Person: ERMERAK, NEZİH ONUR
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ERMERAK
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NEZİH ONUR
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Publication Open Access Esophageal perforation during intragastric balloon therapy: management of a patient with late referral(2023-01-01) ERMERAK, NEZİH ONUR; UPRAK, TEVFİK KIVILCIM; LAÇİN, TUNÇ; YILDIZELİ, BEDRETTİN; YEGEN, ŞEVKET CUMHUR; ERMERAK N. O., Uprak K. T., Emran M., LAÇİN T., YILDIZELİ B., YEGEN Ş. C.Minimally invasive treatment modalities like intragastric balloon therapy (IBT) gained popularity in the treatment of obesity [1]. Some morbidities have been reported in the literature, but it is limited. Esophageal perforation is the most feared complication of the procedure. Although endoscopic stent placement can be chosen as a treatment option in stable patients, most of the patients are treated with surgical drainage and primary repair [2]. We report an unusual case of intragastric balloon placement complicated with esophageal perforation which was successfully treated with a surgical approach after late referral.Publication Open Access Surgical outcomes of patients with non-small cell lung cancer following neoadjuvant treatment(MARMARA UNIV, FAC MEDICINE, 2018-10-31) ERMERAK, NEZİH ONUR; Ocakcioglu, Ilhan; Alpay, Levent; Ermerak, Nezih Onur; Kiral, Hakan; Tezel, Cagatay; Baysungur, Volkan; Yalcinkaya, IrfanObjective: Although, anatomical resection of non-small cell lung cancer (NSCLC) following neoadjuvant therapy is still controversial, it is a widely accepted approach for thoracic surgery practice. The aim of this study is to briefly evaluate clinical results, long term survival, and factors affecting survival of the patients with locally advanced NSCLC, pancoast tumour and lung cancer with solitary brain metastasis, who have been operated at our institution following neoadjuvant therapy. Materials and Method: Between March 2006 and March 2012, 70 patients with NSCLC diagnosis who underwent anatomic pulmonary resection following neoadjuvant therapy were included in the study. Results: A three year survival (39%) and a 5-year survival (29%) were 16 +/- 6.8 and 37 +/- 9.89 months, respectively. The mean survival was found to be 37.15 +/- 3.06 months. When survival rate was evaluated according to localization of tumor, it was lower in central and left upper lobe tumors compared to other anatomical localizations (P=0.042). The mean 5-year survival times were 50.00 +/- 5.65 months in stage 0 patients, 35.39 +/- 5.85 months in stage 1 patients, 37.40 +/- 6.89 months in stage 2 patients and 21.44 +/- 3.10 months in stage 3 patients. Conclusion: We can achieve significant survival results by the anatomical pulmonary resection following neoadjuvant therapy.Publication Open Access The angiogenic gene profile of pulmonary endarterectomy specimens: Initial study(2023-01-01) ERMERAK, NEZİH ONUR; YILMAZ, BETÜL; BATIREL, SAİME; OLGUN YILDIZELİ, ŞEHNAZ; KOCAKAYA, DERYA; MUTLU, BÜLENT; YILDIZELİ, BEDRETTİN; ERMERAK N. O., YILMAZ B., BATIREL S., OLGUN YILDIZELİ Ş., KOCAKAYA D., MUTLU B., Tas S., YILDIZELİ B.© 2023 The Author(s)Objectives: The underlying mechanisms for the development of chronic thromboembolic pulmonary hypertension and prognostic biomarkers are not clear yet. Thus, our aim is to assess and identify new biomarkers for the expression of 84 key genes linked to angiogenesis. Methods: Patients who had levels more than 1000 dynes·sec·cm−5 were included in the test group, and the other patients were included in the control group. Twelve specimens were taken from the patients. RT2 Profiler PCR Array (Qiagen) was used to quantify the expression of the 84 key genes. Results: Eight patients (6 male, 2 female, median age 54.4 ± 13.1 years) who underwent pulmonary endarterectomy were included. Pulmonary vascular