TR-Dizin İndeksli Yayınlar Koleksiyonu

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Early clinical predictors of intractable epilepsy in childhood
(2014) Saygi, Semra; Erol, Ilknur; Alehan, Fusun
Aim: In this retrospective study, we evaluated the clinical responses to antiepileptic drug (AED) therapy in pediatric epilepsy patients treated at a single center. Materials and methods: We identified 28 children with intractable epilepsy and 213 patients with drug-responsive epilepsy. Results: Univariate analysis showed that age at onset, high (daily) initial seizure frequency, infantile spasm, history of neonatal seizures, abnormal neurodevelopmental status, neurological abnormalities, mental retardation, remote symptomatic etiology, and abnormal brain imaging results were significant risk factors for the development of intractable epilepsy (P < 0.05). Multivariate logistic regression analysis revealed that high (daily) initial seizure frequency and remote symptomatic etiology were significant and independent risk factors for intractable epilepsy (P < 0.05). Conclusion: Our study suggests that the risk of developing intractable epilepsy in childhood may be predicted, to some extent, by the early clinical course. Early identification of patients at high risk of developing intractable epilepsy will guide appropriate therapy and reduce exposure to ineffectual treatments.
Paraaortic Lymph Node Dissection in Endometrial Cancer; Is It Necessary?
(2014) Dizdar, Omer; Oguz, Arzu; Kucukoztas, Nadire; Dursun, Polat; Altundag, Ozden; Ayhan, Ali
Use of Mesenchymal Cells to Modulate Immune Suppression and Immune Reconstruction in a Patient with Aplastic Anemia Complicated by Invasive Sino-Orbital Aspergillosis
(2014) Ozdogu, Hakan; Yeral, Mahmut; Boga, Can; Kozanoglu, Ilknur
Cultured human bone marrow mesenchymal cells (MSCs) have immunomodulatory and tissue regenerative properties. This report summarizes the result of post-transplant treatment with MSCs of a 26-year-old patient with aplastic anemia complicated by invasive sino-orbital aspergillosis. The patient was treated with MSCs to benefit from the dual effects of MSCs in immune reconstitution: suppression against alloreactive T cells and facilitation of the re-engraftment process. The patient did not develop acute or chronic graft-versus-host disease. The aspergillus infection healed completely. The engraftment failure was also ended without any complications. During his last visit in his fourth year after transplantation, the patient was in hematological remission. Human bone marrow-derived MSCs seem to have an important role in preventing or overcoming immunological complications in patients who undergo stem cell transplantation.
A Preliminary Investigation on the Presence of Calcifying Nanoparticles in the Breast Tumor
(2014) Ozkal-Baydin, Pinar; Gocmen, Sedef J.; Erdemli, Esra; Tunc, Ibrahim G.; Sener, Hasan B.; Gumuskaya, Berrak; Sunguroglu, Asuman
Calcium phosphate is deposited in many diseases, but the molecular basis of mineralization remains largely unknown. Biomineralizied calcifications that are formed by calcium deposits are also detected in breast mammograms. Some of the detected microcalcifications are thought to be related with malignancy. Taken together, calcifying nanoparticles (CNP) may be thought as a source of malign calcifications in breast cancers. The aim of the study is to research the presence of CNP in breast tumor tissue. With this aim, the presence of CNP was investigated by culturing 16 patients' breast tumor tissue and from 2 pathologic tissues with transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Their growth was monitored by optical density (OD) at a wavelength of 650 nm. CNP couldn't be found in the analysed tissues. The presence of CNP in the breast tumor tissue was researched for the first time. We could not find CNP in the breast tumor tissue, but we think this research will open a new field of study for researchers.
Endovascular treatment of an iliac artery rupture caused by invasive Salmonella spondylodiscitis
(2014) Kursun, Ebru; Turunc, Tuba; Ozkan, Ugur; Demiroglu, Yusuf Ziya; 25230272
The rate of non-typhoid Salmonella infections has increased remarkably in recent years. Endovascular system infection is one of the most serious forms of extraintestinal Salmonella infection. The abdominal aorta is frequently involved, while bone and joint involvement are rarely seen. We present a rare case of successful endovascular treatment of a left iliac artery rupture and pseudoaneurysm both occurring due to the direct invasion of lumbar spondylodiscitis caused by Salmonella typhimurium.
