[German S1 Guideline Long-/Post-COVID]. / S1-Leitlinie Long-/Post-COVID.

The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.

Gastrointestinal lymphomas in patients with AIDS.

Non-Hodgkin-lymphoma (NHL)-most frequently high grade B-cell lymphoma-occurs in 5-10% of individuals with HIV-infection. The gastrointestinal tract (GIT) is the most frequent extranodal site of the disease. The optimal therapy for HIV-related lymphoma remains a matter of controversy. In a retrospective analysis we found gastrointestinal lymphoma in ten of 306 HIV-infected patients (3.3%) with a median CD4-count of 92/microliter at time of diagnosis. Median survival for the chemotherapy treatment group was 15 months. The high incidence of gastrointestinal NHL prompted us to commence a prospective survey on diagnostic procedures, therapy and outcome of patients with HIV-infection and gastrointestinal symptoms. 93 of 341 HIV-infected patients with gastrointestinal symptoms were examined by endoscopy. In selected patients we used in addition endoscopic ultrasound (EUS) for visualization and staging before and after chemotherapy. NHL of the GIT was detected in seven of 93 endoscopically examined patients (7.5%). All patients were treated with CHOP initially. Mean survival time was ten months, mean CD4-count at diagnosis 193/microliter (range 0-417). Our results indicate that the diagnosis of gastrointestinal lymphoma should be considered in any HIV-infected patient presenting with unexplained gastrointestinal symptoms. In this group of patients NHL was detected in 7.5% of cases. The use of EUS improves the staging procedure before therapy. Treatment with CHOP resulted in relatively high remission rates and was associated with a low rate of treatment-induced myelosuppression.

Endoscopic ultrasound in the diagnosis and staging of gastrointestinal Kaposi's sarcoma.

BACKGROUND AND STUDY AIMS: Endoscopic ultrasonography (EUS) has been evaluated for diagnosing and staging of a variety of gastrointestinal tumors, but there are no data on EUS in Kaposi's sarcoma (KS). The aim of the present study was to evaluate the role of EUS in addition to endoscopy in the diagnosis and staging of patients with established or suspected upper gastrointestinal KS. PATIENTS AND METHODS: 22 male acquired immune deficiency syndrome (AIDS) patients were prospectively studied, three of them before and after chemotherapy with liposomal doxorubicin. The features of gastrointestinal KS were recorded, and EUS was assessed for diagnosis in endoscopically negative or inconclusive cases, and for staging in endoscopically visible KS lesions. RESULTS: The typical EUS feature of KS was a hypoechoic and nonhomogeneous lesion leading predominantly to mucosal and submucosal thickening, whereas a few lesions presented only with submucosal involvement. EUS detected suspicious lesions in two patients with negative endoscopy, which turned out to be KS on follow-up. Restaging after chemotherapy in three patients showed regression of lesions both on endoscopy and EUS. CONCLUSIONS: EUS may contribute to better detection of early KS lesions and a more reliable delineation of the extent of gastrointestinal KS, which is valuable for assessing the effect of various forms of therapy.

[Diagnosis and therapy of gastrointestinal Kaposi's sarcoma in AIDS]. / Diagnostik und Therapie gastrointestinaler Kaposi-Sarkome bei AIDS.

Gastrointestinal Kaposi's sarcoma (KS) is one of the most frequent neoplastic diseases seen in AIDS. Visceral involvement is associated with shorter survival as compared to cutaneous KS. Our aim was therefore to investigate patients with KS endoscopically. In order to improve the early diagnosis of gastrointestinal KS we also employed endoscopic ultrasonographic examinations (EUS). 22 patients recruited for a prospective trial addressing this issue were examined by endoscopy and by EUS. 21 patients had severe cutaneous KS, one patient had no cutaneous KS but showed signs and symptoms of gastrointestinal KS. 15/22 patients (68%) had gastrointestinal KS. Seven patients (32%) had endoscopically normal mucosa. In 2 patients only EUS showed findings suggestive for KS which had not been seen by endoscopy. Follow-up examinations proved typical KS lesions endoscopically in those 2 patients. Using liposomal encapsulated Doxorubicin within a trial (20 mg/m2 intravenously every 3 weeks), we were able to follow 3 patients prior to and during therapy. EUS showed a significant reduction in number and volume of KS lesions as well as a reduction of infiltration depth. In one patient macroscopic and histologic examinations showed complete remission. We conclude that EUS of the upper gastrointestinal tract can be used as a sensitive method for the detection of early gastrointestinal KS. Furthermore, EUS is a method which allows determination of tumor volume and helps in quantification of tumor response after chemotherapy.