Ultrasonography, macroscopy, and frozen section: which is better for predicting deep myometrial invasion in endometrial cancer?

OBJECTIVE: The aim of this study was to compare the power of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section for predicting deep myometrial invasion in endometrial cancer. METHODS: This is a retrospective review involving 68 patients who underwent surgical staging for endometrial cancer from 2014 to 2017. Patients with grade 3 endometrial cancer and non-endometrioid tumors were excluded. The findings related to preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were compared with definitive histopathological diagnosis. RESULTS: The mean age, gravidity, and body mass index of the patients were 58.1±8.9 years (range: 30-80 years), 3.2±2.1 (range: 0-9), and 33.5±6.6 kg/m2 (range: 20-52 kg/m2), respectively. Only 11 (16.2%) patients were in the premenopausal period, while 57 (83.8%) were in the postmenopausal period. Grade 1 endometrial cancer was found in 29 patients (42.6%) and grade 2 tumors were specified in 39 patients (57.4%). Stage IA disease was found in 45 (66.2%) patients, while stage IB disease was observed in 23 (33.8%) patients. The 5-year survival rate was 91.2%. The sensitivity of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were 56, 34, and 52%, respectively, for predicting deep myometrial invasion. In contrast, the specificity of preoperative ultrasonography, intraoperative macroscopic examination, and frozen section were 86, 100, and 100%, respectively. CONCLUSION: Transvaginal ultrasonography and intraoperative frozen section were found to have similar sensitivity and specificity for predicting deep myometrial invasion. Preoperative transvaginal ultrasonography appears as an efficient approach for predicting endometrial cancers with deep myometrial invasion.

Cerebral Tissue Oxygen Saturation Measurements in Perinatal Asphyxia Cases Treated with Therapeutic Hypothermia.

Cerebral tissue oxygen saturation (CrSO2) measured with near-infrared spectroscopy (NIRS) technology has recently become the subject of several research studies. The aim of this study was to investigate the diagnostic value of CrSO2 measurements in perinatal asphyxia (PA) cases. The study included a patient group of 42 PA cases, who were to be applied with therapeutic hypothermia (TH), and a control group of 42 healthy term newborns. PA cases were determined as moderate or severe encephalopathy (Sarnat score stage II or III) in clinical evaluation. In both groups, left (CrSO2L) and right (CrSO2R) NIRS measurements were taken for 10 minutes on the scalp. The arithmetic mean value of measurements was calculated and compared. The mean measurements were CrSO2R 67.38 ± 9.39 and CrSO2L 66.73 ± 7.76 in the patient group, and CrSO2R 80.28 ± 8.04 and CrSO2L 79.14 ± 8.49 in the control group. The mean CrSO2R and CrSO2L measurements of the patient group were statistically significantly lower than those of the control group (p < 0.001). In the Pearson correlation analysis, a significant correlation was determined in the patient group between cord blood gas pH and CrSO2R (r: 0.539, p < 0.001) and CrSO2L (r: 0.54, p < 0.001). For a cutoff value of CrSO2L ≤ 72%, the positive predictive value was 80 and the negative predictive value was 84.6. For a cutoff value of CrSO2R ≤ 74%, the positive predictive value was 79.5 and the negative predictive value was 82.5. Low CrSO2 measurements obtained with the NIRS method in PA cases to be applied with TH together with cord blood gas parameters can be considered a helpful parameter in diagnosis.

The Effect of Bright White Light on Fatigue Levels in Patients with Gynecological Cancer: A Randomized Control Trial.