The Effect of Haematological Parameters on Overall Survival in Advanced Stage Non Small Cell Lung Cancer
(2014) Oguz, Arzu; Colak, Dilsen; Ersoy, Ugur; Imamoglu, Inanc G.; Altinbas, Mustafa; Unal, Dilek; Zararsiz, Gokmen
In this study, we aimed to evaluate the prognostic value of pretreatment blood count values, particularly WBC counts, in patients with advanced non-small cell lung cancer (NSCLC). The records of 186 patients with advanced stage (stage IIIB and IV) NSCLC were assessed retrospectively. Patients were divided into 3 subgroups according to WBC levels; <= 0000 /mm(3) as Group 1, >10000 and <= 15000/mm(3) as Group 2 and >15000/mm(3) as Group 3. Patient and tumor characteristics as well as outcomes in terms of overall survival (OS) were evaluated. Median OS was 13.3 months in the whole population, 25.7 months in stage IIIB and 8.9 months in stage IV patients. According to the pretreatment leukocyte values, median OS was 17.9 months in Group 1, 11.2 months in Group 2 and 8.4 months in Group 3 (p= 0.003). Median OS values in WBC groups according to stages IIIB and IV were significantly different (p< 0.001). In multivariate analyses, ECOG-PS 2 or 3, stage IV disease, anemia and high WBC levels were associated with poorer OS. In this study, higher pretreatment WBC levels were associated with poorer OS in patients with advanced stage NSCLC. Pretreatment WBC counts may represent a simple prognostic factor and may aid in tailoring treatment in patients with advanced NSCLC.
Effects of ozone therapy and taurine on ischemia/reperfusion-induced testicular injury in a rat testicular torsion model
(2014) Aydos, Tolga Resat; Basar, Mehmet Murad; Kul, Oguz; Atmaca, Hasan Tank; Uzunalioglu, Tuba; Kisa, Ucler; Efe, Oguzhan Ekin; 25539540
Background/aim: To investigate the effect of ozone and/or taurine treatment comparatively on testicular damage due to ischemia/reperfusion (I/R) injury in an experimental torsion model in rats. Materials and methods: Adult Wistar rats with and without torsion/detorsion were used. In order to monitor the effect of ozone and/or taurine treatment on testicular damage due to I/R injury, following histopathological investigation apoptotic indexes were scored by TUNEL method. Moreover, tumor necrosis factor receptor 1 (TNFR1), caspase 3, caspase 8, endothelial nitric oxide synthase (eNOS), tumor necrosis factor alpha (TNF alpha), and cytochrome C immunostainings were performed and the levels of malondialdehyde, glutathione peroxidase, superoxide dismutase, catalase, total sulthydryl, and nitric oxide were determined in the testicular tissue. Results: Intraperitoneal ozone and/or taurine treatment prevented both histopathological damage and increase in the apoptotic index. Torsion did not exert an effect on the levels of TNFa and cytochrome C. Ozone and/or taurine treatment prevented increases in TNFR1, caspase 3, and caspase 8. The level of oxidative stress markers was unchanged. The increases in NO level and eNOS expression were prevented by ozone and/or taurine treatment in I/R groups. Conclusion: Using ozone therapy and/or taurine before reperfusion may be a solution for germ cell degeneration resulting from testicular torsion and related infertility.
Interrelation of RDW and coronary flow reserve in patient with idiopathic dilated cardiomyopathy
(2014) Ozulku, Mehmet; Caliskan, Mustafa; Gullu, Hakan; Erdogan, Dogan; Caliskan, Zuhal; Muderrisoglu, Haldun
Objective: Idiopathic dilated cardiomyopathy (IDC) impairs and reduces coronary flow reserve (CFR). High level of red cell distribution width (RDW) is an independent risk factor for cardiovascular diseases. Therefore, in this observational case-control study we have aimed to determine whether RDW level is associated with CFR impairment in patients with IDC. Methods: We examined 36 patients with IDC and 35 healthy subjects formed as a control group. In addition to this, patients with IDC were divided into two subgroups according to their CFR levels [normal CFR group (CFR value >= 2) and lower CFR group (CFR value<2)]. Control and patients groups were compared using the student t-test for multiple comparisons. The subgroups were compared using the Mann-Whitney U test for continuous variables and chi-square for categorical variables. The Pearson's and Spearman correlation analysis was used to test the possible associations between CFR and the study variables as appropriate. The receiver-operating characteristic (ROC) curve was determined to evaluate the predictive performance of RDW to detect low CFR. Results: There were no significantly differences between the lower and higher CFR groups' clinical data, baseline hemodynamic, medication and biochemical data except RDW and high-sensitivity C-reactive protein (hsCRP) levels. We found that RDW level was a good predictor of low CFR at the receiver-operating characteristic curve. The area under the curve (AUC) was 73% (95% confidence interval between 0.56-0.90 is 95%, p:0.018) After adjusting potential confounders include age, body-mass index, blood pressure, lipid and glucose, RDW independently associated with CFR level (Beta:-0.374; p=0.015) and hsCRP value (Beta:-0.520; p=0.001) were the independent predictors of lower CFR. Conclusion: Results showed that there was an independent correlation between RDW level and CFR level in patients with IDC.
