PAULO SAVOIA DIAS DA SILVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina
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- Ultrasonographic evaluation of cecal appendix diameter in pediatric population(2022) QUEIROZ, Marcos Roberto Gomes de; FRANCISCO NETO, Miguel Jose; RAHAL JUNIOR, Antonio; JABOUR, Victor Arantes; ANDRADE, Guilherme Neves Lourenco; SILVA, Paulo Savoia Dias da; GARCIA, Rodrigo Gobbo; PEREIRA, Marcelo dos Santos; SANTOS, Marina Ramos; LUNA, Pedro Andrade Alencar; SAMESHIMA, Yoshino Tamaki; GUAL, Fabiana; DUTRA, Marcelo Guimaraes; GERMINO, Beatriz Placca; ALVES, Isabella FerreiraObjective: To stratify ultrasound samples in a pediatric population undergoing evaluation for acute appendicitis to examine the variability in cecal appendix diameter, in different age groups, and to determine whether there is a prevalent value for each age group. Methods: A retrospective cross- sectional study with 196 children aged 0 to 15 years. Data were extracted from reports of ultrasound examinations carried out between 2008 and 2015. Children with sonographic diagnosis of appendicitis or other signs of periappendiceal inflammation were excluded. Results: The evaluation of the anteroposterior measurement of the cecal appendix revealed a mean diameter of 4.14mm (standard deviation: 0.93mm; 95%CI: 3.86-4.14). Cecal appendix diameter did not differ significant between age groups. Conclusion: Evaluation of the anteroposterior diameter of the cecal appendix in centimeters in a sample of 196 children aged 0 to15 years revealed a mean diameter of 4.14mm (standard deviation, 0.93mm. There were no significant differences in cecal appendix diameter following stratification by age. Results indicate a single value can be adopted for mean cecal appendix diameter in pediatric populations.
bookPart Aplicação da ultrassonografia nos pacientes em choque circulatório protocolos de atendimento e algoritmo de manejo dos pacientes(2016) BARROS, Dalton de Souza; SILVA, Paulo Savoia Dias da; FRANCISCO NETO, Miguel Jose- Postmortem chest computed tomography in COVID-19: A minimally invasive autopsy method(2024) SAVOIA, Paulo; SAWAMURA, Marcio Valente Yamada; MONTEIRO, Renata Aparecida de Almeida; DUARTE-NETO, Amaro Nunes; MARTIN, Maria da Graca Morais; DOLHNIKOFF, Marisa; MAUAD, Thais; SALDIVA, Paulo Hilario Nascimento; LEITE, Claudia da Costa; SILVA, Luiz Fernando Ferraz da; CARDOSO, Ellison FernandoObjectives: Performing autopsies in a pandemic scenario is challenging, as the need to understand pathophysiology must be balanced with the contamination risk. A minimally invasive autopsy might be a solution. We present a model that combines radiology and pathology to evaluate postmortem CT lung findings and their correlation with histopathology. Methods: Twenty-nine patients with fatal COVID-19 underwent postmortem chest CT, and multiple lung tissue samples were collected. The chest CT scans were analyzed and quantified according to lung involvement in five categories: normal, ground-glass opacities, crazy-paving, small consolidations, and large or lobar consolidations. The lung tissue samples were examined and quantified in three categories: normal lung, exudative diffuse alveolar damage (DAD), and fibroproliferative DAD. A linear index was used to estimate the global severity of involvement by CT and histopathological analysis. Results: There was a positive correlation between patient mean CT and histopathological severity score indexesPearson correlation coefficient (R) = 0.66 (p = 0.0078). When analyzing the mean lung involvement percentage of each finding, positive correlations were found between the normal lung percentage between postmortem CT and histopathology (R=0.65, p = 0.0082), as well as between ground -glass opacities in postmortem CT and normal lungs in histopathology (R=0.65, p = 0.0086), but negative correlations were observed between groundglass opacities extension and exudative diffuse alveolar damage in histological slides (R=-0.68, p = 0.005). Additionally, it was found is a trend toward a decrease in the percentage of normal lung tissue on the histological slides as the percentage of consolidations in postmortem CT scans increased (R =-0.51, p = 0.055). The analysis of the other correlations between the percentage of each finding did not show any significant correlation or correlation trends (p >= 0.10). Conclusions: A minimally invasive autopsy is valid. As the severity of involvement is increased in CT, more advanced disease is seen on histopathology. However, we cannot state that one specific radiological category represents a specific pathological correspondent. Ground -glass opacities, in the postmortem stage, must be interpreted with caution, as expiratory lungs may overestimate disease.
