Gallstone ileus in the Jordanian Royal Medical Services in a 10-year period.

Six patients (5 women and 1 man, with a median age of 71 years) were operated on for gallstone ileus in the 10-year period 1988-98. The diagnosis was made before operation in 2 patients. The obstructing stones were located in the terminal ileum in 3 patients and in the proximal ileum or jejunum in 3 patients. Choledochoduodenal fistula was present in all patients. A single-stage procedure (removal of the impacted stone, fistula repair and cholecystectomy) was performed in 1 patient, enterolithotomy alone in 4 patients and resection of part of the intestine where the stone was impacted with primary anastomosis performed in 1 patient. In the postoperative period, 2 patients developed infection of the wound and 2 patients developed deep vein thrombosis; 1 of these died of pulmonary embolism.

Different subtypes of pseudohypoparathyroidism in the same family with an unusual psychiatric presentation of the index case.

A 13 year old Asian girl presenting with apparent hysterical paralysis and subsequent rapid cycling bipolar mood disorder was found to have biochemical evidence of pseudohypoparathyroidism type II. The mood disorder responded to treatment of the pseudohypoparathyroidism with a vitamin D analogue. Investigation of her parents and siblings showed phenotypes consistent with two distinct types of pseudohypoparathyroidism (type I and type II) in different family members.