I am not sure of the exact ingredients as I never eat them. Undoubtedly, someone will come along and provide full recipes for both: Actually, there are regional variations. In eastern France , a "macaron" is a coconut macaroon. Since a "macaron" has a completely different meaning in Paris , a coconut macaroon is called a "congolais" there.
Thanks for that, kerouac - I was wracking my brain trying to remember "Congolais". Are they still called this?
Macaron vs. Macaroon - Paris Forum
I know another pastry that has been changed to something like "Le Criollo", instead of the very un-PC but very innocently descriptive "Tete de Negre". I think they changed something in the recipe, too, since it doesn't seem to taste quite the same. Alec - you've got it right. I think English-speakers say "mack ah roon" because it's just more familiar-sounding to them than "mack ah roh", which sounds wrong, somehow.
But if you turned the tables, the French would butcher "macaroon", since they would be screwing up their mouths trying to make that impossible French "u" sound and it would come out like this -. In Southern France macarons are made with egg whites, sugar and almonds. In the UK, for as long as I can remember, we've had two types of macaroon this is before the recent invasion of the French pastel-coloured and flavoured fashion accessory version. Unlike the macarons frequently discussed here, they don't come in flavours or sandwiched together so sound as if they are closely related to Pvoyageuse's southern macarons.
Maybe these haven't crossed the Atlantic. In any case, I don't understand why it's an issue if people refer to macaroons rather than macarons - it's a perfectly legitimate translation. One reason is that in French, "macaron" has another meaning -- it is any little round disc, usually of official significance for example a decal to stick on a car for some reason, or a formal award to be worn on a lapel. This topic has been closed to new posts due to inactivity. We hope you'll join the conversation by posting to an open topic or starting a new one.
We remove posts that do not follow our posting guidelines, and we reserve the right to remove any post for any reason. All of your saved places can be found here in My Trips. Log in to get trip updates and message other travelers. Log in Join Recently viewed Bookings Inbox. Browse forums All Browse by destination. Neoadjuvant chemoradiation treatment CRT has been shown to be responsible for significant tumor regression and local recurrence rate reduction[ , ]. The result of medical treatment has been so remarkable that Dr.
Habr-Gama set the bar at a higher level and decided not to operate on patients having a complete clinical response cCR after CRT[ ]. All these patients underwent R0 radical surgery; no recurrence was recorded after The mean age of the patients in the study was Following the same pathway, the same group designed a different approach for those patients who partially responded to CRT ypT, N0 and they performed transanal endoscopic microsurgery TEM in 27 patients to partially remove the rectal wall containing the cancer instead of classic TME radical surgery[ ].
Nine patients had a recurrence after a median follow-up of 15 mo 5 with exclusively systemic relapse and 4 with local relapse. The TEM specimens of 3 patients had shown ypT2 cancer while one patient with local recurrence was previously staged as ypT1. Again, the study was clearly not designed for elderly patients perhaps unfit for major surgery but it should be considered an interesting start within a promising application regarding frail elderly patient care.
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Postoperative memory loss and delirium after general anesthesia and hospitalization have also been widely feared by elderly patients and their caregivers. Several attempts have been made to reduce the risk of postoperative delirium but, unfortunately, no effective strategies have been identified. In a recent study, Hempenius et al[ ] designed a dedicated geriatric multidisciplinary approach for patients with solid cancer. Unfortunately, the randomized trial failed to demonstrate any advantage in patients who were treated with a multimodality approach compared with standard care.
Several strategies have been promoted in order to achieve early functional capacity after major oncological surgery, beginning with the preoperative period, continuing with less invasive surgical techniques and, subsequently, postoperative strategies. The laparoscopic approach for CRC elderly patients has previously been discussed. Two additional papers are mentioned as examples.
The first is by Frasson et al[ ] who specifically focused on functional recovery after laparoscopic surgery and the specific benefits for the elderly. The CRC patients represented Within the two groups, the outcomes of young patients under 70 years of age were compared with those obtained in patients over 70 years of age. The authors concluded that laparoscopy should be considered as the first option in elderly patients as it improves the preservation of functional status permitting a higher rate of postoperative independence at discharge and faster postoperative recovery.
Notable advantages obtained from a laparoscopic approach compared with open surgery were ultimately more pronounced among the elderly than in younger patients. As is well known, fast-track programs include preoperative patient education, no routine bowel preparation, minimal perioperative starvation, early removal of the nasogastric tube and urinary catheter, tailored anesthesia and postoperative analgesia, early postoperative diet intake and mobilization with minimal fluid infusion.
The literature suggests that elderly patients have an advantage in functional recovery if enrolled in a fast-track program. Baek et al[ ] analyzed a group of patients 87 over 70 years of age and under 70 years of age who underwent laparoscopic colorectal surgery with a perioperative fast-track program. In particular, they observed a lower than expected cardiopulmonary complication rate which they acknowledged was most likely due to the use of a low-pressure pneumoperitoneum 8 mmHg.
The only significant differences were observed in readmission rate and emergency room visits No significant differences in d readmission rate 8. Similar results were reported by Keller et al[ ] who prospectively analyzed a group of patients under 70 years of age compared with a group of patients over 70 years of age. We can conclude that fast track protocols are not only feasible but they also have notable advantages in elderly patients compared with younger patients.
