In analyzing standardized mortality ratios (SMRs), it is of interest to calculate a confidence interval for the true SMR. The exact limits of a specific interval can be obtained by means of the Poisson distribution either within an iterative procedure or by one of the tables. The limits can be approximated in using one of various shortcut methods. In this paper, a method is described for calculating the exact limits in a simple and easy way. The method is based on the link between the chi 2 distribution and the Poisson distribution. Only a table of the chi 2 distribution is necessary.

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A retrospective cohort study was carried out in a cardboard factory in Germany to investigate the association between exposure to trichloroethene (TRI) and renal cell cancer. The study group consisted of 169 men who had been exposed to TRI for at least 1 year between 1956 and 1975. The average observation period was 34 years. By the closing day of the study (December 31, 1992) 50 members of the cohort had died, 16 from malignant neoplasms. In 2 out of these 16 cases, kidney cancer was the cause of death, which leads to a standard mortality ratio of 3.28 compared with the local population. Five workers had been diagnosed with kidney cancer: four with renal cell cancers and one with a urothelial cancer of the renal pelvis. The standardized incidence ratio compared with the data of the Danish cancer registry was 7.97 (95% CI: 2.59-18.59). After the end of the observation period, two additional kidney tumors (one renal cell and one urothelial cancer) were diagnosed in the study group. The control group consisted of 190 unexposed workers in the same plant. By the closing day of the study 52 members of this cohort had died, 16 from malignant neoplasms, but none from kidney cancer. No case of kidney cancer was diagnosed in the control group. The direct comparison of the incidence on renal cell cancer shows a statistically significant increased risk in the cohort of exposed workers. Hence, in all types of analysis the incidence of kidney cancer is statistically elevated among workers exposed to TRI.(ABSTRACT TRUNCATED AT 250 WORDS)

A previous cohort-study in a cardboard factory demonstrated that high and prolonged occupational exposure to trichloroethene (C2HCl3) is associated with an increased incidence of renal cell cancer. The present hospital-based case/control study investigates occupational exposure in 58 patients with renal cell cancer with special emphasis on C2HCl3 and the structurally and toxicologically closely related compound tetrachloroethene (C2Cl4). A group of 84 patients from the accident wards of three general hospitals in the same area served as controls. Of the 58 cases, 19 had histories of occupational C2HCl3 exposure for at least 2 years and none had been exposed to C2Cl4; of the 84 controls, 5 had been occupationally exposed to C2HCl3 and 2 to C2Cl4. After adjustment for other risk factors, such as age, obesity, high blood pressure, smoking and chronic intake of diuretics, the study demonstrates an association of renal cell cancer with long-term exposure to C2HCl3 (odds ratio 10.80; 95% CI: 3.36-34.75).

Green and Lash (1999) commented, in a letter to the editor, on our paper reporting an increased incidence of renal cell cancer in workers exposed to high concentrations of trichloroethene over extended periods of time (Vamvakas et al. 1998). Unfortunately, because of irregular handling of the letter by the editorial management of the journal, we were not in a position to follow common practice, that is to respond immediately and in the same issue (see footnote).We do not accept the statement at the outset of Green and Lash's letter that signi®cant methodological¯aws make our results unreliable. Rather, we regard their criticism as unsubstantiated, for following reasons.