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Increasingly, the otolaryngologist is called on to provide exposure for the neurosurgeon performing transsphenoidal hypophysectomy. The 3 most common approaches for this exposure are the transnasal transseptal, sublabial transseptal, and external rhinoplasty approaches. We reviewed our series of 135 patients undergoing transnasal hypophysectomy for postoperative complications. In our series, we found that 18% of patients had a postoperative septal perforation, 2% of which were symptomatic; 6% of patients reported nasal cosmetic deformity; 13% reported transient lip numbness; and 3% reported postoperative nasal dysfunction. When comparing our complication rate with those published for the sublabial and external rhinoplasty approaches, we found the transnasal approach provides excellent exposure with less dissection and fewer postoperative complications. On the basis of these results, we believe that the transnasal transseptal approach provides excellent exposure for transsphenoidal hypophysectomy in all patients who require pituitary surgery.

Objective: In Lebanon there is very limited restriction on drug use. Accordingly, self-medication is highly prevalent. This study examined the influence of these factors on the development of drug-related illnesses that lead to hospitalization., Methods: Patients admitted to the medical and pediatric wards of a tertiary teaching center in Beirut, Lebanon, over a period of 6 months were interviewed and their charts were reviewed. Admissions attributable to adverse drug reactions or therapeutic failures were identified and characterized with respect to demographic factors, medical history, drug intake, and self-medicating behavior. The influence of these variables on the development of drug-related illnesses was examined by logistic regression., Results: Of 1745 adults and 457 children, there were 177 (10.2%) and 36 (7.9%) drug-related illnesses, respectively. Adverse drug reactions accounted for 7.0% and 5.7% and therapeutic failures for 3.2% and 2.2% of adult and pediatric admissions, respectively. Self-medication was commonly practiced (52.6% of adults and 41.6% of children). Logistic regression analysis revealed that female sex increased the risk of adverse drug reaction in adults, whereas self-medication decreased the risk. In children, the risk of adverse drug reaction was increased in lower socioeconomic groups, whereas the risk of therapeutic failure was increased by a positive history of atopy or drug reaction., Conclusions: These results provide the first detailed analysis of the problem of drug-related illnesses in a developing country and identify a number of related or risk factors. Despite the lack of regulation of drug dispensing and the unchecked access to drugs in Lebanon, the incidence of drug-related illnesses is not different from that in Western nations. This finding may have relevance to policies of drug regulation in other countries.