Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
Real time Imaging (Intraoperative Doppler) in Median Arcuate Ligament Syndrome Management: A Case Report
Correspondence Address :
Dr. Haryax Pathak,
Senior Resident, Department of General Surgery, Shree Krishna Hospital and Pramukh Swami Medical College, Bhaikaka University, Karamsad, Anand-388325, Gujarat, India.
E-mail: haryax0909@gmail.com
Median Arcuate Ligament Syndrome (MALS) is a rare cause of chronic abdominal pain due to coeliac trunk compression, typically affecting middle-aged women. Surgical decompression is the gold standard, but technical failure or recurrence poses a significant challenge. The authors report a rare case of recurrent MALS in a 31-year-old male who presented with severe, persistent abdominal pain 1.5 years after an initial laparoscopic ligament release. Preoperative Computed Tomography (CT) and Doppler Ultrasound (DUS) confirmed the recurrence, showing coeliac trunk kinking and a markedly elevated Peak Systolic Velocity (PSV) of 235 cm/sec. Due to dense adhesions from the previous procedure, the patient underwent a re-do surgery via open laparotomy. The key to successful re-operation was the use of intraoperative DUS to precisely localise the coeliac trunk amidst fibrotic tissue. Following complete surgical decompression of the artery, the intraoperative PSV immediately dropped to 80 cm/sec, confirming adequate flow restoration. The patient experienced complete, sustained symptom resolution at the 6-month follow-up. The present case highlights that intraoperative DUS is a vital tool for ensuring the completeness of coeliac axis decompression, especially in complex, re-operative settings where persistent adhesions obscure anatomical planes.
Coeliac artery compression syndrome, Dunbar syndrome, Intraoperative ultrasound, Vascular compression syndrome
A 31-year-old male, with no known co-morbidities, presented with a complaint of generalised abdominal pain, nausea and vomiting for 1.5 years, aggravated in the past 1 month. On examination, the patient had mild, generalised abdominal tenderness, with no other positive findings. The patient had a history of hospital admission for similar symptoms two years ago and was diagnosed with Median Arcuate Ligament Syndrome (MALS) and subsequently underwent laparoscopic surgery for the same. He was free of symptoms for a short period of time (approximately 6 months) following the surgery but developed recurrent symptoms 1.5 years ago. His laboratory parameters (haemogram, liver function tests, renal function tests) were within normal limits.
He was evaluated by a Computed Tomography (CT) scan of the abdomen and pelvis that revealed narrowing of the proximal coeliac artery with anteroinferior kinking and narrowing of the coeliac trunk, as seen in (Table/Fig 1). The superior and inferior mesenteric arteries were unremarkable with no stenosis. Preoperative ultrasound Doppler imaging revealed mild kinking of the coeliac trunk at its origin, with Doppler values showing PSV of the coeliac trunk at origin of 235 cm/sec and PSV of the coeliac trunk post-kinking of 222 cm/sec. He was diagnosed with MALS with prior inadequate release of the MAL.
Intraoperatively, a diagnostic laparoscopy showed dense adhesions in the region of the coeliac axis and lesser sac owing to a previous history of surgery. The crural fibres of the diaphragm were densely adherent to the aorta till the origin of the coeliac axis, with fibrotic tissue encasing the coeliac axis. The proximal portion of the coeliac trunk was buried under the sub adventitial plane of the aorta. The decision was made to go for open surgery in view of adhesions. Intraoperative Doppler was done to localise the coeliac trunk and the PSV was measured, which was 235 cm/sec at the origin. The left gastric artery and common hepatic artery were dissected and looped and followed till coeliac trunk. The fibres encasing the coeliac trunk were dissected, freeing the coeliac trunk from the subadventitial plane of the aorta (Table/Fig 2).
Intraoperative ultrasound Doppler imaging revealed reduction in peak velocity at origin of coeliac trunk down to 80 cm/sec, with no kinking as compared to the preoperative Doppler (Table/Fig 3).
Postoperatively, the patient made an uneventful recovery, with complete resolution of symptoms and no residual complaints on follow-up for up to six months.
The median arcuate ligament typically crosses above the coeliac axis origin, joining the two diaphragmatic crura. However, in rare cases, the ligament may cross in front of the artery; compressing the coeliac axis, impairing blood flow and producing symptoms (1). MALS predominantly affects women between the ages of 30 and 50 years, with a female-to-male ratio of approximately 4:1. The present syndrome causes angina and pain in the abdomen, nausea, vomiting and classical post-prandial upper abdominal pain because of compression of the proximal portion of the coeliac artery (2).
