In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy.

Introduction: Necrosectomy is the gold standard treatment for infected pancreatic necrosis (IPN). A percutaneous and endoscopic approach has been accepted in selected cases. Endoscopic drainage (ED) of IPN can be performed by using transpapillary or transmural procedures, or a combination of both with or without endoscopic ultrasound. Aims: The aim of this study was to determine the indications, complications, success rate, and the importance of assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography (ERP) in patients with IPN. Methods: Records of all patients who underwent endoscopic necrosectomy from January 2002 to December 2007 at Rio de Janeiro Federal University Hospital were reviewed. A total of 56 patients were included. ED was performed using daily transmural and transpapillary drainage. A diagnostic pancreatogram (ERP) to search for communications between the pancreatic duct and the collection were performed in all cases and in cases where communication existed. A pre-cut needle knife was used to puncture the cyst wall, aspirate the content and then enter at the cyst cavity (contrast was injected to ensure opacification of the cyst and subsequent drainage). Sphincterotomy catheter or balloons were used to enlarge and ensure a wide cystoenterostomy. All patients were followed with computerized tomography scans or ultrasound to ensure clinical resolution. Mean follow-up was 21 months. Results: 49/56 patients could be successfully treated. ED was successful in 49 patients (87%) and in 3 (13%) it failed. Mean follow-up was 21 months. During this period, there were 2 (10.5%) pseudocyst recurrences and only 1 (5.2%) recurrence of new episodes of pancreatic necrosis, and all were managed clinically and/or endoscopically. No mortality was related to the procedure. Conclusion: ED with daily necrosectomy is a useful method to remove infected and sterile pancreatic necrosis.

vera lucia lenz vianna 2 resumo: No conto de James Joyce, "Eveline", da obra Dubliners (1914), desenvolve-se o conflito de uma jovem frente à tomada de uma decisão que lhe pode ditar o destino. Construída predominantemente por fluxo de consciência, a narrativa centra-se no espaço interior da protagonista. A condição de Eveline assemelha-se aos conflitos reais, estudados e diagnosticados pelo sociólogo Anthony Giddens, em sua obra Modernidade e identidade (2002). Aplicando conceitos-chave da obra de Giddens, este trabalho objetivou analisar a protagonista, entendendo sua situação como um exemplo do desafio de como o "projeto reflexivo do eu", a que Giddens chama a constante elaboração da auto-identidade, move, nos indivíduos modernos, sensações de "medo", "ansiedade", "insegurança", "isolamento". Sob esta perspectiva, a relação entre ficção e realidade revela-se ainda mais estreita neste conto, em que o realismo descritivo, característica marcante de Joyce, faz de Eveline uma "quase pessoa". Palavras-chave: Joyce; Modernidade; auto-identidade.Abstract: James Joyce's short story "Eveline", present in his work Dubliners (1914), develops the conflict of a girl facing a decision of her destiny. Structered mainly through stream of consciousness, the narrative centers around the interior space of the protagonist. The condition in which Eveline finds herself resembles real conflicts studied and diagnosed by the sociologist Anthony Giddens in Modernity and Self-Identity (2002). By applying key concepts from Giddens work this essay intended to analyze the protagonist, understanding her situation as an example of the challenge of how the "reflexive project of the self" (the name given by Giddens to the constant elaboration of self-identity) promotes in the modern individuals "fear", "anxiety", "insecurity", "isolation". Under this perspective the relation between fiction and reality reveals itself to be even more closely linked in this short story, in which the descriptive realism, key characteristic of Joyce, makes Eveline almost "like a real person".