Enamel Matrix Derivative, 58S5 Bioactive Glass, and Fluoride Varnish for Enamel Remineralization: A Multi-analysis Approach.

PURPOSE: This study aimed to evaluate the enamel remineralization efficacy of enamel matrix derivative (EMD), experimental bioactive glass (BAG), and fluoride varnish in vitro. METHODS AND MATERIALS: Artificial initial caries lesions were developed on fifty human enamel specimens using demineralization solution (pH 4.5, 37°C, 96 hours). Specimens were randomly assigned to five groups (n=10): I-5% NaF varnish (Enamelast), II-experimental 58S5 BAG+37% phosphoric acid (PA), III-EMD (Emdogain) + Ethylenediaminetetraacetic Acid (EDTA), IV-EMD+37% PA, V-Control (untreated). All remineralization agents were applied with pH cycling for seven days. The specimens were scanned by spectral domain optical coherence tomography (SD-OCT) at baseline, at demineralization, and after pH cycling. Lesion depths were measured using image analysis software (ImageJ). Lesions were evaluated using surface microhardness (SMH) and two fluorescence methods (FluoreCam and DIAGNOdent Pen [DDPen]). The data were statistically analyzed by Kruskal Wallis, Friedman, and Wilcoxon tests (α=0.05). RESULTS: According to SD-OCT results, fluoride varnish was found to be the most effective agent in reducing lesion depth (p=0.005). All agents increased the SMH values after pH cycling. No significant difference was found among fluoride varnish, BAG, and EMD+PA groups. These SMH values were significantly higher than EMD+EDTA and control groups (p<0.001). All groups showed lower DDPen scores compared with the control group (p<0.001), however, no significant difference was found among the remineralization agents. In FluoreCam assessment, size and intensity values of all treated groups showed improvement. However, there was no significant difference between the treatment groups in terms of FluoreCam size measurements (p=0.186). CONCLUSION: 58S5 BAG and EMD+PA have remineralization capacity as effective as fluoride varnish. EMD+PA showed better SMH and lesion intensity results than EMD+EDTA.

Occluding Efficiency of Different Desensitizing Agents and Er,Cr:YSGG Laser on Dentin Tubules.

PURPOSE: This study aimed to evaluate the effects of two desensitizers and the Er,Cr:YSGG laser on human dentin tubules, applied alone or in combination. METHODS: Ninety-six dentin specimens were obtained from extracted third molars and divided into six groups: Group 1: no-treatment (Control); Group 2: nano-hydroxyapatite desensitizer (NhapD); Group 3: NhapD+Er,Cr:YSGG laser (L); Group 4: Er,Cr:YSGG laser (L); Group 5: glutaraldehyde desensitizer (GD); and Group 6: GD+L, respectively. All specimens were evaluated using scanning electron microscopy. The diameter and the number of open dentin tubules, the tubules' occluding ratio, and the mineral coverage area were measured via the Image J software at 2000× magnification. Atomic force microscopy was used to determine the blocking mechanism of desensitizing treatments and the surface morphology of dentin specimens. One-way ANOVA and Tukey tests were used for statistical analysis. RESULTS: The number of open tubules and the mean diameter of tubules for all treatment groups showed statistically significant differences from the control group The NhapD+L group had a significantly lower number of open tubules than the L and GD groups. The NhapD+L and L groups significantly had higher occluding ratios than the other groups. CONCLUSIONS: The present study showed that the Er,Cr:YSGG laser alone was effective in terms of tubule occlusion and also contributed to increasing the occluding ratio of nano-hydroxyapatite. It may be recommended to use the Er,Cr:YSGG laser with nano-hydroxyapatite desensitizers to achieve effective tubule occlusion.

Effects of Bioactive Pulp-capping Materials on Cell Viability, Differentiation, and Mineralization Behaviors of Human Dental Pulp Stem Cells In Vitro.

