Recomendaciones para el manejo de las crisis hipertensivas: documento de consenso de la Sociedad Chilena de Hipertensión Arterial / Recommendations for the management of hypertensive crisis: a consensus document of the chilean society of hypertension

The management of severe hypertension in the emergency setting demands a careful evaluation of the different underlying clinical situations, and of the impending risk for the life of the patient or of acute organ damage. Hypertensive emergencies and urgencies have to be identified, and distinguished from chronic severe hypertension, a frequent presentation to the emergency services. A thorough clinical evaluation, and not the magnitude of the blood pressure elevation, should be the basis of the differential diagnosis; this will guide the setting required for treatment (intensive care unit, ward or ambulatory), the drugs of choice, as well as the velocity of blood pressure reduction. Special emphasis has to be given to the management of cerebrovascular accidents and severe preeclampsia, as the reduction of blood pressure entails a risk of hypoperfusion of critical territories as the brain and fetus respectively. A wide range of drugs permits a tailored treatment of a variety of clinical situations. Efforts have to be made to detect and manage chronic hypertensive patients in order to reduce the consultation load represented by severe hypertensives in emergency services, by preventing hypertensive crisis, in order to focalize on real situations of risk

Linfoma primario cerebral post trasplante renal: comunicación de un caso y revisión de la literatura / Primary brain lymphoma post renal transplantation: report of a case and literature review

We report a 30 years old male, presenting eight years after a kidney transplant with intracraneal hypertension and two hyperdense masses detected in a brain CAT scan, whose histopathological study revealed a giant cell immnunoblastic lymphoma. The patient was successfully treated with chemo and radiotherapy and after 18 months of follow up there is no evidence of tumoral relapse. Immunocompromised patients specially transplant recipients, had a several fold higher incidence of malignant tumors, specially primary lymphomas of the central nervous system. These are generally of B type, are associated to Epstein Barr virus and have a high mortality. Cancer must be considered in the differential diagnosis of masses of uncertain origin in transplant recipients

Celiprolol en hipertensión arterial: estudio multicéntrico / Celiprolol in arterial hipertension: a multicenter study

Celiprolol, un Beta-Bloqueador cardioselectivo con acción agonista parcial y vasodilatadora directa vascular, fue ensayado como hipotensor en 109 pacientes con PA diastólica supina entre 95 y 120 mmHg y ausencia de complicaciones renales, cardíacas y cerebrovasculares. Se usó placebo en la fase de admisión de 2 semanas y celiprolol en dosis crecientes quincenales de 200, 400 y 600 mg una vez al día, según respuesta terapéutica, buscando normalización de la PAD (*90 mmHg); 35 eran hombres y 76 mujeres, edad promedio 59 ñ 12 años. Se observó que con 200 mg, 53% de los casos normalizó la PA, con 400 mg la cifra aumentó a 78% y con 600 mg a 89%. Doce pacientes no lo lograron y fueron cambiados a otro esquema terapéutico. Hubo relación directa dosis-efecto antihipertensivo y dosis-efectos adversos. En total, un 26% sufrió algún tipo de efecto adverso, cualquiera fuese la dosis, y los más frecuentes fueron: cefalea (13%), mareo (14%), sudoración (4,6%), calambres (5,5%) y fatigabilidad (5,5%). No hubo cambios farmacológicos ni órgano-viscerales deletéreos. Hubo que suspender el fármaco sólo en 2 pacientes. Se concluye que celiprolol es un antihipertensivo eficaz, con efectos adversos clínicos poco frecuentes y tolerables sin efectos adversos farmacológicos, por lo que aparece como un beta Bloqueador muy útil en el armamentario antihipertensivo