A rare cause of circulatory shock
(2014) Altin, Cihan; İzmir, Arzu; Osmanoglu, Sevda; Gezmis, Esin; Sagduyu, Afsin; 25233504
Inferior Vena Cava Oxygen Saturation during the First Three Postnatal Days in Preterm Newborns with and without Patent Ductus Arteriosus
(2014) Yapakci, Ece; Ecevit, Ayse; Ince, Deniz Anuk; Gokdemir, Mahmut; Tekindal, M. Agah; Gulcan, Hande; Tarcan, Aylin; 25337418
Background: Inferior vena cava (IVC) oxygen saturation as an indicator of mixed venous oxygenation may be valuable for understanding postnatal adaptations in newborn infants. It is unknown how this parameter progresses in critically ill premature infants. Aims: To investigate IVC oxygen saturation during the first three days of life in preterm infants with and without patent ductus arteriosus (PDA). Study Design: Case-control study. Methods: Twenty-seven preterm infants were admitted to the Neonatal Intensive Care. Preterm infants with umbilical venous catheterization were included in the study. Six umbilical venous blood gas values were obtained from each infant during the first 72 hours of life. Preterm infants in the study were divided into two groups. Haemodynamically significant PDA was diagnosed by echocardiography in 11 (41%) infants before the 72nd hour of life in the study group and ibuprofen treatment was started, whereas 16 (59%) infants who didn't have haemodynamically significant PDA were included in the control group. Results: In the entire group, the highest value of mean IVC oxygen saturation was 79.9% at the first measurement and the lowest was 64.8% at the 72nd hour. Inferior vena cava oxygen saturations were significantly different between the study and control groups. Posthoc analysis revealed that the first and 36th hour measurements made the difference (p=0.01). Conclusion: Inferior vena cava oxygen saturation was found to be significantly different between preterm infants with and without PDA. Further studies are needed to understand the effect of foetal shunts on venous oxygenation during postnatal adaptation in newborn infants.
Amyloid Goiter Due to Familial Mediterranean Fever in a Patient with Byler Syndrome: A Case Report
(2014) Cigerli, Ozlem; Unal, Asli Dogruk; Parildar, Hulya; Demiralay, Ebru; Tarcin, Ozlem; 25337425
Background: Familial Mediterranean Fever (FMF), also inherited with autosomal recessive trait, is characterized by recurrent episodes of fever, arthritis, and serositis. Congenital Byler Syndrome (Progressive Familial Intrahepatic Cholestasis) inherited with autosomal recessive trait and characterized by defective secretion of bile acids. FMF associated Amyloid A deposition occurs in many tissues and organs, but amyloid goiter is a rare entity that leads to enlargement and dysfunction of the thyroid. Case Report: We present a rare case of 24 year old male patient who had liver and kidney transplantation due to Byler Syndrome and secondary amyloidosis related to FMF, diagnosed as rapidly growing large amyloid goiter. Deposits of extracellular amyloid and dense adipose metaplasia diagnostic for amyloid goiter are determined upon histopathological examination of thyroidectomy material. Conclusion: When goiter was detected in cases with history of systemic amyloidosis and rapidly growing goitre, amyloid goiter should be remembered at first. This case is unique since two autosomal genetic disorders are together in the same patient and important as it emphasizes the consequences of consanguineous marriage, early diagnosis and treatment compliance of FMF and the awareness of amyloid goiter in patients followed by primary care physicians and healthcare professionals.