PURPOSE: The objective of this study was to assess the effect of bioactive pulp-capping materials on human dental pulp stem cell (hDPSC) behavior in terms of cell viability and bioactivity via mineralization potential. METHODS AND MATERIALS: Nanoparticles of 58S5 bioactive glass (nBG) powder were elaborated by a sol-gel process. Primer hDPSCs were cultured with experimental nBG, Biodentine, TheraCal LC, and ProRoot mineral trioxide aggregate (MTA) extracts. Cell viability was measured for 1, 3, and 7 days by water-soluble tetrazolium salts (WST-1) assay. Expression of mineralization-related marker genes (dentin sialophosphoprotein [DSPP] and osteocalcin [OCN]) was quantified by a real-time polymerase chain reaction. Detection of DSPP protein expression in hDPSCs was also assessed by western blotting. Alizarin red staining was used to detect the formation of mineralized nodules, and alkaline phosphatase (ALP) activity was quantified by a photometric method (days 7 and 14). All data were statistically analyzed with a one-way analysis of variance (ANOVA) and Tukey's post-hoc test (p<0.05). RESULTS: The cell viability of hDPSCs in all groups decreased except for nBG, and the lowest cell viability was determined in TheraCal LC at all incubation times. nBG and MTA showed significantly higher ALP activity than the control group. The tested materials elevated the calcium nodule form of hDPSCs except for TheraCal LC. The highest DSPP expression was seen in nBG for both incubation times. CONCLUSION: nBG promotes differentiation and mineralization of hDPSCs at a higher rate than other bioactive pulp-capping materials tested.

Cellular blue nevus tumor presenting as a submandibular lymph node in a 16-year-old.

The cellular blue nevus tumor is a type of dendritic melanocytic nevus that is typically benign and exceedingly rare. The incidence of all blue nevi is about 1%, usually affecting the adult population and appearing on the extremities, sacrococcygeal or gluteal regions. There have only been a handful of case reports cited in the literature where cellular blue nevi present in the head and neck region, usually affecting the scalp and young adult population (7, 8). As such, it is exceedingly rare to encounter a cellular blue nevus tumor in the neck or infiltrating into neck lymph nodes. Here we report a rare case of a cellular blue nevus tumor presenting as a right neck mass in a pediatric 16-year-old patient, shown to invade into the submandibular lymph node and surrounding soft tissue. It is important to be aware of the cellular blue nevus tumor as a differential diagnosis in pediatric neck masses. Histological evaluation is necessary to determine tumor aggression and malignant potential which can guide further treatment in pediatric patients.

Advanced calibration kit for scanning microwave microscope: Design, fabrication, and measurement.

We present in this paper a new design of a capacitive calibration kit for scanning microwave microscopy (SMM). As demonstrated by finite element modelings, the produced devices are highly independent of material parameters due to their lateral configuration. The fabrication of these gold-based structures is realized by using well established clean-room techniques. SMM measurements are performed under different conditions, and all capacitive structures exhibit a strong contrast with respect to the non-capacitive background. The obtained experimental data are employed to calibrate the used SMM tips and to extract the capacitance of produced devices following a method based on the short-open-load calibration algorithm for one-port vector network analyzers. The comparison of experimental capacitance and nominal values provided by our models proves the applicability of the used calibration approach for a wide frequency range.

External carotid artery pseudoaneurysm following upper respiratory infection masquerading as a pharyngeal abscess in an 8-month-old.

Pseudoaneurysms are very rare with an incidence of less than 0.1% in the pediatric population. Approximately 30 cases of carotid artery aneurysms in children have been published in the literature, usually affecting children over one year of age. We present one of the youngest cases in the literature; the patient is an 8-month old female with a strep throat infection complicated by pseudoaneurysm development of the external carotid artery. Because of the rarity of these lesions, there is little known regarding the types of clinical presentation and management. They are commonly the result of direct arterial trauma; however, they can also occur secondary to infection, connective tissue disease or arteritis. We are presenting a case with a highly atypical presentation. When present, pseudoaneurysms harbor the potential risk of life-threatening hemorrhage and warrant immediate management. It is important to be aware of cases and the treatment modalities used to guide future diagnosis and planning.

Comparison of the Efficacy of the Global Leadership Initiative on Malnutrition Criteria, Subjective Global Assessment, and Nutrition Risk Screening 2002 in Diagnosing Malnutrition and Predicting 5-Year Mortality in Patients Hospitalized for Acute Illnesses.

