For the past 20 years, methadone has been experiencing resurgence in the palliative care community as a second-line opioid for the treatment of cancer pain. The advantages of using methadone for refractory pain in patients with cancer or in those who could not tolerate the side effects of other opioids such as morphine are well cited in recent literature. Advantages of methadone over other opioids include dual elimination without active metabolites, allowing safe use with renal and liver failure, N-methyl-D-aspartate (NMDA) and delta receptor activity in addition to mu receptor agonism, multiple routes of administration, rapid onset of action, long half-life, low cost, and fewer adverse effects. Despite the abundance of recent case reports and literature reviews demonstrating the effective use of methadone in patients with cancer, there is a lack of consensus for an appropriate method for converting morphine (and by extension, other opioids) to methadone. This article will review methadone pharmacology and multiple proposed conversion methods; a case report illustrating a popular method for high-dose conversion is also included.

Pulmonary hamartomas are the most common benign tumor of the lung. As the term "hamartoma" suggests, these tumors were at one time considered to be embryological malformations. New evidence indicates, however, that hamartomas are benign tumors of mesenchymal origin and that "mesenchymoma" is a more appropriate term. Despite the fact that hamartomas, or mesenchymomas, have been described in the medical literature since 1904, there is not a consistent methodology for the diagnosis and management of these lesions. This report reviews the available literature regarding pulmonary hamartomas with 3 illustrative cases. An algorithm is proposed for the diagnosis and management of this benign respiratory neoplasm.