[Stabilization of unstable intertrochanteric fractures with the proximal femoral nail]. / Osteosynthese von per- und subtrochantären Femurfrakturen mit dem proximalen Femurnagel.

OBJECTIVE: Restoration of function and anatomy of the proximal femur. Possibility of full weightbearing after surgery. Less invasive intramedullary osteosynthesis. INDICATIONS: Unstable trochanteric fracture (AO classification 31-A2, 31-A3), subtrochanteric fracture (AO classification 32-A1), fracture of the femoral shaft in the proximal region. CONTRAINDICATIONS: Ipsilateral coxarthrosis, open growth plate, hip fracture. SURGICAL TECHNIQUE: Closed or open reduction on the extension table. Intramedullary reaming of the proximal femur, insertion of PFNA and blade as proximal locking screw, static or dynamic distal locking screw. Implantion of bone cement via blade, if necessary. POSTOPERATIVE MANAGEMENT: Weightbearing as limited by pain. Osteoporosis diagnostics and initiation of treatment, if necessary. RESULTS: The stabilization of trochanteric fractures is usually done with PFNA. Compared to other methods, e.g., DHS, fewer complications were observed with the PFNA. Subtrochanteric fractures were associated with higher complication rates compared to intertrochanteric fractures.

Induction of primary NY-ESO-1 immunity: CD8+ T lymphocyte and antibody responses in peptide-vaccinated patients with NY-ESO-1+ cancers.

Cancer-testis antigen NY-ESO-1 is one of the most immunogenic tumor antigens defined to date. Spontaneous humoral and CD8+ T-cell responses to NY-ESO-1 are detected in 40-50% of patients with advanced NY-ESO-1-expressing tumors. A clinical trial was initiated to study the immunological effects of intradermal vaccination with 3 HLA-A2-binding NY-ESO-1 peptides in 12 patients with metastatic NY-ESO-1-expressing cancers. Seven patients were NY-ESO-1 serum antibody negative, and five patients were NY-ESO-1 serum antibody positive at the outset of the study. Primary peptide-specific CD8+ T-cell reactions and delayed-type hypersensitivity responses were generated in four of seven NY-ESO-1 antibody-negative patients. Induction of a specific CD8+ T-cell response to NY-ESO-1 in immunized antibody-negative patients was associated with disease stabilization and objective regression of single metastases. NY-ESO-1 antibody-positive patients did not develop significant changes in baseline NY-ESO-1-specific T-cell reactivity. However, stabilization of disease and regression of individual metastases were observed in three of five immunized patients. These results demonstrate that primary NY-ESO-1-specific CD8+ T-cell responses can be induced by intradermal immunization with NY-ESO-1 peptides, and that immunization with NY-ESO-1 may have the potential to alter the natural course of NY-ESO-1-expressing tumors.