BACKGROUND: The Global Leadership Initiative on Malnutrition (GLIM) has developed new criteria for diagnosing patients with malnutrition. The aims of this study were to investigate the prevalence of malnutrition according to the GLIM criteria, Subjective Global Assessment (SGA), and Nutrition Risk Screening 2002 (NRS-2002) and their association with long-term mortality in patients hospitalized for acute illnesses. METHODS: A retrospective analysis was performed in a sample of 231 patients with different comorbidities hospitalized for acute illnesses in medical or surgical wards. Nutrition status was retrospectively assessed with GLIM criteria using patients' records at admission in addition to SGA and NRS-2002. The agreement between the tools was calculated using κ statistics, and the association of malnutrition according to each tool and mortality were analyzed using Cox regression analysis. RESULTS: The mean age of the patients was 62.2 ± 18.2 years, and 56.7% were women. The prevalence of malnutrition was 35.9% with GLIM criteria, 37.2% with SGA, and 38% with NRS-2002. The agreement between tools was good (GLIM-SGA, κ = 0.804; GLIM-NRS-2002, κ = 0.784). During a median follow-up period of 63.2 months, 79 deaths occurred. The sensitivity in predicting 5-year mortality was 59.49%, 58.23%, and 58.23%, and specificity was 76.32%, 73.68%, and 72.37% for GLIM criteria, SGA, and NRS-2002, respectively. After adjusting for confounders, GLIM criteria best predicted 5-year mortality (hazard ratio, 3.09; 95% CI, 1.96-4.86; P < .001). CONCLUSIONS: Our findings support the effectiveness of GLIM in diagnosing malnutrition and predicting all-cause mortality among patients hospitalized for acute illnesses.

Duplication of the pituitary gland and basilar artery, with multiple midline fusion defects and craniofacial anomalies.

Duplication of the pituitary gland (DPG) is a phenomenon with no clear syndromic association. This case adds to the literature as a DPG-plus syndrome patient with multiple fusion defects of unknown etiology, fetal risk factors of first trimester tobacco usage and intrauterine drug exposure. An 8-month old female presented with noisy breathing, poor feeding, cleft palate, seizures and failure to thrive. MRI scan revealed duplicate pituitary gland, tubomammillary fusion, absent cleavage of brainstem and superior cerebellar peduncles, and cervical spinal malformations. We performed an airway evaluation, with a glossomandibulopexy for glossoptosis, and a primary palate repair.

Effect of chitosan on sealer penetration into the dentinal tubules.

OBJECTIVE: The objective of this study is to compare the effectiveness of final irrigation with chitosan, ethylenediaminetetraacetic acid (EDTA), and citric acid (CA) on a resin-based sealer (AH plus sealer [Dentsply DeTrey, Konstanz, Germany]) penetration into dentinal tubules using confocal laser scanning microscopy. MATERIALS AND METHODS: Seventy recently extracted human mandibular premolars were instrumented and irrigated with sodium hypochlorite (NaOCl), then divided into four groups according to the final irrigation regimen used: (1) the EDTA group: 17% EDTA + 2.5% NaOCl, (2) the CA group: 10% CA + 2.5% NaOCl, (3) the chitosan group: 0.2% chitosan + 2.5% NaOCl, and (4) the control group: 2.5% NaOCl. All teeth were obturated using the cold lateral condensation technique with gutta-percha and AH Plus sealer labeled with fluorescent dye. The apical 2 mm of specimen was discarded, and slices were obtained for apical, middle, and coronal thirds of the root with 1 mm intervals. Maximum, mean, and percentage of sealer penetration (SP) inside tubules were measured using confocal laser scanning microscopy. RESULTS: The percentage of SP was significantly higher in chitosan, EDTA, and CA group than control group for coronal thirds (P < 0.05), whereas there was no significant difference among all groups for middle and apical thirds. Chitosan and EDTA showed increased mean values of SP depth for middle thirds (P < 0.05). In all sections, the maximum depth of SP was significantly lower in EDTA group than other groups (P < 0.05). CONCLUSIONS: Chitosan, EDTA, and CA significantly improved the percentage of SP for coronal thirds.

Diffuse, encasing lymphangioma of the supraglottis.