Objectives: Bright white light (BWL) therapy is one of the non-pharmacological methods in the management of fatigue. The aim of the study was to evaluate the effect of BWL on fatigue levels in patients with gynecological cancer who were receiving chemotherapy. Methods: This randomized controlled study were made with 72 women (intervention (n:36) and control (n:36) groups) at gynecologic oncology clinic. Standard BWL at the intensity of 10,000lux was applied to the patients in the intervention group at the same time every day between the second and the eighth days of the chemotherapy cycle. Fatigue levels of all patients (n: 72) were evaluated on the first,ninth and 21st days. Results: The first, ninth, and 21st days general fatigue scores of intervention and control groups was 4.876 ± 0.000;4.384 ± 0.270;4.387 ± 0.258 and 4.876 ± 0.000;5.033 ± 0.270;4.984 ± 0.258, respectively (p = 0.100). Interference of fatigue with daily life scores was found statistically different between the intervention and control groups in the first, ninth, and 21st day, respectively 4.55 ± 0.26; 3.53 ± 0.23; 3.57 ± 0.22 and 4.95 ± 0.26;4.79 ± 0.23;4.82 ± 0.22 (p = 0.029). Conclusions: BWL therapy was effective in reducing interference of fatigue with daily life in patients receiving chemotherapy, but did not affect the general fatigue level of the patients. Based on the available data, it is possible that the application of BWL may have a positive effect on general fatigue when the number of samples and the application time are increased. Trial Registration: ClinicalTrials.gov Identifier: NCT05009693.

Ultrasonography, macroscopy, and frozen section: whıch is better for predicting deep myometrial invasıon in endometrial cancer?

SUMMARY OBJECTIVE: The aim of this study was to compare the power of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section for predicting deep myometrial invasion in endometrial cancer. METHODS: This is a retrospective review involving 68 patients who underwent surgical staging for endometrial cancer from 2014 to 2017. Patients with grade 3 endometrial cancer and non-endometrioid tumors were excluded. The findings related to preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were compared with definitive histopathological diagnosis. RESULTS: The mean age, gravidity, and body mass index of the patients were 58.1±8.9 years (range: 30-80 years), 3.2±2.1 (range: 0-9), and 33.5±6.6 kg/m2 (range: 20-52 kg/m2), respectively. Only 11 (16.2%) patients were in the premenopausal period, while 57 (83.8%) were in the postmenopausal period. Grade 1 endometrial cancer was found in 29 patients (42.6%) and grade 2 tumors were specified in 39 patients (57.4%). Stage IA disease was found in 45 (66.2%) patients, while stage IB disease was observed in 23 (33.8%) patients. The 5-year survival rate was 91.2%. The sensitivity of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were 56, 34, and 52%, respectively, for predicting deep myometrial invasion. In contrast, the specificity of preoperative ultrasonography, intraoperative macroscopic examination, and frozen section were 86, 100, and 100%, respectively. CONCLUSION: Transvaginal ultrasonography and intraoperative frozen section were found to have similar sensitivity and specificity for predicting deep myometrial invasion. Preoperative transvaginal ultrasonography appears as an efficient approach for predicting endometrial cancers with deep myometrial invasion.

Effect of Massage With Lavender Oil on Postoperative Pain Level of Patients Who Underwent Gynecologic Surgery: A Randomized, Placebo-Controlled Study.

This was a randomized, placebo-controlled study. The sample consisted of 3 groups of patients: an experimental group, massage application with lavender oil (n = 15); a placebo group, massage application with ultrasound gel (n = 15); and a control group (n = 15). Massage application was performed 3 hours after analgesic application. Pain levels of the patients in the experiment and placebo groups were evaluated with a Verbal Rating Scale (VRS) at the 30th minute and the 3rd hour after the application. Similarly, the pain level of patients in the control group was also evaluated with the VRS at 3 hours after the initial analgesic administration and following the 30th minute and the 3rd hour. Generally, the VRS scores of the 3 groups did not show a significant difference in terms of group and time interaction (P = .221). However, there was a significant difference in VRS scores between the experimental and control groups at the 30th minute after the massage (P = .036). This difference was caused by the lower pain level of the group, which had massage with lavender (2.66 ± .89) compared with the control group (3.80 ± 1.01). According to the study results, while only hand massage application after gynecologic surgery was effective for a short period in decreasing postoperative pain, it was determined that massage application with lavender had a longer effect in decreasing postoperative pain. The results of this study showed that this inexpensive and easy-to-apply method can be safely performed by nurses on postoperative patients and can support pain management of patients in the first hours after gynecologic surgery.

