Sentinel laboratory surveillance of hepatitis C antibody testing in England: understanding the epidemiology of HCV infection.

This paper describes sentinel laboratory surveillance of hepatitis C antibody testing in England. Demographic and test result data were supplemented by follow-up questionnaires sent to the requesting clinician. Between October 2002 and September 2003 almost 75000 anti-HCV tests were performed in eight sentinel centres. More males were tested than females and over half of those tested were aged 25-44 years. Overall 5.7% (3333/58144, range 2.8-7.7%) individuals tested positive. Follow-up questionnaire data showed that 82% (1043/1277) of the positives had injecting drug use reported as the main risk exposure. The majority of negative individuals were undergoing routine screening as recommended for specific patient groups. Most individuals were asymptomatic. Antibody prevalence was estimated to be 34% in current injecting drug users and 42% in former injectors. Comparing positives to routine national surveillance suggests that only 53% (1782/3333) of diagnosed cases were reported. Sentinel laboratory data can provide valuable supplementary data to national surveillance.

Routine intraoperative angiography. An essential adjunct in vascular surgery.

Intraoperative angiography was performed during a variety of 155 arterial reconstructive procedures including bypass, endarterectomy, embolectomy, thrombectomy, primary reconstruction, and angioplasty. In 27 or 17% of these cases, defects were identified that could be corrected. These included technical errors at the suture line, accumulation of platelet thrombus and atherosclerotic debris, or unrecognized lesions in the runoff. The likelihood of identifying such lesions is greatest in patients undergoing bypass surgery, particularly when the distal anastomosis involves one of the leg arteries. Routine use of intraoperative angiography as an adjunct to vascular surgery is justified and will help to obviate many early graft failures.