Subcutaneous emphysema, pneumo-orbita and pneumomediastinum following a facial trauma caused by a high-pressure car washer
(2014) Yilmaz, Fevzi; Ciftci, Orcun; Ozlem, Miray; Komut, Erdal; Altunbilek, Ertugrul
Pneumomediastinum is air leakage to mediastinal space from various potential sites, including lung, esophagus, trachea, and neck. It is a rare condition that develops either spontaneously with increased intraalveolar or intrabronchial pressure, or due to trauma. Although cases where face or neck trauma with subcutaneous emphysema that extended to mediastinal cavity via anatomical connections in face and neck have been reported, orbital traumas leading to pneumomediastinum are very rare occurrences that have seldom been reported. This paper documents a 17-year-old male who presented with diffuse subcutaneous emphysema involving paraorbital facial areas, which extended to neck and mediastinal cavity.
The relationship between coronary collateral artery development and inflammatory markers
(2014) Oguz, Didem; Atmaca, Yusuf; Ozdol, Cagdas; Ozdemir, Ayhan Ongun; Kaya, Cansin Tulunay; Erol, Cetin
Objective: This study aims to show the effect of myeloperoxidase (MPO), hsCRP, TNF-alpha values and leukocyte count on the development of coronary collateral arteries in patients with severely diseased coronary arteries. Methods: Current study is an observational cross-sectional study. In the study, 295 patients who had functional obstruction or total coronary occlusion at least 1 month on their angiograms were included. We divided the study population into two groups according to their collateral grade as good collateral (Group 1) (169 patients) and poor collateral (Group 2) (126 patients). Multiple logistic regression analysis was used for independent variables associated with the coronary collateral grade. Results: History of stable angina pectoris was statistically more prevalent in good collateral group (61.5% and 48.4%, p=0.025). Furthermore, MPO activation was higher in good collateral group and the difference was statistically significant (3.7 U/mL and 3.0 U/mL p=0.001). In multiple logistic regression analysis, stable angina pectoris [OR 1.7, 95% CI (1.05-2.8), p=0.03] and high MPO levels [OR 2.7, 95% CI (1.7-4.3), p<0.001] were found to be independent predictors of good collateral development. Conclusion: We think that proinflammatory enzymes and cytokines released from these cells rather than inflammatory cells themselves may play an important role on the collateral development.
SECOND-ORDER RESPONSE SURFACE METHOD: FACTORIAL EXPERIMENTS AN ALTERNATIVE METHOD IN THE FIELD OF AGRONOMY
(2014) Tekindal, Mustafa Agah; Bayrak, Hulya; Ozkaya, Berrin; Yavuz, Yasemin
The main purpose in all experimental designs is to take into account the factors that are considered likely to have an effect on the response variable emphasized, and to minimize the error of experiment in this way. Bread, which is the staple human food, cannot have any negative effect on human beings as long as it is produced by using suitable materials under appropriate conditions. However, when inappropriate amounts of raw materials are used (e.g. non-optimal amounts of bran, yeast or other additives), bread threatens health. In this study, Box-BehnkenDesign (BBD) and Central Composite Design (CCD), the two different designs of the response surface method, were applied to a single dataset. Two designs were evaluated in terms of the results obtained. The purpose in the second-order factorial experiments is to identify the optimum levels of independent variables for the dependent variable. In this study, the implementation of second-order response surface model and interpretation of the results were based on 2(k) CCD (Central Composite Design) and BBD (Box-Behnken Design) with one replicate. In the CCD, the amount of bran added, flour type, the ratio of yeast added, furnace temperature, the duration of remaining in the furnace, and fermentation time were accepted to be significant factors that affected volume yield. In addition, R-2 = 80.7% shows that the regression equation explains variables by 80.7%. In the BBD, the ratio of bran added, the type of flour, the ratio of yeast added, furnace temperature (only in quadratic form), the duration of remaining in the furnace (only in quadratic form), and fermentation time (only in quadratic form) were accepted to be significant factors that affected volume yield. Furthermore, R-2 = 89.64% shows that the regression equation explains variables by %89.64. This method provides savings in terms of time and the amount of material by limiting the area at particular levels. Researcher may use the results of either CCD or BBD (whichever s/he deems suitable) according to the volume s/he wants to obtain.