Frequency of Epstein-Barr virus and human papilloma virus in patients with nasopharyngeal carcinoma.

PURPOSE: Nasopharyngeal cancer is a type of malignancy originating from the epithelial cells lining the nasopharynx. In genetic and environmental factors, infection with Epstein-Barr virus is one of the particular factors held accountable for the etiopathogenesis. Human papillomavirus has been associated with cervical, anogenital, and oropharyngeal cancers. The aim of the present study is to demonstrate the presence and incidence of Epstein-Barr virus and human papillomavirus in patients with nasopharyngeal cancer. METHODS: The information collected for these patients included age at the time of biopsy, gender, alcohol consumption and smoking, and histopathological type of nasopharyngeal cancer. Only patients for whom nasopharyngeal biopsy was performed as punch biopsy were included in the study. In situ hybridization was performed with formalin-fixed, paraffin-embedded tissue sections for Human Papillomavirus and Epstein-Barr virus nucleic acids obtained by means of automated Ventana BenchMark Medical system RESULTS: Utilizing in situ hybridization with samples obtained from 56 patients diagnosed with nasopharyngeal cancer. Epstein-Barr virus was positive in 41 out of the 56 (73.2%) patients, while human papillomavirus was positive in 3 (5.4%), and 1 patient (1.8%) had co-infection. Thirty seven (90.2%) of the 41 patients positive for Epstein-Barr virus were Type-2 according to WHO, while 4 (9.8%) were Type-1. All three patients (100%) with Human Papillomavirus positivity were Type-2 according to WHO. CONCLUSIONS: This study shows the close association between nasopharyngeal cancer and Epstein-Barr virus whereas such an association is not shown for Human Papillomavirus.

Ganoderma carnosum and Ganoderma pfeifferi: Metal concentration, phenolic content, and biological activity.

Medicinal Ganoderma mushrooms have long tradition in Asia, and recently they began to be consumed in Europe as well. Among hundreds of Ganoderma species, only a few of them are intensively investigated, i.e., G. lucidum and G. applanatum, whereas the chemistry and bioactivities of the other species, especially of European origin, still remain unknown. This study comprises detailed chemical analysis of two Ganoderma species growing wild in Turkey, G. pfeifferi and G. carnosum. Metal composition of both species shows high concentrations of biogenic metals. Phenolic composition of the isolated extracts of G. carnosum and G. pfeifferi shows that these species are rich in simple phenolic acids, such as 2,5-dihydroxybenzoic acid and vanillic acid, but also in flavonoids. These compounds are found to be carriers of the antioxidant activity but also enzyme inhibition activity of the analyzed extracts. Overall results indicate that these two Ganoderma species have strong potential to be used for medicinal purposes.

The Effect of Pentoxifylline and Hyperbaric Oxygen on Achilles Osteotendinous Junction Injury: An experimental animal model study.

BACKGROUND: To investigate the effects of hyperbaric oxygen (HBO) and pentoxifylline (PTX) treatment on osteotendinous junction healing of Achilles tendon in an animal model. MATERIALS AND METHODS: Thirty-six adult female Wistar-albino rats were randomly divided into three groups as control, PTX and HBO groups with a total of 12 rats per group. Under general anesthesia, the Achilles tendons were cut at the level of the osteotendinous junction and repaired. After the surgery, no treatment was given to the control group. Fifty mg/kg intraperitoneal PTX was administered to the PTX group daily for 1 week. The HBO group was exposed to 2,5 atmospheric pressure, 100% oxygen for 2 hours daily for 1 week. All animals were sacrificed at the end of sixth week. Biomechanical tests and histological examinations were performed. RESULTS: Energy absorption was significantly higher in the PTX group than that in the control group after biomechanical tests (p=0.010). Histopathological evaluation results revealed no difference between the groups: however, hyalinization level was relatively better in the HBO group than that in the control group (p=0.026). CONCLUSIONS: 1. We concluded that PTX has a positive effect on the treatment of osteotendinous junction injuries based on our results. 2. Although HBO therapy did not provide statistically significant differences, it might have some positive effects on these injuries. 3. Further experimental studies and clinical trials should be conducted.

