Case presentation: Concomitant avulsion fracture of the posterior calcaneal tubercle and rupture of the Achilles tendon. / Presentación de caso: fractura avulsión del tubérculo posterior de calcáneo con rotura de tendón de Aquiles en un tiempo.

The Achilles tendon acts by transmitting the force created by the contraction of the sural triceps to the calcaneus. This allows the elevation during the gait cycle. A sudden contraction in elderly patients may generate avulsion fracture of the posterior tubercle of the calcaneus due to poor bone quality or rupture of the tendon, with one of these two structures yielding in most cases. We report the case of a 72-year-old woman who suffered a low energy right heel trauma while stepping off the bus. She was diagnosed an avulsion fracture of the posterior tubercle of the calcaneus. When performing ORIF procedure of the fracture, an associated rupture of the Achilles tendon is diagnosed. Both pathologies are treated in the same surgical act. We recommend using a second imaging study along with the x-ray in order to anticipate associated injuries and adequate surgical planning in elderly patients.

Effect of Anapsos (Polypodium leucotomos extract) on in vitro production of cytokines.

AIMS: The aim of the study was to test the immunomodulating capacity of Anapsos, Polypodium leucotomos extract, in vitro in an attempt to explore how this extract acts from an immunological point of view and thus to identify a common link capable of explaining most of its effects. METHODS: Polypodium leucotomos rhizomes were harvested in Guatemala and the extract, Anapsos, obtained. Mononuclear cells were obtained by density gradient centrifugation from healthy donors, and stimulated with phytohemagglutinin or Pokeweed with and without Anapsos and with Anapsos alone. Cell proliferation was determined by thymidine incorporation. Cells were also stimulated and the following cytokines determined by ELISA at 0, 12, 24, 48, 72, and 96 h: IL-1 beta, TNF-alpha, IL-2, INF-8, IL-4 and IL-10. RESULTS: Anapsos, Polypodium leucotomos extract, has a modulating effect on the in vitro production and release of cytokines by peripheral blood mononuclear cells of healthy subjects. At doses effective in vivo, Anapsos can stimulate PBMNc proliferation, delay IL-1 beta secretion and at the same time increase that of IL-2, IL-10, and INF-gamma. CONCLUSIONS: Anapsos may have an antagonistic effect on some of the cytokines released on cell stimulation with LPS and/or PHA, which suggests that this product has a pleiotropic effect on different populations in the immune system.