Levamisole (150 mg once weekly) was compared with penicillamine (250 mg daily) in a single blind independent observer study in 28 patients with rheumatoid arthritis over twelve months. Fifty percent (8/16) of patients stopped levamisole, five within three months of starting, while only two of twelve stopped penicillamine. In those patients able to tolerate treatment for twelve months, both regimens produced a significant and comparable reduction in disease activity, with the onset of action of penicillamine occurring at three months compared with six to nine months for levamisole. Radiological progression of disease occurred in both groups. Levamisole in low dose may improve parameters of disease activity in rheumatoid arthritis but poor patient tolerance, slow onset of action and failure to prevent radiological progression limit its usefulness.

Luxatio erecta or inferior dislocation of the shoulder joint is rare and is caused by a hyperabduction injury. The clinical appearance is characteristic, with the arm locked in an elevated position. Radiographically, the shaft of the humerus is directed upwards and the humeral head lies inferior to the glenoid fossa, although not in contact with it. Attention should be given to possible complication, particularly concurrent fractures, as well as injury to the brachial plexus or the axillary artery.

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Ethanol connumption had been shown t o r e s u l t i n an increase in hepatocyte s i z e which is due t o ap increase i n i n t r a c e l l u l r r water (Orrego et al mechanism by which this could occur is by an effect on the membrane bound encyme Na+, K+-ATPaae. The purpose of the present study WM t o investigate t h e possible d i r e c t e f f e c t s of ethanol and its m a i n metabolite acetaldehyde on the a c t i v i t y of t h i s enzyme and other pl-a membrane bound enzymes, Mg++ ATPase and FNucleot i h e (5-Nt). libllowing the in vitro addition of e t h m o l or acetaldehyde, enzyme a c t i v i t i e s were meamred spectrophotolaetricdly from the releese of inorganic phosphate from ATF'or AMP i n isolated rat hepatocyte plagra membranes. No significant inhibition of Na+, K+-ATPMe a c t i v i t y by ethanol WM seen over a concentration range of 8 mmol/L t o 100 mol/L (50 mg% t o 500 a&). b a n bMal a c t i v i t y , following 8 m o l / L and 100 m o l / L ethanol were: 23'9+SD 2.7. 2).2+SD 2.5, 22.6+sD 3.2 umol Pi& protdn/h'; reupectively. Lack of inhibition of enzyme a c t i v i t y with acetaldehyde over a range of 10 umolh t o 3 mol/L was also found. A c t i v i t i w of Mg++ ATPaae and 5-Nt were also unaffected by both ethanol and acetaldehyde at these concentration ranges. However, at higher concentrations, a generalised non-competitive inhibition of these enzyme8 W M found: inhibits: Na+, K+-ATpase 19% (pCOo.O1), Ug++ ATPM~ 15% (N.S.), 5-Nucleotidase 3.2% (N.S.). Alcohol (494.6 mol/L): 64%. %% and 13% respectively (p