Cervical cytologic smear false negative fraction. Reduction in a small community hospital.

OBJECTIVE: To determine the false negative fraction (FNF) at a small community hospital and its relation to the discovery of a significant error. STUDY DESIGN: All cervical cytologic smears (6,889) initially interpreted over a one-year period (1992) as "normal" or "near normal" were retrospectively rescreened and interpreted by outside institutions, without knowledge of the initial interpretation, to calculate yearly and quarterly FNFs. RESULTS: The overall FNF for 1992 was 12.3% and was 19.1%, 22.2%, 3.8% and 6.1% per successive quarters in 1992. A significant error was discovered at the start of the third quarter that subsequently received both local and national media attention. CONCLUSION: This study gives further proof that the FNF can be reduced to < 5% by motivated cytotechnologist/ pathologist teams, although it may not be possible to maintain this low an FNF.

Replication of hepatitis B virus in adult carriers in an endemic area.

We have examined serological markers of replicative and nonreplicative infection in 124 adult, black South African carriers of hepatitis B virus (HBV), in whom this infection is predominantly acquired in early childhood. The mean age of the group was 36 years. Antibody to hepatitis B e antigen (anti-HBe) was present in the serum of 93.5% of these carriers. Only 25.8% of the carriers were positive for HBV DNA in serum, and in the majority of these only trace amounts were detectable. IgM antibody to hepatitis B core antigen (IgM anti-HBc) was negative in 54% of the carriers, and only 26% had IgM anti-HBc in high titer. A significantly greater proportion of carriers who were positive for anti-HBe were positive for IgM anti-HBc (43.1%) than were positive for HBV DNA (24.5%). Serum aminotransferases were less than twofold elevated in 90.3% of the carriers. Only one carrier has thus far developed hepatocellular carcinoma. These results suggest that there is an inexorable progression to predominantly nonreplicative infection in the majority of southern African adult, black carriers, an occurrence that may take several decades. In areas endemic for HBV infection, antiviral agents effective against replicative HBV will have to be administered in childhood.

Hepatitis B virus carrier state in black children in Ovamboland: role of perinatal and horizontal infection.

Hepatitis B surface antigen (HBsAg) was detected in 17% of adult males and 11% of mothers in Ovamboland , South West Africa/Namibia. Hepatitis B e antigen (HBeAg) was present in 15% of HBsAg-positive mothers. Only 1% of children less than 6 months of age were HBsAg-positive, compared with 13% of children over the age of 1 year. 27% of mothers who were HBsAg-positive had HBsAg-positive children, whereas the corresponding figure for mothers who were HBsAg-negative was 6%. 63% of mothers who were positive for both HBsAg and HBeAg had HBsAg-positive children. 37% of HBsAg-positive children had HBsAg-positive mothers, compared with 8% of HBsAg-negative children. Later "horizontal" rather than neonatal maternal-infant transmission of the hepatitis B virus (HBV) seems to be the more important mode of spread of this infection in Ovambo children. The difference in the pattern of transmission of this virus between the Far East and Africa seems to centre mainly on the differences in the HBeAg status of the mothers in these two regions.