BACKGROUND: Lymphangioma of the head and neck is considered a rare congenital tumor with the vast majority presenting before two years of age. Surgical excision and sclerosing therapy using OK-432 are recognized as effective treatment options for the majority of these lesions; however, treatment options of laryngeal lesions are less straightforward due to the risk of airway compromise and the desire to maintain the integrity of a functional larynx. We present the case of a four month old male who presented with chief complaint of inspiratory stridor after a single episode of pneumonia. His clinical presentation, flexible fiberoptic laryngoscopic examination, and operative evaluation were consistent with a lymphangioma completely encasing the epiglottis and arytenoids and isolated to the supraglottis. This report outlines our approach to workup and treatment of this rare lesion. METHOD: Case report of presentation, diagnosis and treatment is presented. RESULTS: A four-month old male presented to ENT clinic with inspiratory stridor, worsened with crying, without frank respiratory distress. History and initial examination was consistent with airway obstruction. Flexible fiberoptic laryngoscopy showed laryngomalacia as well as diffuse and symmetric supraglottic edema. Surgical evaluation identified edema limited to the supraglottis, notably along the ventral surface of the epiglottis and dorsal surface of bilateral arytenoids. Biopsies were taken and immunohistochemical staining was performed with strong positivity for D2-40 and CD31, supporting the diagnosis of isolated lymphangioma of the supraglottis. Treatment was performed through multiple point spot welding with a fiber equipped CO2 LASER (OmniGuide TM) at 5 watt continuous power. CONCLUSION: Isolated supraglottic lymphangioma was diagnosed via direct laryngoscopy, with pathologic and immunohistochemical confirmation. Carbon dioxide laser spot welding technique was used with excellent clinical improvement in stridor. Clinical improvement is sustained after 6 months follow-up.

Does pregnancy-induced hypertension affect the electrophysiology of the heart?

Pregnancy-induced hypertension (PIHT) increases both maternal and neonatal mortality and morbidity in pregnant women. We sought to investigate the electrocardiographic findings in pregnant women with PIHT. Seventeen pregnant women (29.4 ± 5 years) with PIHT and 24 pregnant women (27.3 ± 6.1 years) with normal blood pressure (control group) were included in the study. A 12-lead surface electrocardiogram was used to evaluate the electrocardiographic parameters. Pregnant women with PIHT had higher blood pressure (p = 0.001). The Tp-e interval was longer in PIHT pregnant women at 83.5 ± 7.8 ms versus 75.8 ± 8.4 ms in the control group (p = 0.007). The Tp-e/QTc ratio was higher in pregnant women with PIHT than that in healthy controls (0.19 ± 0.02 vs. 0.18 ± 0.02, respectively). This study demonstrated that Pd, QTd and the P wave durations were similar in the PIHT pregnant women and control group, but the Tp-e and Tp-e/QTc ratio were higher in pregnant women with PIHT than in normotensive pregnant women.

Pituitary Insufficiency and Hyperprolactinemia Associated with Giant Intra- and Suprasellar Carotid Artery Aneurysm.

Pituitary insufficiency secondary to internal carotid artery (ICA) aneurysm is a very rare condition. Its prevalence is reported as 0.17% (Heshmati et al., 2001). We present a case of pituitary insufficiency and hyperprolactinemia secondary to suprasellar giant intracranial aneurysm. A 71-year-old man was admitted to our clinic with symptoms of hypopituitarism, hyperprolactinemia, and visual field defect. His pituitary MRI and cerebral angiography revealed a giant saccular aneurysm filling suprasellar cistern arising from the ophthalmic segment of the right ICA. Endovascular treatment was performed on the patient to decrease the mass effect of aneurysm and improve the hypophysis dysfunction. After treatment, his one-year follow-up showed the persistence of hypophysis insufficiency, decrease of prolactin (PRL) level, and normal visual field. An intracranial aneurysm can mimic the appearance and behavior of a pituitary adenoma. Intracranial aneurysms should be taken into consideration in the situation of hypopituitarism and hyperprolactinemia. It is important to distinguish them because their treatment approach is different from the others.

Comparison of Serum Vitamin D Levels Among Patients With Chronic Kidney Disease, Patients in Dialysis, and Renal Transplant Patients.

OBJECTIVE: Vitamin D is a hormone with a variety of functions, and its deficiency and insufficiency are commonly seen both in the general population and in patients with chronic renal disease. The aim of this study was to compare vitamin D levels in patients with chronic renal disease who are on hemodialysis, peritoneal dialysis, or no renal replacement therapy and patients who underwent renal transplantation. METHODS: A total of 169 patients who had not used vitamin D for ≥ 1 year and who had no diabetes mellitus or proteinuria were included in the study. These included: 40 patients with renal transplantation, 40 patients on hemodialysis, 49 patients on peritoneal dialysis, and 40 patients with chronic renal failure stage 1, 2, 3, or 4. 25-Hydroxy vitamin D levels were evaluated in the sera of the patients. RESULTS: 25-Hydroxy vitamin D levels in patients with renal transplantation and in predialysis patients were 12.74 ± 10.24 ng/mL and 11.16 ± 12.25 ng/mL, respectively. The levels were 7.77 ± 6.71 ng/mL and 5.96 ± 4.87 ng/mL in patients on hemodialysis and peritoneal dialysis, respectively. CONCLUSIONS: Vitamin D levels are lower in patients on hemodialysis and peritoneal dialysis compared with the patients with renal transplantation for a variety of reasons. In this study, objective results were obtained supporting the administration of vitamin D supplements without glomerular filtration rate measurement in all patient groups with the diagnosis of chronic renal failure in accordance with the guidelines.

