A 70-year-old man had annular erythema on the area extending from the right scapular region to the right axillary region, where he got tick bites on June 20, 1991. The erythema occurred soon after the bites and spread gradually to become as large as 20 square cm within 25 days. He also felt fatigue. An electrocardiogram revealed an atrioventiricular nodal block. We treated the patient with amoxycillin (750 mg daily) for 35 days. He has been now free from any symptoms over one year. Although repeated serological tests could not detect an antibody to Borrelia burgdorferi, typical erythema chronicum migrans and cardiac manifestation strongly suggested that the case could be diagnosed as Lyme disease.

Age and gender differences in ADL ability were investigated using 568 Japanese partially dependent older people (PD, Mean age=82.2 ±7.76 years) living in welfare institutions. The subjects were asked about 17 ADL items representing 7 ADL domains by the professional staff working at subjects’ institutions. Each item was assessed by a dichotomous scale of “possible” or “impossible”. Item proportions of “possible” response were calculated for gender and age groups (60s, 70s, 80s and 90s). Two-way analysis of variance (ANOVA) using the arcsine transformation method indicated no gender differences. Significant decreases in ADL ability with aging were found in 13 of the 17 items. The dependency of ADL in the PD significantly increases with aging, and there is no significant difference in this trend between men and women. The dependency of more difficult activities using lower limb increase from the 70s, and independency of low-difficult activities such as manual activities, feeding and changing posture while lying is maintained until the 80s and over.
Activities of Daily Living ; Ability ; Gender ; PUPILLARY DISTANCE ; age differences

A study was conducted to examine sex differences in subjective symptoms of fatigue in men and women with reference to the experience of awareness and cognitive appraisal based on symptom of fatigue content. A total of 54 questionnaire items were administered to 730 people (290 men and 440 women) . The subjects indicated whether or not they were aware of the content, and to what degree the content of the question for each item was important. Sex differences in the response to the ratio of awareness and the degree of importance were then. The mean importance scores for subjective symptoms of fatigue in men and women were 3.9-5.4 and 4.5-5.6, respectively. It was found that a majority of the men and women showed awareness of each item. A significant difference was recognized in the factor of awareness in all items as a result of two-way ANOVA of the degree of importance by which the presence of awareness and its sex difference were assumed to be factors, and those who were aware deemed the degree of importance high. On the other hand, the 28 items for which a significant sex difference was recognized showed a high value, and there was a marked content of Languor, Loss of Vigor, and A Feeling of Impatience and Physical Disintegration in women. In the same items, it was inferred that persons who were more aware than the persons who were not aware regarded subjective symptoms of fatigue as important. Most items in which a main effect of sex was recognized were content of Loss of Vigor and a Feeling of Impatience and Physical Disintegration. It was thought that women considered these symptoms more important than men. The sex difference in symptoms of fatigue was inferred to be due to the difference in the level of acknowledgment based on experienced knowledge.

The purpose of this study was to examine sex differences in subjective symptoms of fatigue (SSF) in high school and college students by considering the relationship between subjective feeling of fatigue and life habits.
A questionnaire on SSF (54 items), dealing with subjective feeling of fatigue and life habits (frequency of exercise, going to sleep, waking in the morning and physical condition) was administered to 5622 healthy students aged 15-20 yr, and data of 5335 properly completed questionnaires was analyzed.
The following was determined :
1) Sex differences were confirmed in most SSF items. SSF complaints for females was generally higher than that of males.
2) The relationship between SSF and the age was low in both sexes.
3) Subjective feeling of fatigue is somewhat related to SSF.
4) The going to sleep last night influence on SSF was different in both sexes and related largely to the next day SSF in males.
5) Waking this morning and today's physical condition are related to SSF in both sexes.
6) In males, the influence of exercise habits on SSF regarding drowsiness is relatively large.

The purposes of this study were to examine reliability and validity of ADL index for older people at home, and relationships between ADL score and various factors (ex. self-assessment of health status and physical fitness level, and exercise frequency/week), and to examine the screening basis for execution of physical fitness test based on distribution of ADL score. A questionnaire consisting of 12 ADL items and a physical fitness test of Ministry of Education, Science and Clture were administered to 5, 715 subjects 65 years or more age (male: 2, 745; female: 2, 970) . As a result of examining test-retest reliability of the ADL index, significant high correlations were shown among 12 ADL items (0.674≤r≤0.886), and in overall score (r=0.943) . The ADL score was significantly related to age and physical fitness test scores, and tended to be higher in subjects with a higher self-assessment of health status and physical fitness level, and with more frequency. It was suggested that these results prove the utility of the present ADL index. Further, as the result of examining relationships between distribution of overall ADL score and physical fitness test scores, the following screening bases were considered to be valid for judgement whether the physical fitness tests could be executed. The three screening bases using overall ADL score were: 1) 12 or under; 2) over 13 to under 24; 3) 24 and over. The four bases using item score were: 1) a category 1 response for items 1, 5 and 6; 2) a category 2 or 3 response for items 1, 5 and 6, and a category 1 response for items 3 and 4; 3) a category 3 response for items 2 and 14; 4) a category 1 response for items 10 and 12.

The purpose of this study was to propose useful ADLs (activities of daily living) and scales to estimate ADL ability on community older people from the viewpoints of aging, physical fitness level, and interrelationship among ADL. The survey constructing of 15 ADL items and physical fitness test of Ministry of Education, Science and Culture were carried out on 458 older people. Each ADL item was constructed with 3 level scales.
As the results of this study, the following 12 ADLs were proposed as useful ADL items; in the locomotion domain, jumping across a ditch, walking, running, up and down stairs, and transfer; in the manipulation domain, taking bedding in and out, buttoning a shirt; in stability domain, standing in the bus or train, dressing while standing (trousers), standing on one foot with eyes open; in the posture-change domain, sitting up, standing up from the floor. These items were significantly related to age and physical fitness elements contributed largely to achievement of each ADL. Since significant high correlation was found between the index using 12 ADL items and that using 15 items, it is considered that the 12 items scale can account for the variance corresponded enough to that of 15 items scale, and that the new index is practical and simple.
In further research, it will be required to examine validity of each ADL item and index by using more large sample, and to clarify the relation to various factors influenced to ADL ability level.

We reported nine cases of metastatic skin carcinoma experienced at the Department of Dermatology, Obihiro Kosei Hospital during the period from April 1991 to March 1993. Lung was the most common primary lesion (four out of nine cases), followed by uterus (two) and stomach, breast, and kidney (one each). The clinical features of the metastases were classified into nodular (five cases), inflammatory (one case) and sclerotic (three cases) types. Peculiar zoster-like inflammation was seen in metastatic gastric cancer. Pathologically, adenocarcinoma was more common than squamous cell carcinoma. The average interval between the diagnosis of the primary cancers and the development of the skin metastases was about 30±25 months. The average life span after the detection of the skin metastases was 6.8±5.6 months. Poor prognosis of skin metastasis was thus reconfirmed.