Periodontal inflammation is associated with morphological changes in the blood vessels which may influence the regulation of gingival blood flow (GBF). Our aim was to adapt the heat provocation test to the human gingiva to assess vascular reactivity in periodontal inflammation. Method: GBF was recorded by Laser Doppler Flowmetry before and after heat provocation in healthy volunteers (n = 50). Heat was generated either by warm saline or a halogen lamp. The latter method was also utilized for a heat test in non-smoking and smoking patients with periodontal inflammation. The circulatory parameters were correlated to the inflammatory marker, i.e. gingival crevicular fluid (GCF) production measured by Periotron. Results: Local application of heat caused a rapid, significant and transient increase in GBF regardless of the method used. The increase in the speed and not in the concentration of moving blood cells was responsible for increased GBF. Higher GCF values were correlated with increased peak flow, flux pulse amplitude and faster restoration of GBF after the test in non-smokers, but not in smokers. Conclusions: The heat test could be a valuable tool to check the vascular reactivity of gingival vessels. Moderate periodontal inflammation may facilitate gingival vascular responsiveness which can be suppressed by smoking.

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hold contacts received ciprofloxacin prophylaxis. Predischarge levAbdominal Pain and Fever -An Unusual Presentation of els of terminal complements (C5-C9) were determined, and proMeningococcemia perdin assay was performed; all findings were supranormal.A 34-year-old housewife with a medical history of mild-toIt is rare, although not unheard of, for meningococcal disease to moderate hypertension was admitted to the hospital with a 48-present with focal extraneurological manifestations. Peritonitis caused hour history of fever, nausea, vomiting, and right upper quadrant by Neisseria meningitidis without any signs of either meningitis or abdominal pain extending into the lower right chest. At the time meningococcemia has been reported [1,2], and a case of pelvic of admission, she looked ill, with an oral temperature of 103.9ЊF, inflammatory disease associated with N. meningitidis bacteremia and apical heart rate of 135, blood pressure of 190/124 mm Hg, and Fitz-Hugh-Curtis syndrome has also been reported [3].respiratory rate of 20. No skin rash was noted, and the neck was We describe two patients with N. meningitidis bacteremia who supple. Cardiovascular examination was notable for tachycardia. presented with severe abdominal pain and fever but without menin-The chest was clear during auscultation, and no splinting was geal signs, hypotension, or cutaneous manifestations of meningonoted. Abdominal examination revealed severe right upper quadcoccemia.rant tenderness on palpation but no organomegaly, rebound, or A 37-year-old previously healthy male roofer presented to the guarding. Bowel sounds were present. hospital with a 7-hour history of severe right upper quadrant abThe peripheral WBC count was 8,100 1 10 9 /L with 87% neutrodominal pain radiating to his shoulders that was associated with phils. Levels of serum electrolytes and a urinalysis were normal, an abrupt onset of fever, chills, and nausea. He had not vomited and a pregnancy test was negative. A chest roentgenogram, plain but had had two loose bowel movements in the 12 hours preceding abdominal films, and abdominal ultrasonogram obtained at admisthe onset of fever. At the time of admission, the rectal temperature sion were also normal. Levofloxacin (500 mg iv daily) and metrowas 103.5ЊF, apical heart rate was 107, and blood pressure was nidazole (250 mg iv every 6 hours) were administered for treatment 156/56 mm Hg. No rash was noted, and the neck was supple.of presumed intraabdominal infection. Cardiovascular examination was unremarkable. Breath sounds The patient's condition improved dramatically over the followwere noted to be somewhat decreased at the right lung base, but ing 12 hours with near-complete resolution of the abdominal pain results of the lung examination were otherwise normal. Abdominal and defervescence. Cultures of two sets of blood specimens obexamination was remarkable for severe epigastric and right upper tained at admission yielded b-lactamase-negative N. meningitidis. quadrant tenderness with a positive Murphy's sign and localize...