Validity of the Demirjian method for dental age estimation for Southern Turkish children.

OBJECTIVE: The aim of this study was to evaluate the applicability of the Demirjian method for southern Turkish population. MATERIALS AND METHODS: Panoramic radiographs of 535 patients (276 females, 259 males aged from 10 to 18 years) selected retrospectively. Dental age was calculated using the Demirjian's method. Chronologic age was calculated by subtracting the date of the birth from the date of the panoramic radiograph after having converted both to a decimal age. The chronologic and dental ages were compared using the paired t-test. RESULTS: The mean difference between the chronologic and dental ages ranged from 0.02 to 0.79 years in females. These differences in females between the chronologic and dental ages were statistically significant in total (P < 0.050) and in G1 (10-10.90 years) (P < 0.010) and G2 (11-11.90 years) (P < 0.001). The mean difference between the chronologic and dental ages ranged from 0.04 to 0.85 years in males. These differences in males between the chronologic age and dental age were statistically significant in total (P < 0.010) and in G4 (13-13.90 years) G5 (14-14.90 years) G6 (15-15.90 years) groups (P < 0.050). CONCLUSIONS: It is appropriate to use the Demirjian method in southern Turkish children; however, a revision is needed in some age groups.

The effects of some tumor markers on human erythrocyte (HCA-I and HCA-II), bovine erythrocyte (BCA) and bovine lung (CA-IV) carbonic anhydrase enzyme activities in vitro.

OBJECTIVE: The influence of prostatic acid phosphatase (PAP) and human chorionic gonadotropin (HCG), tumor markers have been investigated on human erythrocyte carbonic anhydrase (HCA-I and HCA-II) and bovine erythrocyte (BCA) and bovine lung carbonic anhydrase (CA-IV) in vitro. BACKGROUND: Tumor markers are substances that can often be detected in higher-than-normal amounts in the blood, urine, or body tissues of some patients with certain types of cancer. Tumor markers are produced either by the tumor itself or by the body in response to the presence of cancer or certain benign (noncancerous) conditions. In addition to their role in cancer diagnosis, some tumor marker levels are measured before treatment to help doctors plan appropriate therapy. RESULTS AND CONCLUSION: All of the tumor markers were determined to have inhibition effect, on human CA-I, CA-II, bovine erythrocyte CA (BCA) and bovine lung CA-IV isoenzymes. The effect of each tumor marker on CA was investigated by Wilbur-Andersen method modified by Rickly et al Inhibition effects of two different tumor markers on human CA-I, CA-II, bovine erythrocyte CA (BCA) and bovine lung CA-IV isoenzymes were determined by using the CO2-Hydratase method by plotting activity % vs (tumor markers). I50 values of tumor markers exhibiting inhibition effects were found by means of these graphs (Tab.1, Fig. 2, Ref. 20).

The effect of maternal polycystic ovary morphology on first-trimester maternal serum biochemical markers of aneuploidy and fetal nuchal translucency thickness.

OBJECTIVE: To evaluate the effect of maternal polycystic ovary (PCO) morphology on maternal serum free beta-human chorionic gonadotropin (ß-hCG), pregnancy associated plasma protein A (PAPP-A), and nuchal translucency (NT) thickness in the first-trimester. MATERIAL AND METHODS: A total of 92 pregnant women in the first-trimester were included in the study. Of them, 57 had PCO morphology, and 35 women constituted the control group, with apparently normal ovaries. Maternal serum free ß-hCG, PAPP-A, and NT thickness were measured and compared in all patients. RESULTS: The multiples of median (MoM) levels of serum free ß-hCG were significantly higher in the PCO morphology group compared to the normal ovary group (p = 0.024). However, the MoM levels of PAPP-A were similar in both groups (p = 0.947). No difference was found between the groups in terms of fasting glucose levels and NT measurements (p = 0.976 and 0.565, respectively). CONCLUSION: In pregnancies with maternal PCO morphology, the presence of higher maternal serum free ß-hCG levels may require correction in the calculation of risks related to first-trimester screening for chromosomal abnormalities. Larger studies are needed to confirm our preliminary data.

