The explainable potential of coupling hybridized metaheuristics, XGBoost, and SHAP in revealing toluene behavior in the atmosphere.

Toluene is a neurotoxic aromatic hydrocarbon and one of the major representatives of volatile organic compounds, known for its abundance, adverse health effects, and role in the formation of other atmospheric pollutants like ozone. This research introduces the enhanced version of the reptile search metaheuristics algorithm which has been utilized to tune the extreme gradient boosting hyperparameters, to investigate toluene atmospheric behavior patterns and interactions with other polluting species within defined environmental conditions. The study is based on a two-year database encompassing concentrations of inorganic gaseous contaminants every hour (NO, NO2, NOx, and O3), particulate matter fractions (PM1, PM2.5, and PM10), m,p-xylene, toluene, benzene, total non-methane hydrocarbons, and meteorological data. The experimental outcomes were validated against the results of extreme gradient boosting models optimized by seven other recent powerful metaheuristics algorithms. The best-performing model has been interpreted by employing Shapley additive explanations method. In the study, we have focused on the relationship between toluene and benzene, as its most important predictor, and provided a detailed description of environmental conditions which directed their interactions.

Potential of Coupling Metaheuristics-Optimized-XGBoost and SHAP in Revealing PAHs Environmental Fate.

Polycyclic aromatic hydrocarbons (PAHs) refer to a group of several hundred compounds, among which 16 are identified as priority pollutants, due to their adverse health effects, frequency of occurrence, and potential for human exposure. This study is focused on benzo(a)pyrene, being considered an indicator of exposure to a PAH carcinogenic mixture. For this purpose, we have applied the XGBoost model to a two-year database of pollutant concentrations and meteorological parameters, with the aim to identify the factors which were mostly associated with the observed benzo(a)pyrene concentrations and to describe types of environments that supported the interactions between benzo(a)pyrene and other polluting species. The pollutant data were collected at the energy industry center in Serbia, in the vicinity of coal mining areas and power stations, where the observed benzo(a)pyrene maximum concentration for a study period reached 43.7 ngm-3. The metaheuristics algorithm has been used to optimize the XGBoost hyperparameters, and the results have been compared to the results of XGBoost models tuned by eight other cutting-edge metaheuristics algorithms. The best-produced model was later on interpreted by applying Shapley Additive exPlanations (SHAP). As indicated by mean absolute SHAP values, the temperature at the surface, arsenic, PM10, and total nitrogen oxide (NOx) concentrations appear to be the major factors affecting benzo(a)pyrene concentrations and its environmental fate.

The PM2.5-bound polycyclic aromatic hydrocarbon behavior in indoor and outdoor environments, part II: Explainable prediction of benzo[a]pyrene levels.

Among the polycyclic aromatic hydrocarbons (PAH), benzo[a]pyrene (B[a]P) has been considered more relevant than other species when estimating the potential exposure-related health effects and has been recognized as a marker of carcinogenic potency of air pollutant mixture. The current understanding of the factors which govern non-linear behavior of B[a]P and associated pollutants and environmental processes is insufficient and further research has to rely on the advanced analytical approach which averts the assumptions and avoids simplifications required by linear modeling methods. For the purpose of this study, we employed eXtreme Gradient Boosting (XGBoost), SHapley Additive exPlanations (SHAP) attribution method, and SHAP value fuzzy clustering to investigate the concentrations of inorganic gaseous pollutants, radon, PM2.5 and particle constituents including trace metals, ions, 16 US EPA priority PM2.5-bound PAHs and 31 meteorological variables, as key factors which shape indoor and outdoor PM2.5-bound B[a]P distribution in a university building located in the urban area of Belgrade (Serbia). According to the results, the indoor and outdoor B[a]P levels were shown to be highly correlated and mostly influenced by the concentrations of Chry, B[b]F, CO, B[a]A, I[cd]P, B[k]F, Flt, D[ah]A, Pyr, B[ghi]P, Cr, As, and PM2.5 in both indoor and outdoor environments. Besides, high B[a]P concentration events were recorded during the periods of low ambient temperature (<12 °C), unstable weather conditions with precipitation and increased soil humidity.

Rehydration Process in Rustyback Fern (Asplenium ceterach L.): Profiling of Volatile Organic Compounds.

When exposed to stressful conditions, plants produce numerous volatile organic compounds (VOCs) that have different biological and environmental functions. VOCs emitted during the rehydration process by the fronds of desiccation tolerant fern Asplenium ceterach L. were investigated. Headspace GC-MS analysis revealed that the volatiles profile of rustyback fern is mainly composed of fatty acid derivatives: isomeric heptadienals (over 25%) and decadienals (over 20%), other linear aldehydes, alcohols, and related compounds. Aerial parts of the rustyback fern do not contain monoterpene-type, sesquiterpene-type, and diterpene-type hydrocarbons or corresponding terpenoids. Online detection of VOCs using proton-transfer reaction mass spectrometry (PTR-MS) showed a significant increase in emission intensity of dominant volatiles during the first hours of the rehydration process. Twelve hours after re-watering, emission of detected volatiles had returned to the basal levels that corresponded to hydrated plants. During the early phase of rehydration malondialdehyde (MDA) content in fronds, as an indicator of membrane damage, decreased rapidly which implies that lipoxygenase activity is not stimulated during the recovery process of rustyback fern.

