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Mean segmental transit time of radiopaque markers through the right colon, left colon and rectosigmoid areas of adults and children has been calculated form their distribution on consecutive plain films of the abdomen. Overall mean transit does not differ significantly in the large bowel between adults and children. However, there are regional differences within the colon in relation to age. Mean transit time in the right colon is 13.8 hours in adults and 7.7 in children (p less than 0.01). Corresponding values in the left colon are 14.1 and 8.7 hours (p less than 0.02) and, in the rectum, 11 and 12.4 hours (p = NS). The percentage of the mean total large bowel transit time spent in the right colon, left colon and rectosigmoid area are respectively for adults and children 33 +/- 4 and 28 +/- 3 per cent (p = NS); 39 +/- 4 and 32 +/- 4 per cent (p = NS); and 28 +/- 4 and 41 +/- 4 per cent (p less than 0.05), indicating a relative stagnation in the rectosigmoid area of children. These physiologic differences may have implications in diseased states.

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There was no evidence to suggest that those with pre-surgical psychological difficulties did more poorly with VBG. These data call into question screening out individuals with psychological problems from gastroplasty surgery. Furthermore, psychological difficulties, if they exist, appear more related to the nature of morbid obesity than to the character of the individual. Psychological difficulties pre-surgery were normalized following surgery.

One hundred and seven patients whose gallbladder was normal at the time of vertical banded gastroplasty (VBG) were considered for entry into a randomized placebo-controlled double-blind study to determine the effectiveness of ursodeoxycholic acid (UDCA) in preventing cholelithiasis during the period of weight loss. Twenty-one patients (20%) developed gallstones in the six-week period post-VBG and prior to randomization and were therefore excluded. Eighty-six patients were randomized at 6 weeks to active medication or placebo. Of these, 61 patients (71 %) completed the study. Twenty-five patients (29%) failed to complete the study because of incompliance, intolerance to the medication or pregnancy; 17 of these were in the active treatment group and eight were in the placebo group. None of the 27 patients treated with UDCA developed gallstones, whereas eight of 34 (24%) patients taking placebo developed gallstones. This difference was statistically significant (p = 0.0061). These results suggest that UDCA is fully effective in preventing gallstone formation following VBG in patients who follow the prescribed regimen.

OBJECTIVE: To develop a reliable and valid measure of distress, related to extreme obesity. DESIGN: Items related to distress over obesity were selected from the literature, clinical experience and from input provided by a gastroplasty patient support group. The items were assessed in a longitudinal study, with the body mass index (BMI) and psychological assessment occurring 2 ± 6 months prior to, and 12 months following, gastroplasty surgery. SUBJECTS: 81 females and eight males (mean age 35.9 y) who had been accepted for gastroplasty surgery. All but two of the patients had BMIs b 40 (Mean 48.11, s.d. 6.84). MEASUREMENTS: BMIs were calculated using weight and height. Psychological characteristics were assessed using the Mental Health Inventory (MHI), the Sickness Impact Pro®le (SIP), and the Eating Inventory (EI). Demographic information was collected with a questionnaire. RESULTS: Attempts to factor analyse the 95 item questionnaire were unsuccessful. Alternatively, a shorter, 20 item questionnaire was developed. The questionnaire shows good test-retest reliability (r 0.867), good internal consistency (coef®cient alpha 0.719) , good face and construct validity, and is sensitive to pre-post surgical change. CONCLUSIONS: The Obesity Adjustment Survey (OAS) may be useful as a brief measure of distress in obese individuals. This measure can be used to index the psychological impact of gastroplasty surgery on psychological functioning, and can be used in future research as a disease-speci®c measure to predict success of surgery.

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