Bassam Estfan, MD | Authors

Adjuvant Treatment After Orthotopic Liver Transplantation: Is It Really Necessary?

December 16, 2009

This review summarizes the current data on efficacy and rationale of adjuvant treatment for hepatocellular cancer after orthotopic liver transplantation, as well as future prospects. No adjuvant treatment is currently advocated.

Opioid Rotation in Cancer Patients: Pros and Cons

April 01, 2005

Opioid rotation involves changing from one opioid to another usingcorrect equianalgesic conversion techniques to achieve better analgesiaand/or fewer side effects. The strategy appears to work because ofsignificant interindividual variations in response to both analgesic activityand toxicity. Although there are many retrospective studies, fewprospective controlled trials of opioid rotation have been published.The practical and theoretical advantages of opioid rotation includeimproved analgesia, reduced side effects, cost reduction, and improvedcompliance. Disadvantages include problems related to inaccurate conversiontables, limited availability of certain opioid formulations, druginteractions, and the possibility of increased expense. Weighing theadvantages and disadvantages is essential prior to making a decisionabout opioid rotation selection.