Radiological diagnosis is established by DUS, Computed Tomography Angiography (CTA) of the abdomen, magnetic resonance angiography and newer modalities such as selective catheter angiography. The characteristic focal narrowing in the proximal coeliac axis is seen on CTA in patients with MALS. The distinctive hooked appearance of the focal constriction can help differentiate MALS from other causes of coeliac artery stenosis, like atherosclerosis. Collateral vessels and post-stenotic dilatation are among the features of MALS (3). The CT scan of the present patient showed luminal narrowing at the origin of the coeliac artery. However, no post-stenotic dilatation was seen. DUS highlights an increase in PSV at the origin of the coeliac trunk during expiration and exhibits kinking of the coeliac trunk, while CTA gives a comprehensive evaluation of the coeliac trunk anatomy, pre-stenotic and post-stenotic dilatation and differentiates MALS from an aneurysm, thus making both DUS and CTA necessary investigations for diagnosis and aiding in surgical management (3).
Colour Doppler US evaluation allows for dynamic, direct documentation of variations in calibre, colour signal, aorto-mesenteric angle, spectral window and PSV of the coeliac trunk with changes in the respiratory phase. During the deep inspiratory phase, normal colour Doppler features are generally detected. Yet, during the expiratory phase, an abnormal (acute) deflection angle typically appears, with colour aliasing in the proximal lumen of the coeliac trunk and an increase in PSV and end-diastolic velocity. A PSV over 200 cm/s during the expiratory phase or a ratio more than 3:1 of PSV of the coeliac artery to aorta in the expiratory phase is a Doppler criterion for diagnosis of Dunbar syndrome (4).
Surgical decompression of the coeliac trunk remains the gold standard for management of MALS. Surgical decompression may be conducted via laparotomy or laparoscopic approaches. Laparoscopic decompression affords minimally invasive surgical decompression, reduced complications and improved surgical outcomes, with lower recurrence rates, but also has high conversion to open surgeries owing to bleeding (5).
Do MV et al., conducted a retrospective review of patients operated for MALS, comparing laparoscopic and robotic approaches and concluded that while robotic surgeries are a viable option, there is no significant difference in operative outcomes between the two, with a shorter operative duration for laparoscopic surgeries (6). Another innovative approach to MALS surgery was described by Petersen AS van et al., wherein they performed a retroperitoneal endoscopic release of the coeliac trunk with minimal complications and excellent postoperative results (7).
The use of intraoperative DUS has been extensively described in literature and is an increasingly beneficial tool that enhances surgical precision and clinical outcomes. Hayano K et al., describe a case of a 52-year-old female with epigastric pain and vomiting following meals. She was diagnosed with coeliac artery compression syndrome on contrast-enhanced computed tomography. She underwent laparoscopic MAL division for the same and intraoperative transabdominal ultrasound Doppler was done to confirm complete decompression of the coeliac axis. Following an uneventful postoperative course, she was discharged on postoperative day 11 (8). Another similar case was reported by Tsujimoto H et al., wherein a 52-year-old female with MALS was treated with laparoscopic decompression of the MAL, which was confirmed with the disappearance of the preoperative post-stenotic dilatation via an intraoperative DUS (9). A novel approach was recently described by Bayat I et al., in 2020. They operated on a female for MALS laparoscopically and used Intravascular Ultrasound (IVUS) via a brachial artery puncture to access the coeliac axis. Laparoscopic division of the fibres was performed, guided by IVUS, ensuring complete division of the ligament and resolution of the compression (10). Such cases demonstrate the invaluable assistance that intraoperative DUS provides for surgical management of MALS.
The MALS is a rare anatomical anomaly that causes significant and at times debilitating distress in patients and requires precise diagnosis and surgical management. Intraoperative DUS is one of the most effective tools for ensuring the completeness of MALS surgery.
DOI: 10.7860/JCDR/2026/88305.24406
Date of Submission: Feb 17, 2026
Date of Peer Review: May 18, 2026
Date of Acceptance: Jun 15, 2026
Date of Publishing: Sep 01, 2026
Author declaration:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 04, 2026
• Manual Googling: Jun 11, 2026
• iThenticate Software: Jun 13, 2026 (1%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com