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[Speaker: Dr. Tony Vine.]
[Visual: Dr. Vine in his medical office speaking to the camera.]
[Music: Soft, inspirational music begins.]
Hi, I'm Dr. Tony Vine. I'm a laparoscopic
surgeon, so I do minimally invasive surgery,
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[Visual: Illustration of the digestive tract.]
involving the intestinal tract all the way
from the esophagus down to the anus.
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[Visual: Dr. Vine walking through the hallway of his
medical practice and into his office.]
How I came to medicine was really through my father.
I asked him if he wanted me to take over his dental practice.
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[Visual: Photo of Dr. Vine smiling with his elderly father.]
And he said to me, “For the four years that you go to dental school,
you may as well go to medical school and learn the whole thing.”
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[Visual: Photo of Dr. Vine standing wearing blue scrubs.
Then, Dr. Vine speaking to the camera.]
I have been practicing medicine for approximately
30 years.
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[Visual: Photo of Dr. Vine with former classmates
at Vanderbilt Medical School.]
I graduated from Vanderbilt Medical School in 1989, and started
at Mount Sinai for my residency in that same year…
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[Visual: Back to Dr. Vine speaking directly to
the camera]
…and did two years of research in the middle of
my residency at Massachusetts General Hospital.
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[Visual: Mount Sinai graduation photo of
Dr. Vine with classmates and professors.]
Came back to Sinai in 1994 and graduated
as a chief resident from there in 1996…
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[Visual: Photo of Dr. Vine performing surgery in blue scrubs.]
…and immediately started work in July of 1996.
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[Visual: Dr. Vine, smiling and speaking to the
camera, then a photo of Dr. Vine playing violin in green scrubs.]
In my spare time,
whatever little there may be of it,
you can find me practicing my violin.
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[Visual: Video of Dr. Vine at desk.]
[Visual: Then, photos of Dr. Vine with NY State Senators.]
You might find me preparing for a meeting
with a New York State Senator for lobby day.
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[Visual: Photo of Dr. Vine with one of
his chief residents.]
You might find me teaching the
medical students and residents.
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[Visual: Photo of Dr. Vine with a chief resident.]
I think that my humanistic background,
having been an English major in college,
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[Visual: Video of Dr. Vine playing with the orchestra.
Music: Background music fades out.
Sound of Dr. Vine playing the violin begins.]
being a violinist, I feel that I come to medicine
with more of a humanistic, compassionate approach.
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[Visual: Dr. Vine speaking to camera.
Music: Violin music fades out.
Original background music resumes softly.]
I really try and treat my patients as if they were my family members.
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[Visual: Fade to black.
Music fades out.]
Median Arcuate Ligament Syndrome (MALS)
Median Arcuate Ligament Syndrome (MALS) is a rare condition in which a band of tissue in the lower part of the chest (median arcuate ligament), rests lower than normal and presses against the celiac artery and the celiac plexus nerves. The celiac artery is a major blood vessel supplying blood to the stomach, liver, pancreas and other abdominal organs. When the celiac artery and plexus are compressed a number of symptoms may result as described below.
MALS is often misdiagnosed, as symptoms are similar to other conditions like Irritable Bowel Syndrome (IBS), appendicitis, gastritis, gallstones, peptic ulcer disease among others.
Symptoms of MALS
- Upper abdominal pain typically after eating, may radiate to chest or back
- Weight loss due to lack of appetite and stomach pain
- Nausea and vomiting
- Bloating
- Diarrhea or constipation
- Heartburn
- Fatigue
MALS Causes and Risk Factors
The exact cause of MALS is not known. However, there are several factors that may increase a person’s risk of developing Median Arcuate Ligament Syndrome including:
- Anatomical variations – differences in body structure may cause the median arcuate ligament to sit lower than normal, pressing on the celiac artery and nerves.
- Age and gender – anyone can have MALS, however, it’s most common in thin, younger women between the ages of 20 and 40.
- Family history – while genetic predisposition is unclear, there have been cases of identical twins with MALS leading doctors to believe there may be a hereditary component.
How is MALS Diagnosed?
After accessing your symptoms and family history, followed by a physical exam, certain radiographic tests may help aid in the diagnosis including,
- MRA (Magnetic Imaging Angiography) – looks for signs of celiac artery compression
- CTA (Computed Tomography Angiogram) – detailed imaging that shows a cross-sectional view of the celiac artery to identify compression or narrowing
- Doppler Ultrasound – measures blood flow within the celiac artery
- Celiac Ganglion Block – temporary nerve block to determine if symptoms are related to celiac nerve compression
Dr. Anthony Vine has successfully treated many patients suffering from MALS. For more information, please visit our Laparoscopic MALS Surgery page.
Dr. Anthony Vine is an Attending Surgeon and Clinical Professor of Surgery at the Icahn School of Medicine at Mount Sinai Hospital. His office is located at 1010 5th Avenue at the Laparoscopic Surgical Center of New York.