The accessory navicular (AN) is an accessory ossicle anatomically located on the medial side of the foot, proximal to the navicular and continuous with the tibialis posterior tendon. It is occasionally a source of pain and local tenderness. Knowledge of the AN and its morphological variations can help identify the source of a patient's symptoms and prevent misinterpreting them as fractures. Foot radiographs from 1,240 patients who presented in two centers with chronic foot pain, or persistent pain developed after trauma, were retrospectively reviewed to determine the incidence and variations of the AN in relation to gender. The AN was found in 20.9% (259/1240). Among 259 feet with AN, Type 1 was identified in 25.4% (66/259), Type 2 in 42.4% (110/259) (20.0% (52/259) Type 2 A and 22.4% (58/259) Type 2B), and Type 3 in 32.0% (83/259). After 13 patients with incomplete medical records had been excluded, the remaining records showed that foot pain was associated with an AN in 10.6% of patients (26/246). In 1.2% of cases, two additional ossicles were found proximal to the navicular, possibly the result of multiple ossification centers that did not unite at the time of development. Patient symptomatology was related to the presence of an AN in 2% of patients with chronic foot pain. The AN could vary morphologically. Our data can enhance our diagnostic skills in detecting these ossicles. Clin. Anat. 30:436-444, 2017. © 2017 Wiley Periodicals, Inc.

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Background Skin prick test (SPT) is the most common diagnostic procedure that is performed considering the history of aeroallergen sensitivity among patients. Moreover, it is important to identify the diagnostic and therapeutic benefits of allergen’s number in skin prick testing in both adults and children. Objective The present study aims to detect the minimum number of allergens used in SPT to identify 95% of sensitized patients in both pediatric and adult age groups in Jordan. Patients and Methods Retrospective analysis of a 20 allergen extracts SPT results for 2253 patients (aged 8 and above) was conducted to assess the minimum number of allergen extracts needed to identify 95% of the sensitized patients in both adults and children. Results The results showed that 50.9% of the pediatric group was sensitized to at least one aeroallergen extract in comparison to 48.3% of the adult group. Only 8 allergen extracts were necessary to identify 95% of the sensitized patients which are olive pollen, Dermatophagoides pteronyssinus , Salsola kali, 4 cereals, Wall pellitory, Dermatophagoides farinae , Cypress and mugwort. Same number was needed in children but with the replacement of mugwort with alternaria to achieve a similar result. Conclusion The study concluded that only 8 allergen extracts were needed for detecting 95% of sensitized patients (both pediatrics and adults) in SPT. The authors proposed a two-stage screening: stage 1 includes the minimum number of allergen extracts to detect 95% of sensitized patients and stage 2 for the patients who tested negative in stage 1 which will include a broader allergen extracts panel excluding those which were already tested in stage 1.

Sickle cell disease is one of the most common inherited hemoglobinopathies diagnosed in the United States. Patients often present with severe anemia, pain crises, infections, and vaso-occlusive phenomena. Complications of these disorders can lead to significant debilitating morbidity and mortality. Fat embolism syndrome (FES) is a rare and devastating complication of sickle cell disease. It usually presents with a rapidly deteriorating clinical course, and the prognosis is dismal. We report a case of FES in a 19-year-old African American male with a history of sickle cell disease who presented with tonic-clonic seizures and was found to have multi-organ failure. FES was diagnosed 20 days from a presentation based on blood cytopenias and magnetic resonance imaging findings that were obscured at the initial presentation. We describe in this report, the patient's course from presentation until diagnosis and resolution. Our case is peculiar as the patient had a very good outcome without the need for red blood cell (RBC) exchange; instead, supportive treatment and simple RBC transfusions were enough to change the clinical course of this almost fatal syndrome.

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