CD105 (endoglin) expression as a prognostic marker of angiogenesis in squamous cell cervical cancer treated with radical radiotherapy.

INTRODUCTION: Increased levels of endoglin may represent a new reagent of active neovascularization and angiogenesis process in various cancer types. The prognostic value of tumor CD105 (endoglin) expression in cervical squamous cell cancer (CSCC) patients treated with radical radiotherapy (RT) ± chemotherapy was investigated. MATERIALS AND METHODS: CD105 (endoglin) expression was assessed by immunohistochemical methods in seventy patients, who were treated with radical RT ± chemotherapy for CSCC. The prognostic effects of CD105 on patient and treatment characteristics, local-regional control, and survival were assessed. RESULTS: The median follow-up was 24 (5-99) months for the whole cohort. The median CD105 microvessel density was 55.5 (range; 12-136). Age (≤61 vs. >61 years; P = 0.015), lymph node metastasis status (absent vs. present; P = 0.028), International Federation of Gynecology and Obstetrics stage (Ib-IIa vs. IIb-IVa; P = 0.036), cycles of concurrent chemotherapy (1-3 vs. 4-6 cycles; P = 0.001), and hemoglobin levels (≤10 g/dL vs. >10 g/dL; P = 0.006) appeared to associate significantly with overall survival on univariate analysis. DISCUSSION: No correlation was identified between the tumor CD105 (endoglin) expression and survival in CSCC patients treated with radical RT ± chemotherapy.

Does size matter? Retrospective analysis of large gynecologic tumors.

OBJECTIVE: To evaluate the characteristics of patients who underwent surgery due to the presence of a large pelvic-abdominal mass over a 5-year period in a university clinic. MATERIAL AND METHODS: Among 3476 gynecologic operations, intraoperative findings were evaluated retrospectively. Uterine and/or adnexal masses smaller than 20 cm were excluded to refine "large" tumors and 74 patients with large tumors were enrolled in the study group. Demographic characteristics, intraoperative findings, and results of histopathologic examinations were recorded. Moreover, preoperative and intraoperative findings were compared among tumors with adnexal origin according to their final histopathologic results. RESULTS: The mean age of the patients was 46 years. The most common symptom was abdominal pain, as recorded in 38 (51.4%) patients. Among all patients, 31 (41.9%) had coexisting illness and 13 (17.6%) had a history of surgery. The mean tumor diameter was 25.9±8.6 cm (20-60) and 60 (78.9%) tumors were of adnexal origin. The ratios of malignancy for large adnexal and uterine tumors were 34.4% and 12.5%, respectively. When the large adnexal tumors were re-evaluated, the mean cancer antigen (CA) 125 level was significantly higher, and ascites was more frequently detected in malignant tumors (p<0.01) then in benign and borderline tumors. CONCLUSION: Benign and borderline tumors are more common among large abdominopelvic masses, although the presence of ascites and elevated CA 125 may present malignancy in large gynecologic tumors. Further studies with larger sample sizes are needed to define the characteristics of large tumors and their malignant potentials.

Factors associated with survival after relapse in patients with low-risk endometrial cancer treated with surgery alone.