Antagonistic Interaction between Phosphinothricin and Nepeta rtanjensis Essential Oil Affected Ammonium Metabolism and Antioxidant Defense of Arabidopsis Grown In Vitro.

Phosphinothricin (PPT) is one of the most widely used herbicides. PTT targets glutamine synthetase (GS) activity in plants, and its phytotoxicity is ascribed to ammonium accumulation and reactive oxygen species bursts, which drives rapid lipid peroxidation of cell membranes. In agricultural fields, PPT is extensively sprayed on plant foliage; however, a portion of the herbicide reaches the soil. According to the present study, PPT absorbed via roots can be phytotoxic to Arabidopsis, inducing more adverse effects in roots than in shoots. Alterations in plant physiology caused by 10 days exposure to herbicide via roots are reflected through growth suppression, reduced chlorophyll content, perturbations in the sugar and organic acid metabolism, modifications in the activities and abundances of GS, catalase, peroxidase, and superoxide dismutase. Antagonistic interaction of Nepeta rtanjensis essential oil (NrEO) and PPT, emphasizes the existence of complex control mechanisms at the transcriptional and posttranslational level, which result in the mitigation of PPT-induced ammonium toxicity and in providing more efficient antioxidant defense of plants. Simultaneous application of the two agents in the field cannot be recommended; however, NrEO might be considered as the PPT post-treatment for reducing harmful effects of herbicide residues in the soil on non-target plants.

The PM2.5-bound polycyclic aromatic hydrocarbon behavior in indoor and outdoor environments, part I: Emission sources.

The previous research, aimed at exploring the relationships between the indoor and outdoor air quality, has evidenced that outdoor PM2.5-bound polycyclic aromatic hydrocarbons (PAH) levels exhibit significant daily and seasonal variations which does not necessary corresponds with PAH indoor dynamics. For the purpose of this study, a three-month measurement campaign was performed simultaneously at indoor and outdoor sampling sites of a university building in an urban area of Belgrade (Serbia), during which the concentrations of O3, CO, SO2, NOx, radon, PM2.5 and particle constituents including trace metals (As, Cd, Cr, Mn, Ni and Pb), ions (Cl-, Na+, Mg2+, Ca2+, K+, NO3-, SO42- and NH4+) and 16 US EPA priority PAHs were determined. Additionally, the analysis included 31 meteorological parameters, out of which 24 were obtained from Global Data Assimilation System (GDAS1) database. The Unmix and PAH diagnostic ratios analysis resolved the source profiles for both indoor and outdoor environment, which are comparable in terms of their apportionments and pollutant shares, although it should be emphasized that ratio-implied solutions should be taken with caution since these values do not reflect emission sources only. The highest contributions to air quality were attributed to sources identified as coal combustion and related pyrogenic processes. Noticeable correlations were observed between 5- and 6-ring high molecular weight PAHs, but, except for CO, no significant linear dependencies with other investigated variables were identified. The PAH level predictions in the indoor and outdoor environment was performed by using machine learning XGBoost method.

Explainable extreme gradient boosting tree-based prediction of toluene, ethylbenzene and xylene wet deposition.

Current research suggests that, apart from photochemical reactions, toluene, ethylbenzene and xylene (TEX) removal from ambient air might be affected by atmospheric precipitation, depending on the concentrations and water solubility of the compounds, Henry's law, physico-chemical properties of the water, as well as the frequency and intensity of precipitation events. Nevertheless, existing knowledge of the role that wet deposition plays in biogeochemical cycles of volatile species remains insufficient, and this topic requires more scientific effort to be explored and understood. In this study, we employed the eXtreme Gradient Boosting tree ensemble for revealing TEX transfer from ambient air to rainwater, and applied a novel SHapley Additive exPlanations feature attribution framework to examine the relevance of the monitored parameters and identify key factors that govern wet deposition of TEX. According to the results, main impacts, including ambient air TEX concentrations, and rainwater and air temperatures, and occasional, but less important impacts, including wind speed, air pressure, turbidity, and total organic carbon, NO3-, Cl- and K+ rainwater concentration, shaped TEX partition between gaseous and aqueous phases during rain events.

The importance of choice of resection procedures in T1 and T2 stage of carcinoma of the ampulla of Vater.

