Family planning and female sterilization in the United States.

This report critically examines the issue of sterilization in the United States based on data from the National Survey of Family Growth, Cycles I and II, spanning the years 1973 to 1976. Of particular concern is analysis of sterilization rates as they vary across categories of race, socioeconomic status, welfare status, number of children and desire for the service. The development of a framework containing competing theories and philosophies, based upon previous literature in the area, provides a useful paradigm for an understanding of the significance of sterilization rates. The methodology includes bivariate techniques involving tabular analysis as well as multivariate techniques through the use of logistic regression analysis. Findings support hypotheses related to class factors and parity, while the racial and altruistic interpretations are not supported. Policy implications and areas requiring further research are specified.

KIE: The initiation of federal payments for contraceptive sterilizations in the 1970s was accompanied by reports of abuse and charges of racial and class bias. Using data from the National Survey of Family Growth, Cycles I and II (1973-1976), the authors examine rates of female sterilization for contraceptive purposes in the United States, with particular attention to the variables of race, poverty, welfare status, and parity. They conclude that a strong case for discriminatory sterilization exists, with rates determined more by class and welfare status than by race, and that these findings have serious implications for social policy.

Peritoneovenous shunting in the management of malignant ascites.

The incapacitating, malignant ascites of 37 patients were treated with peritoneovenous shunt using the LeVeen valve. Palliation of ascites was achieved in 27 of 37 patients until they died of their underlying diseases. In ten of the 37 patients, no long-term palliation was accomplished. Complications relating to the shunt procedure were noted in six patients. No evidence of abnormal malignant dissemination was noted. We concluded that the peritoneovenous shunt can be used with relative safety to manage progressive malignant ascites.

Adenocarcinoma of the pancreas: a statistical analysis of biliary bypass vs Whipple resection in good risk patients.

A series of 297 patients with adenocarcinoma of the head of the pancreas was reviewed. Forty-eight patients was identified with disease limited to the pancreas or adjacent tissues. Twenty-four patients underwent Whipple resection. A second group of 24 patients underwent elective biliary bypass. No patient had liver, omental or peritoneal metastases. All cases of ampullary carcinoma and islet cell tumors were excluded. Assessment of clinical and laboratory parameters revealed the two groups to be statistically comparable. There were no 5-year survivors in either groups. Mean duration of survival was not significantly different. Life table analysis showed no significant difference between the survival rates of the two groups. Frequency of clinic followup, rehospitalization and reexploration were used to assess palliation. Success of palliation was poor in both groups and no statistically significant differences were noted. Surgical mortality in the resected group was 8% and did not differ from the 4% surgical mortality in the bypass group. Surgical morbidity was significantly higher in the resected group. Implications of this data in the management of patients with resectable carcinoma of the pancreas are discussed.