OBJECTIVE: To determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone. METHODS: A multicenter, retrospective department database review was performed to identify patients with recurrent "low-risk EC" (patients having less than 50% myometrial invasion [MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected. RESULTS: We identified 67 patients who developed recurrence of their EC after initially being diagnosed and treated for low-risk EC. For the entire study cohort, the median time to recurrence (TTR) was 23 months (95% confidence interval [CI]=11.5-34.5; standard error [SE]=5.8) and the median OSFR was 59 months (95% CI=12.7-105.2; SE=23.5). We observed 32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were loco-regional whereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group (GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as high-intermediate risk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR ≥36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65-43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69-12.58; p=0.003) were significant predictors. CONCLUSION: Low-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence.

Comparison Of Early-Stage High-Grade Serous Primary Fallopian Tube Cancers and Epithelial Ovarian Cancers: A Multicenter Study.

INTRODUCTION: We compared the disease free-survival (DFS) and overall survival (OS) rates of patients with high-grade serous primary fallopian tube cancer (HG-sPFTC) and high-grade serous epithelial ovarian cancer (HG-sEOC). METHODS: 22 early-stage cancer patients (International Federation of Gynecology and Obstetrics (FIGO) stages I-II) with HG-sPFTC were retrospectively evaluated. In addition, 44 control patients diagnosed with HG-sEOC were matched to these patients with respect to tumor stage at diagnosis. All patients underwent complete surgical staging, followed by adjuvant chemotherapy. Kaplan-Meier curves were used to generate survival data. RESULTS: The mean age of HG-sPFTC patients was 59.4 ± 6.2 years, and that of HG-sEOC patients 55.2 ± 11.0 years (p = 0.002). All patients underwent 6 cycles of platinum-based adjuvant chemotherapy. All operations were optimal. The 5-year DFSs were 77.3% for HG-sPFTC patients and 75% for HG-sEOC patients (p = 1.00).The 5-year OS rates were 81.8% in women with HG-sPFTC and 77.3% in those with HG-sEOC (p = 0.75). CONCLUSION: The DFS and OS rates of patients with early-stage (FIGO stages I and II) HG-sPFTC and HG-sEOC were similar. The surgical and adjuvant therapy management of these malignancies should be similar.

Contribution of myeloperoxidase and inducible nitric oxide synthase to pathogenesis of psoriasis.

INTRODUCTION: Histological changes of psoriasis include invasion of neutrophils into the epidermis and formation of Munro abscesses in the epidermis. Neutrophils are the predominant white blood cells in circulation when stimulated; they discharge the abundant myeloperoxidase (MPO) enzyme that uses hydrogen peroxide to oxidize chloride for killing ingested bacteria. AIM: To investigate the contribution of neutrophils to the pathogenesis of psoriasis at the blood and tissue levels through inducible nitric oxide synthase (iNOS) and MPO. MATERIAL AND METHODS: A total of 50 adult patients with a chronic plaque form of psoriasis and 25 healthy controls were enrolled to this study. Serum MPO and iNOS levels were measured using ELISA method. Two biopsy specimens were taken in each patient from the center of the lesion and uninvolved skin. Immunohistochemistry was performed for MPO and iNOS on both normal and psoriasis vulgaris biopsies. RESULTS: While a significant difference between serum myeloperoxidase levels were detected, a similar statistical difference between participants in the serum iNOS levels was not found. In immunohistochemistry, intensely stained leukocytes with MPO and intensely staining with iNOS in psoriatic skin was observed. CONCLUSIONS: Neutrophils in psoriasis lesions are actively producing MPO and this indirectly triggers the synthesis of iNOS. Targeting of MPO or synthesis of MPO in the lesion area may contribute to development of a new treatment option.

Fetal Bowel Dilatation due to Intestinal Neuronal Dysplasia: A Rarity.

Intestinal neuronal dysplasia (IND) type B is characterized by malformation of parasympathetic plexus and manifests at more than 6 month of age with progressive severe constipation. We report a case of IND type B presented with bowel dilatation on antenatal scan and neonatal intestinal obstruction which is unusual with this type of IND.

