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Purpose Breast ultrasound has been widely used as an essential examination for diagnosing breast cancer. However, standardized diagnostic criteria are as yet lacking. This study aimed to develop a simple diagnostic flowchart for beginners learning breast ultrasonography. The diagnostic flowchart was developed based on the recall criteria widely used in Japan. Methods We conducted a multicenter study to examine recall criteria usefulness in the diagnostic phase of breast disease. Women with ultrasound-visible breast masses who underwent B-mode breast ultrasound examination were recruited from 22 hospitals in Japan between September 2009 and January 2010. B-mode images were evaluated by members of the centralized image interpretation committee. We developed the new diagnostic flowchart based on the results. The usefulness of the diagnostic flowchart was assessed by employing datasets from the current study and another study which we conducted (BC-04 study). Results We evaluated 1045 solid masses (malignant: 495, benign: 550). Multivariate analysis showed that shape, margin, echogenic halo, interruption of the mammary gland interface, and depth width ratio were significant findings for distinguishing between benign and malignant masses. We modified the recall criteria and developed our novel diagnostic flowchart using these findings. The sensitivity and specificity of the new flowchart (current study: 0.97, 0.45; BC-04 study dataset: 0.95, 0.45) were similar to those of experts (current study: 0.96, 0.54; BC-04 study dataset: 0.98, 0.38). Conclusion We developed a simple diagnostic flowchart for breast ultrasound. This flowchart is anticipated to be applicable to educating beginners learning breast ultrasound.

We prove that a one-dimensional holomorphic foliationswith generic singularities on a complex projective space ℂP m+1, m ≥ 2, exhibiting a Lie group transverse structure in some Zariski open subset, is logarithmic. That is, it is given by a system of m closed rational one-forms with simple poles. The foliation is given by a linear vector field in some affine space ℂ m+1 ⊂ ℂP m+1 if, and only if, it exhibits only one singularity in this affine space. An application to foliations invariant under Lie group transverse actions is given.

Clinical trials conducted in Western countries have shown that aromatase inhibitors are associated with better disease-free survival (DFS) than tamoxifen in postmenopausal early breast cancer. Because pharmacogenetic differences in drug-metabolizing genes may cause ethnic differences, assessment of the efficacy and tolerability of aromatase inhibitors in non-white women is warranted. This open-label, randomized clinical trial included 706 postmenopausal Japanese women with hormone-receptor-positive breast cancer, who had received tamoxifen for 1 to 4 years as adjuvant therapy. This study was closed early after entry of approximately 28% of the initially planned patients. They were randomly assigned to either switch to anastrozole or to continue tamoxifen for total treatment duration of 5 years. Primary endpoints were DFS and adverse events. At a median follow-up of 42 months, the unadjusted hazard ratio was 0.69 (95% confidence interval, 0.42-1.14; P = 0.14) for DFS and 0.54 (95% CI, 0.29-1.02; P = 0.06) for relapse-free survival (RFS), both in favor of anastrozole. The incidence of thromboembolic events in the tamoxifen group and bone fractures in the anastrozole group was not excessively high. Switching from tamoxifen to anastrozole was likely to decrease disease recurrence in postmenopausal Japanese breast cancer patients. Ethnic differences in major adverse events may be attributable to a low baseline risk of these events in Japanese.

Isolated granulomatous inflammation of the appendix is extremely rare, and its etiology is still unknown. Thus, differentiating between idiopathic granulomatous appendicitis and isolated appendiceal Crohn's disease is difficult. We report a case of idiopathic granulomatous appendicitis with long-term follow-up after surgery. A 26-year-old woman was referred to our hospital for investigation of persistent right lower abdominal pain. Abdominal computed tomography showed a mass, suggesting an inflammatory tumor around the appendix; thus, we suspected subacute appendicitis and performed laparoscopically assisted ileocecal resection. Histological examination of the resected specimen revealed several noncaseous epithelioid granulomas in the wall of the appendix, but no foreign bodies, obstructing lesions, or parasites. Stains for acid-fast bacillus and fungi, and serology for yersinia were all negative. The patient has been followed up for 9 years and remains asymptomatic. This clinical course suggests that her isolated granulomatous appendicitis was idiopathic granulomatous appendicitis unrelated to Crohn's disease.

One of the main tools in the study of real foliations of codimension one is the use of transverse sections. Given a codimension one real foliation on a compact manifold there is always a transverse circle and the topology of its embedding into the ambient manifold often has important consequences on the global behavior of the foliation; as in Haefliger’s Theorem and Novikov’s c7ompact leaf theorem for instance.

This report presents an unusual case of an extensive retroperitoneal abscess caused by appendicitis in a child. A 3-year-old boy who presented with right lower abdominal pain and a high fever was found, by abdominal ultrasonography (US) and computed tomography (CT), to have a retroperitoneal abscess. Percutaneous drainage of the abscess under US guidance was successfully performed. There was no sign of recurrence of appendicitis or the abscess 12 months after the drainage.

Chronische lage-rugpijn is een belangrijk socio-economisch probleem in geindustrialiseerde landen. Omdat het ontstaan van lage-rugpijn verband lijkt te houden met onvoldoende kracht van de rompmusculatuur, worden voor veel patienten met lage-rugpijn spierversterkende oefeningen voor de rompspieren voorgeschreven. De rompspieren worden meestal verdeeld in twee hoofdgroepen: de rompflexoren (buikspieren) en de rompextensoren (rugspieren).