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P revious research suggests that 16% to 50% of individuals with schizophrenia abuse cocaine (1-3). The prevalence of cocaine abuse in persons with schizophrenia is problematic, considering the debilitating effect that the drug can have on acute symptoms and on illness course. Individuals with schizophrenia and cocaine dependence display more positive symptoms, fewer negative symptoms, and higher rates of extrapyramidal symptoms (EPS) (4,5), which may result from an interaction between dopamine and the psychostimulant properties of cocaine (6).It is widely accepted that aberrations in the dopamine system play a role in the etiology of schizophrenia (7,8) and the maintenance of cocaine addiction via craving (9-11). To examine the clinical impact of these dopamine abnormalities, we compared self-report craving among cocaine addicts and cocaine addicts with schizophrenia. Individuals with schizophrenia and cocaine dependence had significantly more craving, which remained stable over a 72-hour period (12). In a follow-up study, we included a cue-exposure paradigm and found that 97% of the cocaine-dependent persons with schizophrenia were cue-reactive, suggesting the need to target this state in treatment (11).Owing to the rapid increase in dopamine following cocaine use, which can persist for weeks and result in increased craving and depression, researchers have examined dopamine antagonists for treatment of protracted withdrawal. They found Objective: To examine the efficacy of atypical neuroleptics for decreasing craving and drug relapses during protracted withdrawal in individuals dually diagnosed with schizophrenia and cocaine dependence. Method:We conducted a 6-week, open-label pilot study comparing risperidone with typical neuroleptics in a sample of withdrawn cocaine-dependent schizophrenia patients. Results:Preliminary results suggest that individuals treated with risperidone had significantly less cue-elicited craving and substance abuse relapses at study completion. Further, they showed a trend toward a greater reduction in negative and global symptoms of schizophrenia. Clinical Implication · This research suggests that atypical neuroleptic medications, particularly olanzapine, may have anticraving effects and could improve treatment outcomes among the dually diagnosed patients. Conclusion Limitation· This research includes a small sample, an open-label design, and the use of a primarily male veteran population.

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The Veterans Integrated Service Network (VISN)-12, headquartered in Chicago, has implemented a telepathology network between the eight VISN-12 hospital laboratories and Loyola University Medical School linked by an economical, high-speed wide-area network (WAN). Implementation of the WAN has reduced monthly telecommunications costs in VISN-12 by approximately 67%. In addition to telepathology, the WAN enables real-time teleradiology (general, computer tomography, and ultrasound), telefluoroscopy, telenuclear medicine imaging, telepsychiatry, and other forms of teleconsultation. Current applications of telepathology in VISN-12 include: primary diagnosis and consultation in surgical pathology, interpretation of serum protein electrophoresis and immunofixation gels, provision of support for consolidated microbiology laboratories, review of problematic peripheral blood smears, and distance learning. We have learned a variety of lessons from telepathology. The enthusiasm and technical skill of providers are essential for success. As well, frequent communication and rapid technical support are necessary. Finally, in a supportive environment, telepathology is a tool that can help bring together clinical laboratories with shared missions and goals.

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Background: Chronic lumbosacral radicular pain is a common source of radiating leg pain seen in pain management patients. These patients are frequently managed conservatively with multiple modalities including medications, physical therapy, and epidural steroid injections. Radiofrequency has been used to treat chronic radicular pain for over 30 years; however, there is a paucity of literature about the safety and efficacy of repeat radiofrequency lesioning. Objectives: To determine the safety, success rate, and duration of pain relief of repeat pulsed radiofrequency (PRF) and continuous radiofrequency (CRF) lesioning of the dorsal root ganglion (DRG)/ sacral segmental nerves (SN) in patients with chronic lumbosacral radicular pain. Study Design: Retrospective chart review Setting: Outpatient multidisciplinary pain center Methods: Medical record review of patients who were treated with pulsed and continuous radiofrequency lesioning of the lumbar dorsal root ganglia and segmental nerves and who reported initial success were evaluated for recurrence of pain and repeat radiofrequency treatment. Responses to subsequent treatments were compared to initial treatments for success rates, average duration of relief, and adverse neurologic side-effects. Limitations: Retrospective chart review without a control group. Results: Twenty-six women and 24 men were identified who received 50% pain relief or better after PRF and CRF of the lumbar DRG/ sacral SN for lumbosacral radicular pain. The mean age was 62 years (range, 25-86). The mean duration of relief for the 40 patients who had 2 treatments was 4.7 months (range 0-24; Se [standard error] 0.74). Twenty-eight patients had 3 treatments with an average duration of relief of 4.5 months (range 0-19 months; Se 0.74). Twenty patients had 4 treatments with a mean duration of relief of 4.4 months (range 0.5-18; Se 0.95) and 18 patients who had 5 or more treatments received an average duration of relief of 4.3 months (range 0.5-18; Se 1.03). The average duration of relief and success frequency remained constant after each subsequent radiofrequency treatment. Of the 50 total patients, there was only 1 reported complication, specifically, transient thigh numbness which resolved after one week. Conclusions: Repeated pulsed and continuous radiofrequency ablation of the lumbar dorsal root ganglion/segmental nerve shows promise to be a safe and effective long-term palliative management for lumbosacral radicular pain in some patients. Key words: Pulsed radiofrequency lesioning, dorsal root ganglion, segmental nerve, continuous radiofrquency elsioning, chronic lumbosacral radicular pain