Browsing by Author "Roessler, Eric"

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    Association of adrenal medullar and cortical nodular hyperplasia - A report of two cases with clinical and morpho-functional considerations
    (HUMANA PRESS INC, 2006) Valdes, Gloria; Roessler, Eric; Salazar, Ivan; Rosenberg, Helmar; Fardella, Carlos; Martinez, Pedro; Velasco, Alfredo; Velasco, Soledad; Orellana, Pilar
    Arterial hypertension of adrenal etiology is mainly attributed to primary hyperaldosteronism. However, subtle expressions of hyperadrenergic or glucocorticoid excess can also generate arterial hypertension. The present report describes two hypertensive patients cataloged as resistant essential hypertensives, in whom adrenal masses were found incidentally, who highlight the need to recognize these tenuous clinical or laboratory presentations. Case 1 was a 50-yr-old female with hyperadrenergic hypertension associated to a left adrenal node, normal cortisol and aldosterone:renin ratio, marginally increased urinary normetanephrine, and a positive I-131 MIBG radioisotope scan. Adrenalectomy normalized blood pressure and urinary metanephrines. Pathology showed a hyperplastic adrenal medulla associated to a multinodular cortical hyperplasia. Case 2 was a 62-yr-old female with progressive hypertension, a slight Cushing phenotype, non-suppressible hypercortisolism, normal urinary metanephrines, and bilateral adrenal nodes. Bilateral adrenalectomy and subsequent replacement normalized blood pressure and phenotypic stigmata. Pathology demonstrated bilateral cortical multinodular hyperplasia and medullary hyperplasia. The clinical study in both patients was negative for MEN. The apparently rare association of cortical and medullary lesions presented by both patients is probably overlooked in routine pathology exams, but should be meticulously searched since the crosstalk between the adrenal cortex and medulla may prompt dual abnormalities.
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    Clinical Efficacy of SARS-CoV-2 Vaccination in Hemodialysis Patients
    (2022) Torres, Ruben; Toro, Luis; Eugenia Sanhueza, Maria; Lorca, Eduardo; Ortiz, Mireya; Pefaur, Jacqueline; Clavero, Rene; Machuca, Eduardo; Gonzalez, Fernando; Herrera, Patricia; Mocarquer, Alfredo; Frias, Alondra; Roessler, Eric; Munoz, Carolina; Nunez, Miguel; Aravena, Cesar; Quintana, Enrique; Lemus, Juan; Lillo, Mario; Reynolds, Enrique; Morales, Alvaro; Pais, Edgard; Fiabane, Andrea; Parra-Lucares, Alfredo; Garrido, Cristian; Mendez-Valdes, Gabriel; Villa, Eduardo; Mansilla, Rodrigo; Sotomayor, Germana; Gonzalez, Marcela; Miranda, Cecilia; Briones, Eduardo; Gomez, Esteban; Mezzano, Sergio; Bernales, Waldo; Rocca, Ximena; Espinoza, Oscar; Zuniga, Eric; Aragon, Henry; Badilla, Marta; Valenzuela, Marcela; Escobar, Luis; Zamora, Daniela; Flores, Ivan; Tapia, Beatriz; Borquez, Tamara; Herrera, Patricio
    Introduction: The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population.
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    Latin American registry of renal involvement in COVID-19 disease. The relevance of assessing proteinuria throughout the clinical course
    (2022) Lombardi, Raul; Ferreiro, Alejandro; Ponce, Daniela; Claure-Del Granado, Rolando; Aroca, Gustavo; Venegas, Yanissa; Pereira, Mariana; Chavez-Iniguez, Jonathan; Rojas, Nelson; Villa, Ana; Colombo, Marcos; Carlino, Cristina; Guimaraes, Caio; Younes-Ibrahim, Mauricio; Maria Rizo, Lilia; Guzman, Gisselle; Varela, Carlos; Rosa-Diez, Guillermo; Janiques, Diego; Ayala, Roger; Coronel, Galo; Roessler, Eric; Amor, Serena; Osorio, Washington; Rivas, Natalia; Pereira, Benedito; de Azevedo, Caroline; Flores, Adriana; Ubillo, Jose; Rano, Julieta; Yu, Luis; Burdmann, Emmanuel A.; Rodriguez, Luis; Galagarza-Gutierrez, Gianny; Curitomay-Cruz, Jesus
    The Latin American Society of Nephrology and Hypertension conducted a prospective cohort, multinational registry of Latin American patients with kidney impairment associated to COVID-19 infection with the objective to describe the characteristics of acute kidney disease under these circumstances. The study was carried out through open invitation in order to describe the characteristics of the disease in the region. Eight-hundred and seventy patients from 12 countries were included. Median age was 63 years (54-74), most of patients were male (68.4%) and with diverse comorbidities (87.2%). Acute kidney injury (AKI) was hospital-acquired in 64.7% and non-oliguric in 59.9%. Multiorgan dysfunction syndrome (MODS) due to COVID-19 and volume depletion were the main factors contributing to AKI (59.2% and 35.7% respectively). Kidney replacement therapy was started in 46.2%. Non-recovery of renal function was observed in 65.3%. 71.5% of patients were admitted to ICU and 72.2% underwent mechanical ventilation. Proteinuria at admission was present in 62.4% of patients and proteinuria during hospital-stay occurred in 37.5%. Those patients with proteinuria at admission had higher burden of comorbidities, higher baseline sCr, and MODS was severe. On the other hand, patients with de novo proteinuria had lower incidence of comorbidities and near normal sCr at admission, but showed adverse course of disease. COVID-19 MODS was the main cause of AKI in both groups. All-cause mortality of the general population was 57.4%, and it was associated to age, sepsis as cause of AKI, severity of condition at admission, oliguria, mechanical ventilation, non-recovery of renal function, in-hospital complications and hospital stay. In conclusion, our study contributes to a better knowledge of this condition and highlights the relevance of the detection of proteinuria throughout the clinical course.
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    Preload responsiveness-guided fluid removal in mechanically ventilated patients with fluid overload: A comprehensive clinical-physiological study
    (2024) Castro, Ricardo; Born, Pablo; Roessler, Eric; Labra, Christian; McNab, Paul; Bravo, Sebastian; Soto, Dagoberto; Kattan, Eduardo; Hernandez, Glenn; Bakker, Jan
    This study investigated fluid removal strategies for critically ill patients with fluid overload on mechanical ventilation. Traditionally, a negative fluid balance (FB) is aimed for. However, this approach can have drawbacks. Here, we compared a new approach, namely removing fluids until patients become fluid responsive (FR) to the traditional empiric negative balance approach. Twelve patients were placed in each group (n = 24). FR assessment was performed using passive leg raising (PLR). Both groups maintained stable blood pressure and heart function during fluid management. Notably, the FR group weaned from the ventilator significantly faster than negative FB group (both for a spontaneous breathing trial (14 h vs. 36 h, p = 0.031) and extubation (26 h vs. 57 h, p = 0.007); the difference in total ventilator time wasn't statistically significant (49 h vs. 62 h, p = 0.065). Additionally, FR group avoided metabolic problems like secondary alkalosis and potential hypokalemia seen in the negative FB group. FR-guided fluid-removal in fluid overloaded mechanically ventilated patients was a feasible, safe, and maybe superior strategy in facilitating weaning and disconnection from mechanical ventilation than negative FB-driven fluid removal. FR is a safe endpoint for optimizing cardiac function and preventing adverse consequences during fluid removal.