Amiodarone is an antiarrhythmic agent commonly used to treat supraventricular and ventricular arrhythmias. This drug is an iodinecontaining compound that tends to accumulate in several organs, including the lungs. It has been associated with a variety of adverse events. Of these events, the most serious is amiodarone pulmonary toxicity. Although the incidence of this complication has decreased with the use of lower doses of amiodarone, it can occur with any dose. Because amiodarone is widely used, all clinicians should be vigilant of this possibility. Pulmonary toxicity usually manifests as an acute or subacute pneumonitis, typically with diffuse infiltrates on chest x-ray and high-resolution computed tomography. Other, more localized, forms of pulmonary toxicity may occur, including pleural disease, migratory infiltrates, and single or multiple nodules. With early detection, the prognosis is good. Most patients diagnosed promptly respond well to the withdrawal of amiodarone and the administration of corticosteroids, which are usually given for four to 12 months. It is important that physicians be familiar with amiodarone treatment guidelines and follow published recommendations for the monitoring of pulmonary as well as extrapulmonary adverse effects.

Sleep is a vital physiologic process with important restorative functions. Notable qualitative and quantitative changes in sleep occur with age. Moreover, many sleep-related disorders occur with increasing frequency among elderly people. These conditions are often not appreciated by physicians, the associated symptoms ascribed instead to coexistant medical illness. In part 1 of this review, we attempt to summarize several of the most important sleeprelated disorders commonly observed in older patients. In the forthcoming part 2, we will highlight the principles of treatment of these conditions. Age-related sleep changesNormal sleep progresses through several stages in a predictable fashion (Table 1). This cycle repeats several times during the sleep period. With age, important changes in sleep structure occur (Box 1); 1 perhaps most characteristic is a phase advance of the normal circadian cycle. The result is a propensity toward an earlier sleep onset, accompanied by an earlier morning wake signal. Thus, elderly people often go to bed early and report being early risers. With aging, the total amount of time asleep shortens: infants and young children sleep an average of 16-20 hours per day; adults, 7-8; and people over 60 years of age, 6 1 /2 hours daily.2 Delta sleep (stages 3 and 4), the deepest and most refreshing form of sleep, diminishes with age. 2 Sleep pathologies in older patients InsomniaInsomnia, defined as difficulty falling or staying asleep, is frequent in older people.1,2 In some patients, insomnia can be caused by an underlying medical condition or a medication side effect (secondary insomnia). In the absence of a causative factor, it is referred to as primary insomnia. Monane 3 has estimated that insomnia affects nearly half of all those over the age of 65 years. Elderly women tend to report sleep disturbances more frequently than elderly men.4 The sleep changes noted among older women may be partly related to changes in the postmenopausal profile of sex hormones. Estrogen deficiency in particular has been postulated to contribute to the sleep difficulties that women often begin to experience in their perimenopausal period, and then increasingly with age. 5Frequent awakenings are particularly common among elderly people and may be related to their more frequent incidences of concurrent medical conditions. Among the most common causes of secondary insomnia are a variety of musculoskeletal disorders, nocturia related to benign prostatic hypertrophy in men and bladder instability with decreased urethral resistance in women, congestive heart disease, and chronic obstructive lung disease.Depression and anxiety disorders, common among people over 65 years of age, frequently contribute to insomnia. 6Risk factors for depression in older people include loss of a spouse, retirement, social isolation, comorbid disease and onset of dementia.Sleep disturbance or disruption is common among patients experiencing dementia, particularly those with Alzheimer's disease.7 Such patients often have difficulty not on...

Lung adenocarcinoma is the most common cell type in females (smokers or non-smokers) and in non-smoking males. Its incidence has been increasing in younger cohorts of males and females until very recent years. Changes in classification and in pathological techniques account for some of this increase. In females and non-smoker males, the increase could be partly due to a detection bias in former studies. Nevertheless, successive cohorts over time seem more likely to develop adenocarcinoma and less likely to develop squamous cell carcinoma. These differences between birth cohorts suggest that the increasing incidence of adenocarcinoma is not only due to changes in pathological diagnosis. Geographical differences are also observed: in Europe, the squamous cell type still predominates and an increase in incidence of adenocarcinoma has only been reported in the Netherlands. In Asia, in the 1960s and 1970s, the proportion of adenocarcinoma was higher than in North America or Europe and seems to be increasing. To what extent these differences are due to differences. In establishing diagnosis remains unknown. Despite these biases in temporal and geographical trends detailed in this review, there has probably been a true increase in incidence of adenocarcinoma. An explanation for this should be sought in studies on detailed smoking history and passive smoking exposure, occupational exposure, diet and cooking, pollution and other environmental factors.

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