Median Arcuate Ligament Syndrome Is Not a Vascular Disease.

BACKGROUND: Median arcuate ligament syndrome (MALS) is a rare disorder characterized by postprandial abdominal pain, weight loss, and celiac stenosis. Diagnosis can be challenging, leading to a delay in treatment. We report on our continued experience using a laparoscopic approach for this uncommon diagnosis. METHODS: This is an Institutional Review Board-approved, prospectively collected retrospective analysis of patients treated with laparoscopic MAL release at our institution. Data collected included patient demographics, preoperative symptoms, operative approach, and postoperative outcomes. Patients were then contacted to complete a postoperative survey designed to assess the improvement of symptoms and overall patient satisfaction. RESULTS: A total of 39 patients (33 women and 6 men) underwent laparoscopic MAL release from March 2007 to July 2014. Mean age was 40.6 years (range, 17-77 years). Thirty of 39 patients had a postoperative celiac axis ultrasound. Twenty-three had a patent celiac axis on postoperative duplex. Of the remaining 7, 5 with residual celiac axis stenosis and 1 with occlusion, reported complete resolution of their symptoms. One remaining patient with occlusion remained symptomatic. Thirty-three of 39 (84.6%) reported symptom relief after surgery. Nine of 33 (27.3%) responders had cardiovascular risk factors versus 4 of 6 (67%) nonresponders. Five patients with atypical presentations underwent preoperative diagnostic celiac plexus block using local anesthetic, with 4 reporting symptom reliefs after block. These 4 patients also reported postoperative symptom relief. One patient of 39 received a postoperative celiac stent placement and remained symptomatic. There were 4 conversions to open surgery (10.3%) and no deaths. CONCLUSIONS: Laparoscopic MAL release continues to be a safe and effective means of managing MALS. Our data suggest that the symptoms associated with MALS are not related to vascular compromise, and atherosclerotic risk factors may predict poorer outcomes. Symptomatic relief is seen in the vast majority of patients undergoing this procedure. However, patient selection remains critically important in obtaining optimal results.

High energy and quantum efficiency in photoinduced charge separation.

Supramolecular triad assemblies consisting of a central trisbipyridine ruthenium(II) chromophore (C2+) with one or more appended phenothiazine electron donors (D) and a diquat-type electron acceptor (A2+) have been shown to form long-lived photoinduced charge separated states (CSS) with unusually and consistently high quantum efficiency. Up to now, there has been no understanding for why these large efficiencies (often close to unity) are achieved across this entire class of triads when other, seemingly similar systems are often much less efficient. In the present study, using a bimolecular system consisting of a chromophore-acceptor diad (C2+-A2+) and an N-methylphenothiazine donor, we demonstrate that a ground-state association exists between the RuL3(2+) and the phenothiazine prior to photoexcitation. It is this association process that is responsible for the efficient CSS formation in the bimolecular system and, by inference, also must be an essential factor in the fully intramolecular process occurring with the D-C2+-A2+ triad analogues.