantly in lower level (P = 0.026). For NRS, severe pain was significantly lower, in magnesium group, at all intervals of postoperative evaluations, but moderate and mild pain were not lower significantly. Duration of postoperative ileus was 2.3 ± 0.5 days in magnesium group, and 4.2 ± 0.6 days in control group (P = 0.01)..
    Conclusions
    Intravenous magnesium reduces postoperative ileus, postoperative severe pain and intra/post operative analgesic requirements in patients after major GI surgery. No side effects of magnesium in these doses were seen, so it seems to be beneficial along with routine general anesthesia in major GI surgeries..
    Keywords: Analgesics, Ileus, Magnesium Sulphate, Pain, Postoperative Period, Vascular Resistance
  • مطهره پیله ورزاده، افضل شمسی*، سعادت سالاری، فوزیه رفعتی، حکیمه حسین رضایی، عباس عبادی
    زمینه
    ایلیوس پارالتیک بعد از عمل جراحی شکمی موجب اتساع شکم، درد، تجمع گاز، تهوع و استفراغ می شود. جویدن آدامس یکی از روش هایی است که می تواند باعث افزایش حرکت های روده و کاهش طول مدت فلجی گذرا شود.
    هدف
    مطالعه به منظور تعیین اثر جویدن آدامس بدون قند در بهبود ایلیوس بعد از عمل جراحی کله سیستکتومی انجام شد.
    مواد و روش ها
    این مطالعه مداخله ای در سال 1390در دانشگاه علوم پزشکی کرمان بر روی 40 بیمار کاندید کله سیستکتومی انجام شد. بیماران پس از جراحی به طور تصادفی در دو گروه مداخله (جویدن آدامس) و شاهد قرار گرفتند. بیماران گروه مداخله پس از هوشیاری کامل سه بار در روز و هر بار یک ساعت آدامس های بدون قند می جویدند، ولی در گروه شاهد مداخله ای انجام نشد. سپس در هر دو گروه، اولین صدای روده ای و زمان دفع گاز و مدفوع ثبت شد. داده ها با آزمون آماری تی تحلیل شدند.
    یافته ها
    در گروه مداخله و شاهد زمان اولین دفع گاز به ترتیب 8/12 ± 05/21 ساعت در برابر 9/15 ± 8/40 ساعت، زمان دفع مدفوع به ترتیب 8/29 ± 1/38 ساعت در برابر 6/18 ± 25/58 ساعت و اولین صدای روده ای 02/1 ± 4 ساعت در برابر 3/1 ± 9/4 ساعت بود که در هر سه مورد اختلاف معنی داری در بین دو گروه مشاهده شد.
    نتیجه گیری
    با توجه به یافته ها، جویدن آدامس روشی موثر، مفید و ارزان در بهبود ایلیوس پارالتیک بعد از کله سیستکتومی است.
    کلید واژگان: ایلیوس, کله سیستکتومی, جویدن آدامس
    M. Pilehvarzadeh, A. Shamsi *, S. Salari, F. Rafeti, H. Hosseinrezaii, A. Ebadi
    Background
    Paralytic ileus after abdominal surgery causes abdominal distention، pain، accumulation of gas، nausea and vomiting. Chewing gum can increase bowel movements and reduce the transient period of paralysis.
    Objective
    The purpose of this study was to determine the effect of gum chewing in the reduction of paralytic ileus following cholecystectomy.
    Methods
    This interventional study was conducted on 40 patients undergoing cholecystectomy in Kerman University of Medical Sciences، 2011. After surgery، they were randomly allocated to intervention (gum chewing) and control groups. Patients in the intervention group chewed sugar free gum 3 times a day for an hour each time after full consciousness. The first bowel sounds، flatus passage and defecation were recorded in both groups. Data were analyzed using student T-test.
    Findings
    The first gas passing was reported 21. 05±12. 8 and 40. 8±15. 9 hours following operation in intervention and control groups، respectively. The first defection was occurred 38. 1±29. 8 and 58. 25±18. 6 hours after operation in intervention and control groups، respectively. The first bowel sounds were heard 4±1. 02 and 4. 9±1. 3 hours post-operatively in intervention and control groups، respectively. In all three cases، the differences between two groups was statistically significant.
    Conclusion
    With regard to the results، gum chewing is an inexpensive and useful approach that reduces paralytic ileus following cholecystectomy.
    Keywords: Ileus, Cholecystectomy, Chewing Gum
  • Farideh Mohsenzadeh Ledari, Shanaz Barat, Mouloud Agajani Delavar, Seyed Zahra Banihosini, Soriya Khafri
    Background
    Gum chewing after cesarean section may stimulate bowel motility and decrease duration of postoperative ileus..
    Objectives
    The current study assessed the effect of chewing sugar-free gum on the return of bowel function, where cesarean section had been performed in nulliparous women.
    Materials And Methods
    In a randomized clinical trial, 60 patients, scheduled for cesarean section were randomly divided in to 2 groups gum-chewing group (n = 30) and control group (n = 30) postoperatively. The patients in the gum-chewing group postoperatively chewed sugar free gum 3 times daily each time for 1 hour until discharge. The patient's demographic characteristics, duration of surgery, mean hunger time, flatus and bowel motility were compared in the two groups.
    Results
    There was no significant difference between the 2 groups regarding patient demographics, intraoperative, and postoperative care. In the gum-chewing and the control group there was a significant difference in the mean postoperative interval of the first bowel movement (20.89 ± 8.8 versus 27.93 ± 9.3 hours, P = 0.004), the first feeling of hunger (10.37 ± 6.0 versus 16.33 ± 9.3 hours, P = 0.005), the first passage of flatus (25.02 ± 5.8 versus 31.08 ± 9.7 hours, P = 0.003), and the first defecation (31.17 ± 5.3versus 40.08 ± 8.8 hours, P = 0.000) respectively, which were significantly shorter in the gum-chewing group compared to those of the control group. There were no major complications in either group. All patients in the gum-chewing group tolerated it without any major complications and side effects.
    Conclusions
    The study results demonstrated that bowel motility after cesarean section in nulliparous women can be accelerated by gum chewing which is a useful, inexpensive and well-tolerated method for mothers in post-cesarean section.
    Keywords: Chewing Gum, Ileus, Cesarean Section, Flatulence, Randomized Controlled Trials as Topic
نکته
  • نتایج بر اساس تاریخ انتشار مرتب شده‌اند.
  • کلیدواژه مورد نظر شما تنها در فیلد کلیدواژگان مقالات جستجو شده‌است. به منظور حذف نتایج غیر مرتبط، جستجو تنها در مقالات مجلاتی انجام شده که با مجله ماخذ هم موضوع هستند.
  • در صورتی که می‌خواهید جستجو را در همه موضوعات و با شرایط دیگر تکرار کنید به صفحه جستجوی پیشرفته مجلات مراجعه کنید.
درخواست پشتیبانی - گزارش اشکال