Exogenous Recombinant Adiponectin Improves Survival in Experimental Abdominal Sepsis
(2014) Salman, Bulent; Yilmaz, Tonguc Utku; Tezcaner, Tugan; Demir, Ebru fluoglu; Pasaoglu, Ozge Tugce; 25337421
Background: Adiponectin, which has anti-inflammatory features, is an important substance in several metabolic mechanisms. Aims: The aim of this study is to evauate the effects of exogenous intraperitoneal administration of adiponectin on the survival, intrabdominal adhesion and inflammatory cytokine levels in an experimental sepsis model. Study Design: Animal experimentation. Methods: Ninety rats were divided into a control group, adiponectin group and sham group. A cecal puncture abdominal sepsis model was performed in the adiponectin and control groups. Every three hours, exogenous adiponectin was administrated to the adiponectin group. At the 3(rd) and 24(th) hours, 10 rats were sacrified in each group in order to measure plasma tumor necrosis factor-alpha (TNF-alpha), interleukin (IL) 10, soluble intracellular adhesion molecule (ICAM)-1, IL-6 and macrophage inhibitory factor levels, and the activity of nuclear factor (NF)-kappa B. The remaining rats were followed for survival. Results: The plasma levels of TNF-alpha, soluable ICAM-1, IL-6, and macrophage inhibitory factor were significantly higher in the control group than in the adiponectin and sham group (p<0.05). The increase in inflammatory cytokines with time was more prominent in the control group. The activity of NF-kappa B in the control group was higher than in the adiponectin group (p<0.05). The survival rate of the adiponectin group was higher than in the control group. Conclusion: Administration of exogenous adiponectin to the peritoneum in abdominal sepsis increased survival and decreased intrabdominal adhesions by decreasing the inflammatory response.
Therapeutic Plasma Exchange in Neurologic Diseases: An Experience with 91 Patients in Seven Years
(2014) Karaca, Sibel; Kozanoglu, Ilknur; Karakurum Goksel, Basak; Karatas, Mehmet; Tan, Meliha; Yerdelen, V. Deniz; Giray, Semih; Artier, Zulfikar
Introduction: In this study, we report the results of our experience of therapeutic plasma exchange (TPE) for neuroimmunologic disorders performed at our hospital over a seven-year period. Methods: We retrospectively reviewed the medical records of 91 patients (53 male, 38 female) who had been treated at our center with TPE. Results: 60 patients with Guillain-BarrS syndrome (GBS), 23 with myasthenia gravis (MG), 4 with chronic inflammatory demyelinating polyneuropathy (CIDP) and 1 patient each with polymyositis, septic encephalopathy, acute disseminated encephalomyelitis (ADEM) and Opsoclonus-Myoclonus syndrome (OMS) received TPE. 26.7% of GBS patient's made complete recovery, 61.7% had partial recovery and 11.7% patients died due to respiratory failure. Despite our best efforts and effective TPE treatments, 13.4% of MG patients deceased, however, 78% had full recovery. Three patients with CIDP were discharged with full and 1 patient with partial recovery. The patient with ADEM had partial recovery with TPE at first, but deceased 2 months later due to pneumonia-related respiratory insufficiency. While, patient with polymyositis had slight-partial recovery, we obtained full recovery with TPE in septic encephalopathy and OMS patients. The side effects and complications of treatments with TPE, which included hypotension, hypocalcaemia and anemia, were mild and manageable. Conclusion: The improvement rates were encouraging and we concluded that significant benefit can be achieved with TPE for the treatment of neuroimmunological disorders.
Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer
(2014) Selek, Ugur; Bolukbasi, Yasemin; Welsh, James W.; Topkan, Erkan; 25667781
Chemoradiotherapy is the current standard of care in patients with advanced inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC). Three-dimensional radiotherapy (3DCRT) has been a trusted method for a long time and has well-known drawbacks, most of which could be improved by Intensity Modulated Radiotherapy (IMRT). IMRT is not currently the standard treatment of locally advanced NSCLC, but almost all patients could benefit to a degree in organ at risk sparing, dose coverage conformality, or dose escalation. The most critical step for a radiation oncology department is to strictly evaluate its own technical and physical capabilities to determine the ability of IMRT to deliver an optimal treatment plan. This includes calculating the internal tumor motion (ideally 4DCT or equivalent techniques), treatment planning software with an up-to-date heterogeneity correction algorithm, and daily image guidance. It is crucial to optimise and individualise the therapeutic ratio for each patient during the decision of 3DCRT versus IMRT. The current literature rationalises the increasing use of IMRT, including 4D imaging plus PET/CT, and encourages the applicable knowledge-based and individualised dose escalation using advanced daily image-guided radiotherapy.
