[Complicated pregnancy with lithiasis and resectable gallbladder cancer. A case report and literature review]. / Embarazo con litiasis y cáncer vesicular resecable. Comunicación de un caso clínico y revisión bibliográfica.

Pregnancy complicated with gallbladder disease stone has an incidence of 2-14%, and more than 30% of patients do not respond to medical treatment; therefore, in order to reduce the morbidity and mortality in fetus and mother, surgical management would be required. The current use of ultrasound of high resolution has facilitated the diagnosis and also, in the present clinical case, this imaging modality allowed us to suspect the unusual diagnosis reported, that corresponds to a female of 34 years old with 33 weeks of pregnancy, complicated with symptomatic gallbladder disease stone, whose pain was intractable at the expectant management. The clinical diagnosis was corroborated by ultrasound and the report was: lithiasis, biliary sludge and an intragallbladder image of bilobular polypoid. The patient was submitted to cholecystectomy by laparotomy, whose histopathologic findings were: cholelithiasis and in situ gallbladder adenocarcinoma with an exophytic growing variety. The purposes of this article are to report a case and to review the literature.

[Cesarean section: current management of postoperative acute pain. Continuous and intermittent epidural analgesia with and without elastomeric infusion device]. / Cesárea: manejo contemporáneo del dolor agudo postoperatorio. Analgesia epidural continua e intermitente con y sin infusor elastomérico.

OBJECTIVE: To compare the analgesia quality obtained in the management of the acute pain in 50 puerperae post-cesarean section using one of the two therapeutic modalities. The results were evaluated using descriptive and inferential statistics. MATERIAL AND METHOD: Controlled, systematized a clinical trial, carried out from January to June of 2001. REGIMES AND RESULTS: A) Continuous epidural analgesia. With fentanyl citrate plus bupivacaine using a low flow elastomerics infuser (Single day Baxter infuser) 85% referred mild pain in rest or activity; 3% or less in analogic scale visual (VAS) in the first 24 hours of postoperative. B) Intermittent epidural analgesia. With bupivacaine plus intravenous Ketorolaco; 59% of the cases referred mild pain, 32% moderate pain and 9% severe. CONCLUSION: Management of acute pain postcesarean section should be priority with continuous epidural analgesia using the infuser and concentrations of drugs referred in order to minimize the incidence and magnitude of acute postoperative pain.