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We show here how to contract the ITCPN state space. We distinguish three levels of contraction that translate the ITCPN state space into one well timed and coherent timed automation. We consider here only equivalence based on delays. To achieve more contractions, the equivalence based on delays can be completed with equivalence based on colours as shown in [4]. [Copyright &y& Elsevier]

Laparoscopic treatment of small intestinal obstruction is associated with immediate advantages and it may be expected that the recurrence rate will be decreased because of the reduction of wound scars. Between September 1989 and October 1994, 30 patients (19 men and 11 women), mean age 54.4 years, underwent initial laparoscopy for acute small intestinal obstruction. These patients had undergone a total of 52 (1.6 per patient) laparotomies, 15 years before, on average. One patient had never been operated on, 15 had one previous laparotomy, seven had two, five had three, and two had four previous laparotomies. Laparoscopic treatment of intestinal obstruction was possible in 10 cases, including three cases of bands, and six instances of adhesion and one small bowel strangulation in a trocar hole from a previous laparoscopy. In 20 cases, laparoscopy had to be completed by laparotomy, 17 immediately and three secondarily. The cause of immediate failure was the impossibility of finding and/or treating the cause of the obstruction in 11 instances, and there were four cases of intestinal injuries, one case of intestinal necrosis which required resection, and one case of missed right colonic carcinoma. The causes of secondary failure were incomplete liberation of adhesions, secondary volvulus, and missed left colonic carcinoma in one case each. Mean hospital stay and postoperative ileus were significantly shorter in the laparoscopy group than in the laparoscopy + laparotomy group (P < 0.001). Three complications, with one death, were noted in the laparoscopy + laparotomy group. Thus, laparoscopic treatment of intestinal obstruction seems possible but in less than half of cases. Failures are related to the difficulty with which the abdomen may be explored. Laparoscopic treatment should not be pursued in cases with problems. When successful, the immediate postoperative course is simpler. Its role in the prevention of recurrences is difficult to assess because of the unavailability of patients for long-term follow-up.

The first case of Thermomyces lanuginosus endocarditis occurring on a porcine heterograft prosthesis, secondary to a Staphylococcus aureus infection of the aortic valve, is reported. The diagnosis was made post-mortem by direct examination of the prosthesis and culture of surgical samples on Sabouraud's agar. Identification was based on the presence of warty, dark brown aleurioconidia. The route of contamination could not be established but the most likely cause was the air of the operating room or the insertion of a contaminated graft.

The penetration of ciprofloxacin into bronchial secretions was evaluated in 21 patients after a single oral dose of 500 mg of ciprofloxacin. Ten successive serum samples were collected in the interval 0–12 h after administration, and bronchial samples were taken 2, 3, 4 and 6 h after administration. Concentrations were measured in all samples using a standard microbiological assay. The results showed that the kinetics in serum did not differ from those determined in previous studies, a peak level of 2.2±1.3 mg/l being achieved at 2 h followed by a slow decrease of the levels to 0.6±0.4 mg/l at 6 h. The bronchial concentrations reached about 0.5 mg/l at 2 h and remained stable until 6 h, ranging between 0.5 and 0.8 mg/l. The ratio between simultaneous bronchial and serum levels ranged from 0.19 at 2 h to 0.95 at 6 h. These data indicate that ciprofloxacin might be suitable for treatment of severe respiratory infections, especially pneumonia caused byPseudomonas aeruginosa, since the MICs of ciprofloxacin for most bacteria involved in bronchopulmonary infections are very low and tissue diffusion of the drug in the respiratory tract is good.

Summary Ampicillin concentrations in serum and bronchial secretions after oral administration of bacampicillin were evaluated. Twenty-eight hospitalized patients with acute bronchopulmonary infections received a single dose of 800 mg of bacampicillin. Samples of bronchial secretions were obtained during diagnostic bronchoscopy and blood samples were drawn simultaneously. Significant concentrations of ampicillin were found in bronchial secretions, the peak level, reached after approximately two hours, being 0.27 µg/ml on an average. The penetration of ampicillin into the bronchial secretions after the administration of bacampicillin could be correlated with the degree of bronchial inflammation, as illustrated either by macroscopic purulence or protein concentration in the secretions. The results suggest that bacampicillin is a useful drug in acute bronchopulmonary infections.

The first case of Thermomyces lanuginosus endocarditis occurring on a porcine heterograft prosthesis, secondary to a Staphylococcus aureus infection of the aortic valve, is reported. The diagnosis was made post-mortem by direct examination of the prosthesis and culture of surgical samples on Sabouraud's agar. Identification was based on the presence of warty, dark brown aleurioconidia. The route of contamination could not be established but the most likely cause was the air of the operating room or the insertion of a contaminated graft.

Forty-seven nosocomial cases of legionellosis due to Legionella pneumophila serogroup 1 were diagnosed in one major outbreak from November 1982 to March 1983 in a 960-bed teaching hospital. Contaminated water was considered to be a possible source of infection because, during that period, monthly samples were found to be positive with averages of 104 CFU/1. After chlorination of hot water associated with flushing of outlets, nearly all samples taken in the next two years were found to be negative. A case-control study was performed to examine potential risk factors. Three groups of controls were randomly selected among eligible patients: In a multivariate analysis, only three clinical factors were found to be associated with legionellosis patients: malignant illness (relative risk, RR = 3.5), presence of an ultimately fatal disease (RR = 2.6), and exposure to corticosteroids prior to admission (RR = 7.9). Investigations of in-hospital exposures suggest that during this nosocomial outbreak diagnostic or therapeutic respiratory procedures had not increased the risk of illness. Although the epidemiological association between water contamination and disease remains unclear, the eradication of L. pneumophila from the identified supply seems to have been effective in preventing disease in this hospital.