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14). Rather some factors related to place of birth and early residence, perhaps close cohabitation in poor housing with an index patient, seem to promote HTLV-I infection. Improvement in such conditions was a prime reason for migration; indeed in 1897 the first Jamaican account of a tropical spastic paraparesislike syndrome reported that many cases were found among the poor, as was found later.3' 32 In conclusion, our data suggest that place of birth and early residence rather than maternal or age effects are the important factors in HTLV-I infection. No evidence of prolonged seronegative incubation of HTLV-I has been found. We thank the Multiple Sclerosis Society of Great Britain and Northern Ireland for JHR's research fellowship and for supporting this study. JKC received support from the Wellcome Trust. I Yoshida M, Miyoshi I, Hinuma Y. Isolation and characterisation of retrovirus from cell lines of human adult T-cell leukaemia and its implication in the disease.

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Summary. In a prospective randomized study, 36 patients with spontaneous rupture of the membranes of ≥4 h duration were stimulated with 3 mg vaginal prostaglandin E2 pessaries or intravenous oxytocin. Oxytocin stimulation was associated with shorter labours and a lower incidence of abnormal cervimetric progress. Of the patients given prostaglandin pessaries, 40% required a second dose after 4 h for slow progress; 45% of the primigravidae subsequently developed abnormal labour which was corrected by augmentation with oxytocin in all cases. One caesarean section was carried out for disproportion, and the remaining 35 patients were delivered vaginally. Prostaglandin pessaries were not associated with an increased incidence of hyperstimulation or sepsis. In conclusion, although PGE2 pessaries are safe in spontaneous rupture of the membranes, intravenous oxytocin is more efficient in stimulating labour.

The aim of the study was to assess the length of time laparoscopically instilled fluid remains in the peritoneal cavity and to assess its effects on patient discomfort and fluid balance. The setting was a London teaching hospital, and randomized controlled design was used. A total of 24 women undergoing laparoscopic surgery were randomized, one group (n = 12) received 1 l of normal saline instilled into the pouch of Douglas at the end of surgery, and the other (n = 12) acted as controls. A vacuum drain was left clamped at the end of surgery and was released after 2, 4, 8, or 16 h to determine the rate of fluid absorption. Overall fluid balance and analgesic requirements were assessed along with the subjective symptoms of thirst and pain. All of the fluid was absorbed after approximately 16 h. The control group passed significantly less urine (P = 0.046) despite having a similar fluid intake. The experimental group required significantly less intramuscular analgesia (P = 0.040) and required shorter hospitalization (P = 0.029) than the control group. Differences in thirst and pain scores did not reach statistical significance. Intraperitoneal fluid appears to decrease postoperative discomfort and can act as a source of postoperative rehydration.