[Treatment with statins and angiotensin-converting enzyme inhibitors in degenerative aortic stenosis--an up-date]. / Tratamentul cu statine si inhibitori ai enzimei de conversie in stenoza aortica degenerativa--up to date.

UNLABELLED: Degenerative aortic stenosis (AoS) is the most common valvular disease in adults; that's why, the aortic valve replacement is one of the most frequent cardiac surgical procedures. The etiology of degenerative AoS is actually well known, the primary lesion being aortic sclerosis. Aortic sclerosis shares many pathological features and risk factors with atherosclerosis and, because atherosclerosis may be prevented and/or reversed by cholesterol lowering, there has been postulated that cholesterol lowering therapy using statin drugs could modify the course of aortic sclerosis/stenosis. Some studies also demonstrated the implication of renin-angiotensin-aldosterone system in the degenerative aortic disease, and the use of angiotensin-converting enzyme inhibitors could also be used to delayed or even reverse the evolution of Ao sclerosis/stenosis. The paper reviews the latest literature date about the definition and prevalence of aortic sclerosis and stenosis as well as medical treatment of degenerative AoS. CONCLUSIONS: Treatment with statins has not proved effective in preventing the progression of lesions valves but have an important role in patients with associated coronary artery disease. Angiotensin converting enzyme inhibitors does not influence the progression of lesions valves, but may play a role in cardiac remodeling.

[Gastric stromal tumor. Case report]. / Tumora gastrica stromala. Prezentare de caz.

UNLABELLED: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastro intestinal tract and express the c-kit proto-oncogene protein (CD-117). We report herein a case of a 58 years old male with upper abdominal pain and anaemia. Preoperative endoscopic and barium meal exams showed a submucosal tumor in the gastric fornix. Endoscopic biopsy revealed spindle-shaped cells with elongated nuclei specific of GIST. We performed a stapled resection of the gastric fornix associated with Hiss angle reconstruction. Postoperative histologic exam revealed the same spindle-shape cells characteristic of GIST with 2-5 mitosis/50HPF. Almost all of the cells showed immunoreactivity for c-kit, CD-34 and a Ki-67 labeling index of 30%. Postoperative course was non eventful and after 3 month the patient has no recurrence. CONCLUSIONS: GIST are rare gastric tumors and are usually associated with bleeding and abdominal pain. The preoperative diagnosis is usually established by endoscopy with biopsy or endoscopic ultrasonography fine needle aspiration and barium meal exam. Only immunoreactivity is able to differentiate GIST from other mesenchymal tumors. Surgical resection is a safe and effective treatment. The chemotherapy with tyrosine kinases competitive inhibitors (e.g. imatinib mesylate) is also recommended.