- Postmortem Chest Computed Tomography in Fatal COVID-19: A Valuable Diagnostic Tool for Minimally Invasive Autopsy(2021) SILVA, Paulo Savoia Dias da; SAWAMURA, Marcio Valente Yamada; MONTEIRO, Renata Aparecida de Almeida; DUARTE-NETO, Amaro Nunes; MARTIN, Maria da Graca Morais; DOLHNIKOFF, Marisa; MAUAD, Thais; SALDIVA, Paulo Hilario Nascimento; LEITE, Claudia Costa; SILVA, Luiz Fernando Ferraz da; CARDOSO, Ellison Fernando
- Lung ultrasound: an additional tool in COVID-19(2020) OLIVEIRA, Rodrigo Ribeiro de; RODRIGUES, Thiago Potrich; SILVA, Paulo Savoia Dias da; GOMES, Andrea Cavalanti; CHAMMAS, Maria CristinaAbstract Lung ultrasound is a well-defined diagnostic modality in the point of care emergency medicine concept. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the lung ultrasound assumed an essential role in this disease, with a valid correlation of the imaging results with computed tomography. Recognize how the diagnostic possibilities of ultrasound in the approach of COVID-19 and its differential diagnoses are fundamental.
- Point-of-care lung ultrasound imaging in pediatric COVID-19(2020) GIORNO, Eliana P. C.; PAULIS, Milena De; SAMESHIMA, Yoshino T.; WEERDENBURG, Kirstin; SAVOIA, Paulo; NANBU, Danilo Y.; COUTO, Thomaz B.; SA, Fernanda V. M.; FARHAT, Sylvia C. L.; CARVALHO, Werther B.; PRETO-ZAMPERLINI, Marcela; SCHVARTSMAN, ClaudioBackground: There has been limited data regarding the usefulness of lung ultrasound (US) in children with COVID-19. Objective: To describe lung US imaging findings and aeration score of 34 children with COVID-19. Methods: This study included 0-16-year-old patients with confirmed COVID-19, who were admitted between April 19 and June 18, 2020 in two hospitals in the city of Sao Paulo, Brazil. Lung US was performed as part of the routine evaluation by a skilled Pediatric Emergency physician. Clinical and laboratory data were collected and severity classifications were done according to an available clinical definition. The lung US findings were described for each lung field and a validated ultrasound lung aeration score was calculated. Data obtained was correlated with clinical information and other imaging modalities available for each case. Results: Thirty-four confirmed COVID-19 patients had a lung US performed during this period. Eighteen (18/34) had abnormalities on the lung US, but eight of them (8/18) had a normal chest radiograph. Ultrasound lung aeration score medians for severe/critical, moderate, and mild disease were 17.5 (2-30), 4 (range 0-14), 0 (range 0-15), respectively (p=0.001). Twelve patients (12/34) also had a chest computed tomography (CT) performed; both the findings and topography of lung compromise on the CT were consistent with the information obtained by lung US. Conclusion: Point-of-care lung US may have a key role in assessing lung injury in children with COVID-19.
bookPart Tomografia computadorizada de tórax normal(2017) GUERRINI, Ricardo; SHOJI, Hamilton; SILVA, Paulo Savoia Dias dabookPart Paracentese no paciente grave(2016) MAURANO, Alexandre; SILVA, Paulo Savoia Dias da; FRANCISCO NETO, Miguel Jose- Focused assessment with sonography for trauma (FAST)(2023) SAVOIA, Paulo; JAYANTHI, Shri; CHAMMAS, MariaThe main cause of death in traumas is hypovolemic shock. Physical examination is limited to detect hemopericardium, hemoperitoneum, and hemopneumothorax. Computed tomography (CT) is the gold standard for traumatic injury evaluation. However, CT is not always available, is more expensive, and there are transportation issues, especially in hemodynamically unstable patients. In this scenario, a rapid, reproducible, portable, and noninvasive method such as ultrasound emerged, directed for detecting hemopericardium, hemoperitoneum, and hemopneumothorax, in a ""point of care"" modality, known as the focused assessment with sonography for trauma (FAST) protocol. With decades of experience, spread worldwide, and recommended by the most prestigious trauma care guidelines, FAST is a bedside ultrasound to be performed when accessing circulation issues of trauma patients. It is indicated to hemodynamically unstable patients with blunt abdominal trauma, with penetrating trauma of the thoracoabdominal transition (where there is doubt of penetrating the abdominal cavity) and for any patient with the cause of the instability unknown. There are four regions to be examined in the traditional FAST protocol: pericardium (to detect cardiac tamponade), right upper abdominal quadrant, left upper abdominal quadrant, and pelvis (to detect hemoperitoneum). The called extended FAST (e-FAST) protocol also searches the pleural spaces for hemothorax and pneumothorax. It is important to know the false positives and false negatives of the protocol, as well as its limitations. FAST/e-FAST protocol is designed to provide a simple ""yes or no"" answer regarding the presence of bleeding. It is not intended to quantify the bleeding nor evaluate organ lesions due to its limited accuracy for these purposes. Moreover, the amount of bleeding and/or the identification of organ lesions will not change patient's management: Hemodynamically unstable patients with positive FAST must go to the operating room without delay. CT should be considered for hemodynamically stable patients.