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IY to rsus adequa- C Overall s (61-44 note, in. arcinome, arory diaoxcess for uPMted te figures r staUstidoss :,rosof death lust-level law chat would infier 6ret of able t t ,use m eadty is miologicardnohiaL cooto be c. Indiail, and mmcnts in this PC-CX4" epnsure p01JlC m pro- levels . which mmurv poi poswn in would . . . re rr df IIN7lC ,,I pure uu rling ,xcJ fret ~1 I Cv TI III i.nxcer, Afnxcu 4, 1978 4119 ,bp, :,hcrnmivc mixlclrmight reduce or increase this range by y I.,cux' al' perhaps 2 (2}-StK or Ith211%), but the data on wlooh w base such refinements will not be available in the !on'x'cid61clLtnrt . 7,'1'n accept that linear Ja:w+maMm:x models arc appmnrjulc . Ut least l'urcunccr, but to defer r decision until our esumatey am m:um precise: and unulugwa studio have hen conJuacd in usher environments, It may not always be possible to assign meaningful individual expusucm, but average ezposire of the Sears Shown in fig. 4 could 6c estimated in many funnrin.'fhc incidence of bronchial carcinoma and mL7othc linmu roust 6c studied in environments With different fibre sizes belare such prcdittiuna can be gcrttulixd . It should be ,mphuriscd that such studies will nut all'ord much information an the effect of very law doscs.'Iheir only value ix to give rods pmJcm estimates of the slope of the fuse-ngponse curve in otherindustrial actdnga. The epidemiological evidence shat pleural mesotlu liuma can be caused by chrywtlle alone is supported by one observation that chryaotile is quickly eliminated from the lung parenchyma but remains in the pleura, while amphiboles are present in very much lower conccmrauons in the pleura chore in the lung." This may be because amphiboles are more penetrant end less liable to dissolution, and having left the lung are mare widely distributed elsewhere but less likely to remain in the picots. The reported excesses of peritonea! mesotheliuma and other non-respiratory cancers in crocidolitc workers, 14 neither of which occurred in our cohort,"' appear to support this interpretation. The persistence of Some chrysuulc in the pleura but very much less in the lung perhaps reflects diffiarendal dissolution in hex sites. Electron-microscope studies of the peritoneum and other organs are urgently required to confirm or refuse that speculations . Total fibre counts of both air and postmortem tissue samples, in conjunction wish morta- lity data, would greatly increase the value of comparative studies oColher working environments . 1 should like to drank To . and Newell and T.D .A . Industrial Pmducu fur their rnlloborotion in the mllmtiun of these do,., and various collagua, particularly Sir Richard Doll, far criticism rear. Her drafts. The views e :prearcd in (his paper are mine alone, however. REFERENCES i . Hanoi 0xcroini o ..i xr,ivii, Saint, e .. .. ..r. Hy. ivsx . v . 47 . x. Iknri U. in Nblo~pcd LQmn of AtMam; o. 111. Inlemaimd Aloe, to, RexwchonGnar,Lyon,1973 . 7 . (iwnp, N . 5., Ilue4 13. G . [endq. C. H .,1'ew, N. Cwmr N .+, 1Y76, 76, 1971 . 1 . Pent, 7 . in I :nrlroomemJ FIu4h: Qu .numivc MnhWi IW itd b, A . Whirv iemare) . Sooty for [National and Applied MaiMmaia, PAilaOClpnio, 1977. V.K . JiHriWtan: licYdan and St, . . uJ., Spnnwm It . ., r11JV1ooe]ncea .Lonmo Mva 7xt. ~. I!mcrlinc, P., dc Caulk. P., Ilendertun, 0. Rr .7, ind. .NeJ. 197). 70, 163. a \klbnaW. L 1L,14dluY<, N, R, .C,iMx,ti . W.NCIamuW, d.O. .Hu,uner, lL1i .Arcksvn[irJ1f~~.197i.36,A1 . 