62 5°C the holder pasteurisation time of 30 minutes seems unnecessary. We were not concerned about less thermolabile organisms, since they tend to be of unlikely pathogenicity or spore-forming. Mycobacteria are not common pathogens in human milk. We intend to investigate whether a shorter heating time will conserve a higher proportion of immunologically active substances in milk. MedicalJ7ournal, 1979MedicalJ7ournal, , 2, 1322MedicalJ7ournal, -1324 Summary and conclusions The surface areas of 23 artificial ulcers in a rubber manikin and of 35 ulcers in 35 consecutive patients admitted for endoscopy of the upper gastrointestinal tract were estimated by six endoscopists. Of the 138 estimations made in the manikin 80% underestimated the true size of the ulcer: the mean ( ± SD) was -29±40%. The largest and the smallest estimate of the same ulcer by different endoscopists varied on average by a factor of 4 5±3-8, and the estimates by the same endoscopists of ulcers with the same size varied by a factor of 2 3±0 6. In the patients the scatter of the estimates was even larger, the mean factor being 7 8±6 3. Changes in ulcer size are therefore an unsuitable criterion for assessing ulcer healing. Even if consecutive examinations are performed by the same endoscopist, changes in ulcer area smaller than by a factor of 3 are not discernible. IntroductionIn many controlled clinical trials of treatment for peptic lesions changes in the size of an ulcer have been used as an index of ulcer healing.'-7 We decided to test the reliability of the determination of ulcer size by fibreoptic endoscopy.

The addition of 2 diazo dyes Evans blue (EB) and Congo red (CR) to human platelet-rieh plasma caused platelet aggregation at final concentrations of 6.5 • 10 -4 mmole/ml and 1.35 • 10 3 mmole/ml respectively. After dilution of the platelet-ricb plasma with isotonic saline lower dye concentrations were necessary to cause aggregation.With gel filtrated platelets suspended in protein-free medium aggregation was induced with minute quantities of the dyes.Addition of bovine serum albumin markedly reduced the aggregating effect of the 2 substances. During slow i.v.infusion of the dyes into gulnea-pigs platelet aggregates appeared in the blood and total platelet counts decreased.From the experimental results and the dye concentrations obtained when the two reagents are used in man, safety factors could be calculated. It was concluded that single i.v. injections of EB for the determination of blood volume is a safe procedure. The i.v. administration of CR in amyloidosis, however, represents a considerable hazard, particularly in hypalhnminemic patients.

During treatment with doxycycline capsules three patients (aged 24, 34, and 39 years, respectively) developed acute oesophageal ulcers with dysphagia as the cardinal symptoms. They became symptom-free and the ulcers healed promptly on symptomatic treatment. In-vitro experiments in rats indicated that doxycycline accumulates within the erythrocyte membrane and epithelial cells of the oesophagus. This accumulation is followed by cell destruction. It is assumed that doxycycline capsules remain within the oesophageal lumen and release doxycycline, causing epithelial destruction. This will occur more often after dry swallows of the capsules before going to bed.

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