Amelanotic malignant melanoma of the uterine cervix diagnosed by cervical smear.

The melanocytic cells of the cervical epithelium are capable of forming the complete spectrum of melanocytic lesions, from benign lentigines to melanoma. Primary malignant melanoma of the uterine cervix is a rare neoplasm with aggressive behavior. The absence of melanin pigment can lead to misdiagnosis as carcinomas, sarcomas, or lymphoma. Immunohistochemical studies should be used for confirmation. In order to consent the cervix as a primary site, exclusion of any other probable primary sites of melanoma is needed. Here, we present a 61-year-old female patient with postmenopausal vaginal bleeding. After cervical smear, diagnosis was confirmed by cervical punch biopsy. Diagn. Cytopathol. 2016;44:535-537. © 2016 Wiley Periodicals, Inc.

Rare late metastasis of testis seminoma to the bladder.

A 45-year-old male presented to our clinic with complaining of hematuria for a month. The investigations showed a 59 × 24-mm myxoid mass on the right lateral bladder wall and this was removed with transurethral resection. The histopathology evaluation result was seminoma (classic type). The medical history revealed that the patient had undergone inguinal orchiectomy for a testis tumour 10 years before and the diagnosis was classic type seminoma. He received chemotherapy following the orchiectomy, but had not gone for follow-up after the first year. There was no other metastasis and he was put on the iphosphamide, etoposide, cisplatin (IPE) protocol. The patient has been disease-free for the last 5 months and the tumour markers and cystoscopy were normal. Testis tumours can rarely cause other organ metastases in the late stage even if curative surgery and chemo-radiotherapy were initially administered. Proper follow-up is crucial. It is also necessary to query the tumour history when a tumour in any organ is considered.

Liposarcoma of the spermatic cord: A case report.

Spermatic cord liposarcoma is very rare and characterized by a painless inguinal or scrotal mass. This is a case report of a 66-year-old man presenting with a mass in his left scrotum. Inguinal orchiectomy was performed and the histopathological examination revealed a liposarcoma of the spermatic cord.

Prognostic Significance of Retroperitoneal Lymphadenectomy, Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Primary Fallopian Tube Carcinoma: A Multicenter Study.

PURPOSE: The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in patients with primary fallopian tube carcinoma (PFTC). MATERIALS AND METHODS: Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected. RESULTS: In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 ≥ 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count ≥ 400,000 cells/mm(3), staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p=0.002). CONCLUSION: NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.

Vaginal misoprostol versus a rectal nonsteroidal anti-inflammatory drug to reduce pain during Pipelle endometrial biopsies: a prospective, randomized, placebo-controlled trial.

BACKGROUND: To evaluate and compare the efficacy of vaginal misoprostol and a rectal nonsteroidal anti-inflammatory drug (NSAID) on pain relief during Pipelle endometrial biopsies in a placebo-controlled randomized study. METHODS: One hundred and fifty-one women who had an indication for a Pipelle endometrial biopsy were randomized into three groups as follows: group 1, vaginal misoprostol; group 2, rectal NSAID, and group 3, control. After the procedure, the women were asked to record their pain severity on a visual analog scale. The secondary outcome of the study was patient acceptability, and vasovagal symptoms and analgesic requirements after the procedure were also recorded. RESULTS: There were no statistically significant differences in the demographic characteristics of the patients. The primary study outcome was the comparison of the median visual analog scale pain scores of groups 1 and 2 versus group 3 (controls); no statistically significant differences were found (p = 0.502). In addition, the patient acceptability (Likert scale), vasovagal symptoms and analgesic requirements after the procedure were similar among the groups (p = 0.204, 1 and 0.546, respectively). CONCLUSION: Our study did not demonstrate a reduction in pain relief during Pipelle endometrial biopsies for patients receiving vaginal misoprostol or a rectal NSAID when compared to patients receiving placebo treatment.