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This study aimed to identify gender differences in the impact of performance status (PS) 1, that is, of physically mild impairment, on psychological distress and coping in ambulatory cancer patients. The subjects were 260 male and 242 female cancer outpatients who participated in a structured interview and completed the Profile of Mood States and the Mental Adjustment to Cancer scale. Multivariate analyses controlling for confounding biomedical and psychosocial variables revealed a significant impact of PS 1 on helplessness/hopelessness and a trend toward an impact on fighting spirit in women alone, whereas a trend was observed in regard to psychological distress in both genders. The results of this study suggest that PS 1 may be a risk factor for negative ways of coping in female, but not male, cancer outpatients.

This study was undertaken to visualize the subepidermal nerve networks immunohistochemically. Specimens were obtained from the normal skin of the back, abdomen and nose of seven adult male Hartley guinea pigs, and immersed in 1 M NaCl solution. Dermal sheets were obtained by separating the dermis and epidermis, followed by fixation in Zamboni's fixative. The dermal sheets were sectioned parallel to the separated surface. Using the immunoperoxidase technique and immunofluorescence, the sections were immunostained with primary antibodies to S 100 protein (S100), protein gene product 9.5 (PGP 9.5), neuron-specific enolase (NSE), substance P (SP) and calcitonin gene-related peptide (CGRP). In double-labeled immunofluorescence of PGP 9.5 and SP or CGRP, the sections were viewed under a confocal laser scanning microscope. In skin of the back and abdomen, networks of S100-, PGP 9.5- and NSE-positive fibers were observed, some of which showed a multicentric arrangement. The outermost structures were formed by the thickest fibers which were 5-10 micro m thick, the outer networks consisted of fibers 3-6 micro m thick, and the inner networks consisted of fibers 1-3 micro m thick. From these networks, single fibers approximately 0.5 micro m thick branched out and terminated in free endings. The SP- and the CGRP-positive substances appeared as granules on the PGP 9.5-positive fibers. These results confirm that the dermis has a three-layered sensory nerve plexus, i.e. deep, superficial and subepidermal. In the skin of the nose, however, nerve networks were made up of only thick fibers which were probably situated in the subpapillary dermis.

Although pruritus is the cardinal symptom of atopic dermatitis, its mechanism is not well understood. Free nerve endings in the skin are involved in pruritus as itching receptors. We studied the cutaneous nerve fibres in lichenified lesions of 16 patients with adult atopic dermatitis. On immunohistochemistry, fibres immunoreactive for neurofilament, neuron-specific enolase, and protein gene product 9.5 were observed in the papillary dermis and dermoepidermal junctions as well as in the epidermis. In these areas, no fibres stained positively for substance P, neuropeptide Y, vasoactive intestinal peptide, beta endorphin, somatostatin or serotonin. On electron microscopy, the ultrastructure of subepidermal and intraepidermal free nerve endings appeared to be essentially normal. However, the distribution density of the cutaneous nerve fibres was much higher than in normal controls, and the diameter of these fibres was much larger, because of the large number of axons in each nerve fibre. Degranulation of mast cells was not seen. These findings suggest that pruritus in lichenified atopic skin is probably not caused by damage to the cutaneous free nerve endings. In such lesions, the number of the cutaneous free nerve endings is greatly increased, but they may have a normal function.

We studied three cases of genital lichen sclerosus et atrophicus (LSA) using histological, immunohistochemical and ultrastructural techniques to elucidate the characteristics of the collagen fibres, the elastic fibres and the interfilamentous matrix in the upper dermal homogeneous zone. In the early stages of LSA, the homogeneous zone caused elaunin fibres to push downwards and partially disappear, the collagen fibres were presumably phagocytosed by fibroblasts, and there were peculiar cells containing numerous vacuoles in the cytoplasm. In the advanced stages of LSA, the homogeneous zones showed newly formed collagen fibres and amorphous, dispersed, medium electron-dense substances that were probably composed of elastin or elastin-like substances and microfilaments originating from the collagen fibres. Immunohistochemically, there were numerous anti-aortic alpha-elastin-positive substances, but there was no positivity for anti-amyloid P component. These findings suggest that in advanced LSA a hybrid substance (elastocollagenous mass) between collagen fibres and elastic fibres may be formed in the homogeneous zone.

To elucidate the regeneration of cutaneous nerves in human skin, biopsy specimens were taken from the regenerated skin of extremities of five adult men with third degree burns that had occurred about 3 weeks previously. Numerous subepidermal nerves could be detected in the newly formed granulation tissue, independent of the blood vessels. These nerves were axon-Schwann's cell complexes. Some axons were packed with small clear vesicles 40-60 nm in diameter or large dense-cored vesicles 70-100 nm in diameter and large dense bodies. Schwann's cell components showed a relatively abundant cytoplasm and many microfilaments. Intraepidermal nerves were frequently encountered in the interspace between the basal lamina and the cytomembrane of basal keratinocytes in most cases or in the intercellular spaces between basal keratinocytes; however, they were never seen in and beyond spinous layers. They were seen as axon-Schwann's cell complexes or naked axons. In one case a Schwann's cell containing axons migrated into the epidermis. These findings suggest that cutaneous nerves may show hyperregeneration in very early stages of wound healing.