Elderly cancer patients greatly benefit from the avoidance of bowel preparation associated with hydro-electrolyte imbalances and opioid restriction associated with ileus, nausea and vomiting. Furthermore, encouraging early ambulation avoids the risk of prolonged bed rest. Personalized treatment for elderly patients with CRC include not only the main goal of obtaining prolonged survival but also the achievement of a satisfactory QoL. The goal was to obtain data regarding their physical function, body pain, social functioning, vitality and general health perception. The domains which differed significantly among the two groups were physical functioning, functional role, micturition, and stoma-related problems.
Authors ascribed these differences to natural senescence, with the exception of stoma-related problems. An interesting prospective multicenter study by Scarpa et al[ ] analyzed the QoL of elderly vs younger patients undergoing colorectal surgery. A total of patients were enrolled in this study: They showed that elderly patients undergoing a laparoscopic colectomy for cancer experienced fewer postoperative local complications than elderly patients undergoing an open colectomy.
In the laparoscopic elderly patient group, there were no significant differences in satisfaction or QoL, despite a lower postoperative complication rate compared with the elderly open surgery group. Functional recovery and activities of daily living status improved after surgery in the majority of patients; however, a temporary or prolonged decline in recovery was found in those who developed postoperative complications. Aging of world populations is occurring, and especially in Western countries.
Becoming old means being less and less independent from a number of perspectives. Among the various causes leading to a decrease in functional capacity, declining health plays a pivotal role. Aging in the populations of Western countries is becoming one of the most significant challenges for our health care systems. Elderly patients have multiple comorbidities, and unpredictable social and family situations; when cancer is diagnosed, this adds to in an already complicated situation. Among the elderly, those who are vulnerable or even frail are the ones who really deviate from the standard curves.
Despite aging in Western countries and the clear challenge for healthcare professionals and scientists, few studies have specifically been designed to assess the success of care strategies in this cohort of patients. This is quite surprising if we consider one of the most frequent causes of cancer-related death in the elderly population: Why should we focus our attention on complicated, demanding, unconventional, non-reducible-to-the-standard-practice type of patients who are historically considered less amenable to curative treatment because of their age The elderly in Western countries who have CRC have a worse prognosis than younger patients; but this is true only during the first 12 mo after surgery while 5-year cancer-related survival does not differ from the rest of the population which is healthier and has access to more sophisticated treatment.
Macaron vs. Macaroon - Paris Forum
We have to focus our attention on that period of time. Our review showed that, as physicians, the only answer we can give is to implement strategies for personalizing the treatment of the elderly with cancer. Individualized care does not mean being subjective. Many studies have defined rigorous pathways, screening tools and tailored surgical and postoperative strategies in order to obtain this goal. Our review showed how sarcopenia measured both directly and indirectly with TUG or a 6-min walk test seems to be the best predictor for postoperative outcomes.
Prehabilitation, despite the lack of large randomized clinical trials, has been shown to be a promising start in reducing the most worrisome complication for an elderly individual: At the same time, less invasive surgery is being implemented in order to reduce pulmonary and cardiologic complications and eventually the length of stay, such as the advanced laparoscopic approach. During the postoperative period, fast track strategies are extremely beneficial for the elderly who have shown positive results with reduced amounts of opioids, early mobilization and oral feeding.
Intriguing solutions have also been described for a non- or local-surgical approach to low rectal cancer and, despite the lack of specific trials, it could be an interesting solution to be offered to frail individuals who cannot undergo a standard approach. Therefore, why should we treat these challenging, complicated, demanding, unconventional elderly patients with cancer This review cannot provide the profound answer that we need to give as physicians and human beings.
This study was carried out to reveal the evidence in the current literature in order to help whoever decides to assist these frail patients and devote their professionalism to rediscovering the true essence of Medicine: Cui XM L- Editor: Cant MR E- Editor: Citation of this article. Personalized surgical management of colorectal cancer in elderly population. Corresponding Author of This Article. Publishing Process of This Article. Research Domain of This Article. Article-Type of This Article.
Open-Access Policy of This Article. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. Number of Hits and Downloads for This Article. Total Article Views All Articles published online. Times Cited of This Article. Journal Information of This Article. Orsola-Malpighi, Bologna, Italy. All authors contributed to the conception and design of the article, review of the literature and writing of the manuscript; all authors participated equally in the critical revision, editing and approval of the final version of the article.
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September 28, Revised: December 9, Accepted: January 3, Published online: Elderly , Colorectal cancer , Surgery , Personalized treatment , Geriatric assessment. Total mesorectal excision; QoL: Preoperative risk screening tools in surgery. Perspectives and expectations regarding CRC surgery. Malignant bowel obstruction in the elderly. Laparoscopic approach for colon cancer in the elderly. Specific considerations regarding morbidity and mortality. Laparotomy vs laparoscopy for TME. Laparoscopic approach and independence. Radiol Clin North Am. Department of Economic and Social Affairs.
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Personalized surgical management of colorectal cancer in elderly population
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INTRODUCTION
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