Tears are essential for the normal function of the eye. A part of the tears is lost by evaporation. The majority of tears drain to the inferior meatus of the nose. The parasympathic nervous system controls the tear volume reflex by the ffth cranial nerve. When the volume increases or the passage is obstructed, the patient complains about epiphora and blurred vision. Bacterial invasion of an obstructed lacrimal system can occasionally lead to acute dacryocystitis with fstula formation. The patient should be informed that in almost every case (except for orbital abscess) the operation is elective and optional. To choose the correct therapy a careful history nd an examination of the eyelid and the lacrimal system are necessary.

Closed or endonasal rhinoplasty has been practiced since the dawn of the modern rhinoplasty era, see Roe’s description in 1887 . In recent years there has been a growing enthusiasm for both teaching and practice of the open approach to rhinoplasty; this technique is both easier to teach and for the student to learn; however, there are small but signifcant prices to pay for this choice. The most signifcant is the presence of an external scar on the columella, which proponents of the technique claim to be near invisible but which a signifcant population of patients fnd unsightly .Also, despite the clear visibility of both cartilage and bone in the open technique, there is frequent irregularity of contour and of symmetry, especially in inexperienced hands . The authors prefer the closed technique for its precision, rapid recovery, and lack of external scarring. We also fnd the technique sympathetic to the frequent frustrations of the less experienced surgeon attempting the technique. For that reason we teach it to our fellows as a “beginner’s” technique until suffcient experience has been gained to graduate to the more technically demanding open procedure .

In the United States, as the large baby boomer population cohort continues to age, the number of patients presenting with hepatopancreatobiliary (HPB) malignancies has and will continue to rise into the foreseeable future. The US Census Bureau projects that the number of adults aged 65 and older is expected to increase from 46 million in 2014, to 74 million by 2030 . The median age for cancer diagnosis is 66 years, making advanced age an increased risk factor for development of HPB carcinomas . In agreement, cancer incidences for both liver and pancreatic cancers are expected to increase from 2010 to 2030 by 59% (liver) and 55% (pancreas), respectively . Thus, in the upcoming decades, substantial healthcare resources and attention will be devoted to treating HPB malignancies. Surgical resection continues to remain the preferred curative treatment option for HPB neoplasms. However, older patients with HPB disease are often frail and have multiple comorbidities alongside their primary malignancy, thus making aggressive surgical resections high risk for these patients. For frail and elderly patients undergoing elective procedures, perioperative care must be afforded special attention in order to decrease incidences of severe morbidity and mortality. While postoperative care is a mainstay of focus for surgical patients, preoperative assessment is often afforded less attention within the feld of HPB surgery. By the use of standardized patient assessments, clinicians are able to obtain a more accurate representation of a patient’s true health status, thus making it possible to identify surgical patient populations with higher risks of postoperative morbidity, mortality, increased length of hospital stay, and increased risk of being discharged to skilled nursing facilities.