Why she decides this is not clear, as we do not have any reference for whether Madeline will be going home yet. At this point, Miss Clavel decides that it is a good idea to bring 11 young children into a hospital to visit our convalescent heroine. From this we can surmise that Madeline’s medical care was top tier, although again the modern reader might be surprised to note that her stay in the hospital was a full ten days. She wakes up two hours after being taken away from the old house covered in ivy to flowers at her bedside table, in a single room with a view of a park. Madeline’s hospital experience seems to have been a positive one, and her surgery is incredibly quick. Thus, it is important to pause at this point and acknowledge that an attack of appendicitis in pre-1939 Paris would have been of more concern that it is today, with modern medicine at our disposal. I caution the critical reader not to apply modern sensibilities to a book written over 80 years ago. He calls an ambulance and heads outside, Madeline in his arms and the rest of the children and Miss Clavel all in tears. The doctor is summoned, and he diagnoses our intrepid heroine with appendicitis (yet another way yours truly is like Madeline and therefore a heroine). Upon checking on the children, it is clear that Madeline is in medical distress. By signing up you agree to our terms of use Thank you for signing up! Keep an eye on your inbox. Therefore the reason for her nun’s habit is also a mystery, and hopefully one that will also be resolved. It also occurs to me at this point that Miss Clavel must not be a nun, or she would be called Sister Clavel. The supernatural hints in Madeline are never fully realized, but as this is a series, it is possible this is a long-term hint as to future plot points. One night, the apparently psychic nun wakes, knowing something is not right. One of Madeline’s favorite things to do is to frighten Miss Clavel. I am not familiar with the traditional 1930s era dress for boarding school teachers, but the adult, Miss Clavel, appears to be a nun in a habit, and so her hair color is not determined. These are hardly unique traits - I myself embody all three, even if my hair is dyed - but in an illustrated text, Madeline’s red hair is a way to differentiate her from the other 11 children, who all seem to be brunettes. Bemelmans illustrates her individuality by describing her fearlessness of mice, her love of winter, and her red hair. All rights reserved.Our heroine is Madeline, the smallest of the girls. Given higher false negative cases in the application phase, stringent strategy of follow-up and salvage treatment is mandatory to maintain acceptable outcomes.Ĭancer Head and neck Metastasis Sentinel lymph node Surgery.Ĭopyright © 2015 Elsevier Ltd. Subgroup analyses between negative- and positive-SLNs within each phase revealed no significant differences in all endpoints. The neck control rate was 95.2% in the validation phase and 97.5% in the application phase (p=0.52). False omission rates were 6.6% (1/15) in the validation group, and 11.7% (4/34) in the application group, respectively. Sensitivity and NPV of the validation phase were both 100%, with 60.0% and 88.2% in the application phase. Regional recurrences developed from 5 negative SLNs (one in the validation phase, 4 in the application phase), of whom 3 patients were successfully salvaged. Fourteen SLNs of 12 patients (6 in each phase) were positive for metastasis (occult metastasis rate, 19.6%). Sensitivity, negative predictive value (NPV), neck control rate, disease-specific survival (DSS), disease-free survival (DFS), and overall survival (OS) were compared in cN0 oral tongue SCC patients from different phases.Ī total of 133 SLNs from 61 patients (21 in the validation phase, 40 in the application phase) were harvested. This study tested the long-term outcomes of sentinel lymph node biopsy (SLNB) for oral tongue squamous cell carcinoma (SCC) during the transition from validation to application phase.
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