HPV and HPV vaccination: knowledge and consciousness of young women.

AIM: The aim of the study was to explore the knowledge and the awareness of the young Turkish women regarding cervical cancer and human papilloma virus (HPV) vaccines. The authors analyze a probable relationship between the overall knowledge level and a few socio-demographic parameters. MATERIALS AND METHODS: The authors interviewed with students from Canakkale 18 March University and young women that did not continue with school in the same city from January to September 2011. All the students answered the questionnaire voluntarily and independently. RESULTS: The participants had low level of knowledge about the risk factors for cervical cancer. Smoking is the major risk factor that was known by the participants (65%). Proportion of the participants that were aware of pap smear test and HPV were 65% and 17% respectively. A small proportion of young women had knowledge regarding protection from HPV. Educational stream, educational level, family income, and family size had significant association knowledge level (p < 0.05). CONCLUSION: There has not been any improvement in HPV and risk factor of cervical cancer awareness in young women. Health members of the National Cancer Control Programme and delegates of the vaccine corporations have major work in order to increase the level of knowledge so that general public can easily take preventative measures.

Perinatal outcomes of borderline diabetic pregnant women.

We examined the perinatal outcomes of borderline diabetic pregnant women who had impaired 50 g oral glucose challenge test (OGCT) results, but normal 100 g oral glucose tolerance test (OGTT) results. Our study group included 70 pregnant women who had increased 50 g OGCT results, but normal 100 g OGTT results, and a control group of 122 pregnant women with normal 50 g OGCT results. Polyhydramnios, macrosomia and neonatal birth weight were significantly higher in the study group. After adjusting the results for possibly affecting variables, the risk of polyhydramnios remained significant, while the risk of macrosomia and neonatal birth weight was not significant between the groups. The results from the study group were similar to the control group, when adjusted for other risk factors. Increased 50 g OGCT results in pregnant women can be accepted as a benign state if the 100 g OGTT results are normal.

Behcet disease and pregnancy.

PURPOSE: Behcet disease (BD) is a multisystemic vaculitis commonly diagnosed in reproductive years. The authors aimed to investigate the relationship between BD and pregnancy outcomes. MATERIALS AND METHODS: In this multicenter retrospective survey study, the authors compared the pregnancy outcomes of BD patients with the healthy controls. RESULTS: A total of 298 pregnancies of 94 patients with BD and 219 pregnancies of 95 healthy controls were evaluated. The mean birth weight of all babies of women with BD and the control group were 3,214 grams and 3,351 grams, respectively (p = 0.028). The miscarriage rates were also higher in the BD group. The com- plication rates of pregnancy with hypertension, preeclampsia, preterm labour in the study group and the control group were 12.8% and 11.6%, respectively (p = 0.489). CONCLUSION: The current study demonstrated that BD patients delivered smaller babies and they have higher miscarriage rates when compared to the healthy controls which might be due to the vasculitis of the placenta.

Can the addition of a paracervical block to systemic or local analgesics improve the pain perceived by the patient during hysterosalpingography?

The aim of the present study was to investigate whether the addition of a paracervical block to local intrauterine anaesthesia or the use of an intramuscular non-steroidal anti-inflammatory drug was effective for pain control during and at 30 min after hysterosalpingography (HSG). A total of 120 patients undergoing hysterosalpingography were randomised into four groups. Patients received intramuscular dexketoprofen trometamol with or without a paracervical block or intracavitary lidocaine instillation with or without paracervical block. The primary outcome was the overall pain score from the four stages of the procedure. The lowest pain scores were observed in the patients receiving dexketoprofen trometamol with a paracervical block, whereas the highest pain scores were observed in patients with intracavitary lidocaine instillation without a paracervical block (p = 0.021). No beneficial effect was found when a paracervical block (PCB) was added to either systemic or local analgesics. The combination of intramuscular dexketoprofen and a paracervical block with plain lidocaine produced the best pain relief during the three specified steps and at up to 30 min after the HSG procedure.