resistance improved significantly from 811 ± 390 dyn/s/cm−5 to 413.3 ± 144.9 dyn/s/cm−5 (P .005) after surgery. Median length of hospital stay was 11.62 ± 2.97 days. The test group had a distinct pattern of impaired angiogenic and antiangiogenic genes. The expression levels of TGFA, TGFB1, THBS2, THBS1, TGFBR1, SERPINE1, SERPINF1, TGFB2, TIMP2, VEGFC, IFNA1, TNF, CXCL10, NOS3, IGF1, and MMP14 were downregulated in the specimens from the patients who had higher pulmonary vascular resistance values, whereas some genes, including PDGFA, showed upregulation that was statistically nonsignificant in the same group. Conclusions: These results can lead to the development of new markers that could predict adverse outcomes of patients with CTEPH. Identification of new markers that are related to worse outcomes would enable screening patients for early diagnosis and treatment.Publication Open Access Modification of the Nuss procedure: The crossed bar technique for new subtypes of pectus excavatum(2023-05-01) ERMERAK, NEZİH ONUR; ERMERAK N. O., Yuksel M.BackgroundWe aim to describe four new subtypes of PE in detail and represent modification of the Nuss procedure called crossed bar technique for their optimum correction with good results.Methods101 patients who underwent crossed bar technique between August 2005 and February 2022 were included into the study.ResultsThe mean age of the patient series was 21.1 (range 15-38 years) years. Mean Haller index was 3.87. Mean operation duration was 86.84 min. 2 bars were used in 74 (73.3%) of the patients whereas 3 bars were preferred in 27 (26.7%) of them. Mean hospital stay was 4.1 (2-8) days, and all the patients were seen routinely on postoperative follow-up at 1st, 6th, and 18th months. Quality of life questionnaires revealed satisfaction.ConclusionsCross bar technique yields satisfactory results for these new subtypes and can be performed safely with good results in these selected group of patients.Publication Open Access ‘Short Bars Crossed’ to Remodel the Entire Chest Wall in Children and Adolescents with Pectus Excavatum(2024-01-01) ERMERAK, NEZİH ONUR; YÜKSEL, MUSTAFA; Weinhandl A. C., ERMERAK N. O., YÜKSEL M., Rebhandl W.Background: The cross-bar technique of minimally invasive pectus excavatum (PE) correction remains underreported, which is especially true of pediatric patients. We therefore reviewed the experience of a Turkish and an Austrian center. An additional novelty characterizing both pediatric cohorts was the use of short bars. Methods: In a retrospective study, pediatric PE corrections involving ‘short bars crossed’ were analyzed for complications and intra-/postoperative outcomes. Cases with two or three bars were included, given that a horizontal third bar was placed whenever considered useful for upper-chest elevation. All bars were fitted with a single stabilizer near the surgical entry point. In the Austrian center, intercostal nerve cryoablation was used for pain management. Descriptive statistics are presented. Results: Seventy-eight patients ≤18 years old were evaluable at the Turkish (n = 56) and Austrian (n = 22) centers. Total median values were 16.2 (IQR: 15.1–17.4) years for age and 4.60 (IQR: 3.50–6.11) for Haller index. Ten mild or moderate complications (12.8%) were observed, including just one revision requirement due to bar migration (1.28%). Intercostal nerve cryoablation (n = 13) was associated with longer surgical procedures at 150 (IQR: 137–171) versus 80 (IQR: 60–100) minutes but with shorter hospital stays, given an IQR of 3–4 days versus 4–5 days. Conclusion: ‘Short bars crossed’—with a single stabilizer in a ventral position close to the surgical entry point—ensure a wide distribution of forces, protect against bar migration, are safe and effective, and offer stability at an age characterized by growth and physical activity. Level of Evidence: IV.