Duplication of the appendix is a rare congenital anomaly that, in adults, is most often found incidentally during surgery for other reasons. Appendicitis in the duplicated appendix is very rare and has been reported less than 10 times in the medical literature. We describe a 33-year-old woman with worsening periumbilical pain, nausea, vomiting, and fever. Physical examination showed localized peritonitis in the right lower quadrant. She had an elevated white blood cell count with neutrophilia. Computed tomography showed acute ruptured appendicitis. Diagnostic laparoscopy showed 2 appendices attached via separate bases to a single cecum with no other concurrent anomalies. Both appendices were removed laparoscopically. Histopathology confirmed normal appendiceal tissue in one and severe acute transmural appendicitis in the other. Awareness of appendiceal duplication and a thorough intraoperative inspection are critical to assess the presence of significant associated anomalies and avoid life-threatening complications.
HLA typing was done on 2,956 healthy, unrelated individuals living in four areas in Bulgaria. Of these, 163 had G6PD deficiency. The persons examined lived in villages situated at different altitudes. A low degree of correlation was found only for HLA‐Al, ‐Aw23, ‐Bw35 and ‐B40 in the selected group with G6PD deficiency. The decrease of phenotype frequency of each HLA antigen was found to be directly proportional to the decrease of G6PD deficiency frequencies and related to environmental altitude, which is very typical for this selected group of carriers of this deficiency.
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