7.1erJmm, II ., f .ilia, R ., tikti4olR 1 . J. Shnn-gem usht., nqnnrc mN Jd6yN van~sr mk . lkeumed m 7N intnnmimed tiymannium on Do.' ixm urW pn~mim nl'Cvnc<r . New Ywk,197h . ~- Knot, E . u .11,1 . inJ. .11eJ .1471, 30, H. 4 ,IFFk1i.R'.,I :ahantt,Jl . :lrthrrmar.llleh.1473,38,n4 111. Felt, 1..N.. Il .wqlJ,l., i:flll[11, 1 .. I., I.Lwinmhll, 11 . C. llr . ]. m.l . %W. 1477.34,149. I1 . Ann' I'If., I Ialn ..1 . .IMAI.N..IIi11 .I.I1JhiJ. Iw~N,u,.191 . L.I1~N.H.7~H.iw~uw.Yua.A .ri11,131,U7 . Il . 4vwlwuK i .vawluuu M.1_ Nm r " t'eNr. J.i~J.~nrJ.147 477. 1~7. M. L rn Irwln A rir,f .u n.eon .~. . . :a~. . en01w11 . .w Agenkcy Wf NRYKXnMi1.0"a.I. YnM1973 . 1~. NAnr<U, V., Sans . J-GAm~huw, M.7'hnnu,lvTJ7, 777, In . MATx~nIJ,I .11 Pnw~ul[ummw~wYlxn~ . V. hnemWxnol ApeiqY lire NatY<h .m Ca . ddmu.u. I.d .H .IL Mmw~ ynpiv ~m We l :ruluu6m nflAra~wqemouurH ih Cbeaiw'ulx in Mug. ~d . II . i,in, 1477. Ix . 1 . ILx~llenq I.., r.. .u~ue. ..1 INUYkc, . w76, ti &.,arMMi.a:m.i.12,1).. l:,'I'i,Gwp, 4. . NnrnunuL lL N.m. Questionable Routines CRITICAL EVALUATION OF ADENOIDECTOMY J. Itmeexi 1'. M. Sraw. Department of Oro-KAina-furyngolngy, pirivcnity n/ Liverpool and 7:nr. Nose, ond fLruaf Infirmary, liverpual 7.779F Summary In two munched groups of thirty-two children, one which bud tonsillectomy alone and the other which hid tonsillectomy plus alcnoidcctamy, the symptoms generally attributed to adenoidal hyperumphy were equally common in both groups before operation and improved with equal Gc- qurncy after operation whether or not the adenoids were removed . INTRODUCTION TEMPORARY improvement in symptoms after adenutonsillectomy may be due to an operation cachet than the operation;' the effirots of udcnutonsilkewmy should thus be Compared with chose of another operation, to exclude the placebo effect . We have compared the improvement in the symptoms of adenoidal hypertrophy in two groups or patients, only one of which had an uJcnuideclomy . PATIENTS AND METHODS Thirty-two children listed fur adenoideemmy and tonsillec- tomy tin the waiting-list of the Uvcrpnol liar, Nose, and Throat Floepiml were matched fur age and sex with thiny"two children listed fur tonsillectomy alone (table t). 'Phi parents were interviewed and asked about the symp- toms attributed to adenoidal disease (nasal obstruction, snor- ing, rhinnnhu^a, speech problems, cough, and headache I and the chiWrcn were examined for corresponding signs-imanh Urcathing and abnormalities on umcrior rhinuxupy.' .1t tic time of examination the summer did nut know what op7- miun tLo chiWnn wcn". m have . The children were then spouted nn and reassessed six weeks later, ogress without, the examiner knowing what operation thev hurl hurl . The number of positive scurca far each symptom and sign in each group was analysed gency table. The proportion o6fyehail~A.'retnestw,hwoitihmpvro2vexd8 continin each group (x) was calculated and a mudilird arc em transformation dune tin the proportion (y'=oasis (s/n+l)l*umin ix "l/(n+l)1 ~.'[7s transformed proportions were [hen com- paredby a rtes! tiff paired dais. RESULTS In the two groups, there was an significant difference in the number of children who showed signs and symptoma of adenoidal hypertrophy before operation MILK 1-1-ATIENTS . ' 1'.nnillcn.nny uA ." nao4aonw I ' .. . . . . _ `. ~. . . ... 1es No. Age ~;love .\ge r:vyT' j P E w n . n IIN.. o t 1,1 hoot . M I 111 Yf :l Ilht I l ~ In in ,~.~ n m 1 4 ni. . `r p~ I 111 \'r i free .