Restoration of pull-out strength of the failed pedicle screw: biomechanical comparison of calcium sulfate vs polymethylmethacrylate augmentation
(2014) Guler, Umit Ozgur; Derincek, Alihan; Hersekli, Murat Ali; Ozalay, Metin; Cinar, Bekir Murat; Acaroglu, Emre
Objective: The aim of the present study was to compare calcium sulfate (CAS) and polymethylinethaaylate (PMMA) bone cements used for the augmentation of a failed pedicle screw with biomechanical pull-out strength (POS) testing. Methods: Thirty lumbar vertebrae were harvested from 6 calves and bone mineral densities (BMD) were measured. Primary polyaxial pedicle screws were randomly inserted and pulled out and the POSs of the specimen were recorded. For revision, specimens were randomly assigned to the CAS-augmented pedide screws group (Group 1) or PMMA-augmented pedicle screw group (Group 2). Pull-out tests were repeated to compare both groups. Results: Mean BMD of the specimens was 1.006 +/- 0.116 g/cm(2). There were no statistically significant differences between BMD results of the two groups (p=0.116). For Group 1, mean POS of primary screws was 2,441.3 +/- 936.4 N and was 2,499.5 +/- 1,425.1 N after CAS augmentation, demonstrating no statistically significant difference (p=0.865). In Group 2, mean POS of the primary screws was 2,876.6 +/- 926.6 N and significantly increased to 3,745.5 +/- 1,299.2 N after PMMA augmentation (p=0.047). There was also a significant difference in mean POS between the CAS and PMMA groups (p=0.026). Conclusion: Although CAS augmentation facilitates a revision screw POS as strong as that of primary screws, it is not as strong as PMMA augmentation.
Comparison of Acoustic and Stroboscopic Findings and Voice Handicap Index between Allergic Rhinitis Patients and Controls
(2014) Koc, Eltaf Ozbal; Koc, Bulent; Erbek, Selim; 25667789
Background: In our experience Allergic Rhinitis (AR) patients suffer from voice problems more than health subjects. Aims: To investigate the acoustic analysis of voice, stroscopic findings of larynx and Voice Handicap Index scores in allergic rhinitis patients compared with healthy controls. Study Design: Case-control study. Methods: Thirty adult patients diagnosed with perennial allergic rhinitis were compared with 30 age-and sex-matched healthy controls without allergy. All assessments were performed in the speech physiology laboratory and the testing sequence was as follows: 1. Voice Handicap Index (VHI) questionnaire, 2. Laryngovideostroboscopy, 3. Acoustic analyses. Results: No difference was observed between the allergic rhinitis and control groups regarding mean Maximum Phonation Time (MPT) values, Fo values, and stroboscopic assessment (p>0.05). On the other hand, mean VHI score (p=0.001) and s/z ratio (p=0.011) were significantly higher in the allergic rhinitis group than in controls. Conclusion: Our findings suggest that the presence of allergies could have effects on laryngeal dysfunction and voice-related quality of life.
Approach to cases with resistant hypertension
(2014) Torun, Dilek
Resistant hypertension is defined as blood pressure that remains above 140/90 mm Hg despite the concurrent use of optimal dose of 3 antihypertensive agents of different classes. Ideally, 1 of these 3 agents should be a diuretic agent. The etiology of resistance hypertension is multifactorial. Successful treatment requires identification and reversal of lifestyle factors (obesity, dietary salt intake, alcohol intake, lack of adherence to prescribed medicines, and interfering substances), and to exclude the presence of pseudoresistance. Once confounding factors have been ruled out, evaluation for potentially treatable secondary causes of hypertension should be considered. Most forms of secondary hypertension are related with adrenal or renal disorders such as primary hyperaldosteronism and renovascular disease. Although, obstructive sleep apnea syndrome is not a typical cause of secondary hypertension, it is commonly present in resistant hypertension. Diagnostic workup and management of resistant hypertension were discussed in different clinical presentations.