PURPOSE: The ampulla of Vater (AV), with its strategic location and its remarkable predisposition to the development of various malignant tumors, makes it very challenging for surgery. In this study we aimed to examine the prognostic factors in the treatment of early-stage carcinoma of the AV as well as to contribute to the choice of optimal surgical procedure. METHODS: We analyzed 109 AV patients, hospitalized at the Clinical Center of Serbia from January 1999 to December 2008 and we compared the clinicopathological features, analyzed intra- and postoperative data, recurrences and survival, according to duodenopancreatectomy (DP) or local resection (LR). RESULTS: DP was performed in 83 and LR in 26 patients. Overall survival (OS) was significantly influenced by the pathological (p) tumor stage (pT1/T2 vs pT3/T4), pathological nodal stage (pN0 vs pN1), perineural and vascular invasion, grade of tumor differentiation (G1 vs G3), and resection margin status (R0 vs R1). Kaplan-Meier analysis showed 64% 5-year overall survival of patients with pT1/T2 stage in the group with DP, and 58% in the group with LR (p>0.05). Survival analysis of pN1 patients in these two groups showed statistically significant difference (DP 49.67 vs LR 28.68 months, p<0.05). Postoperative complications occurred more frequently in patients treated with DP, compared with LR. Tumor recurrence occurred in 23.07% of LR patients and in 4.0% of DP patients, in pT1/T2 stage. The rate of in-hospital mortality was not significantly different in DP (9.78%) vs LR (0%) patients (p>0.05). CONCLUSION: Resection is mandatory for all proven AV tumors, and DP is the treatment choice. LR, due to reduced morbidity and mortality, might be recommended in elderly patients with comorbidities and in patients with stage pT1/T2, pN0 and well differentiated (G1,G2) tumors.

Assessment of PM10 pollution level and required source emission reduction in Belgrade area.

The aim of this study was to assess PM10 pollution level and estimate required source emission reduction in Belgrade area, the second largest urban center in the Balkans. Daily mass concentrations and trace metal content (As, Cd, Cr, Mn, Ni, Pb) of PM10 were evaluated for three air quality monitoring sites of different types: urban-traffic (Slavija), suburban (Lazarevac) and rural (Grabovac) under the industrial influence, during the period of 2012-13. Noncompliance with current Air Quality Standards (AQS) was noticeable: annual means were higher than AQS at Slavija and Lazarevac, and daily frequency threshold was exceeded at all three locations. Annual means of As at Lazarevac were about four times higher than the target concentration, which could be attributed to the proximity of coal-fired power plants, and dust resuspension from coal basin and nearby ash landfills. Additionally, levels of Ni and Cr were significantly higher than in other European cities. Carcinogenic health risk of inhabitants' exposure to trace metals was assessed as well. Cumulative cancer risk exceeded the upper limit of acceptable US EPA range at two sites, with Cr and As as the major contributors. To estimate source emission reduction, required to meet AQS, lognormal, Weibull and Pearson 5 probability distribution, functions (PDF) were used to fit daily PM10 concentrations. Based on the rollback equation and best fitting PDF, estimated reduction was within the range of 28-98%. Finally, the required reduction obtained using two-parameter exponential distribution suggested that risks associated to accidental releases of pollutants should be of greater concern.

Assessment of depression and anxiety in patients with chronic liver disease.

BACKGROUND/AIM: In recent years mental health of patients including those with chronic liver disease (CLD), has become interesting because its disturbance leads to reduced quality of life, that is associated with worsening of clinical outcome, reduced compliance and increased mortality. The aim of the study was to determinate the frequency and severity of depression and frequency of anxiety in patients with CLD and to assess the contribution of selected socio-demographic, clinical and laboratory risk factors for depression and anxiety. METHODS: In this cross-sectional study, we used the Hamilton depression rating scale (HDRS) and Hamilton anxiety rating scale (HARS) in patients with CLD. RESULTS: The study included 54 male and 43 female patients. Depression was present in 62.9%, and anxiety in 13.4% of the patients. A higher HDRS was noted in the patients older than 50 years (p = 0.022) and unemployed patients (p = 0.043). The patients with at least one episode of gastrointestinal bleeding had a significantly higher frequency of anxiety than those without bleeding (p = 0.018). A higher HARS score was present in the women (p = 0.011), unemployed patients (p = 0.008) and those with non-alcoholic liver disease (p = 0.007). There was a significant correlation between the mean corpuscular volume (MCV) and the value of the HDRS score, and between serum potassium and sodium levels and HDRS score. CONCLUSION: Age and the mean corpuscular volume have significant influence on the HDRS score while unemployment, gastrointestinal bleeding, serum potassium and serum sodium have predictive value for HARS score.

[Beginnings of nursing education and nurses' contribution to nursing professional development in Serbia].

The oldest records of developmental beginnings of patients' healthcare relate to the first hospital founded by St. Sava at the monastery Studenica in 1199. The profile of the Kosovian girl became the hallmark of nursing profession in Serbia. The first school for midwives was founded in 1899 at the Department of Gynecology and Obstetrics of the General State Hospital in Belgrade. However, there were no other schools for nurses in Serbia until the foundation of the School for Midwives of the Red Cross Society in 1021. Until then the healthcare of patients and the injured was carried out by self-taught volunteer nurses with completed short courses of patients' healthcare. The first course for male and female nurses was organized by the Serbian Red Cross at the beginning of the First Serbian-Turkish War in 1876. During wars with Serbian participation in 19th and 20th centuries with Serbian participation, nurses gave a remarkable contribution being exposed to extreme efforts and often sacrificing their own lives. In war times great merit belongs to the members of the humanitarian society the Circle of Serbian Sisters founded in Belgrade in 1903, which was the resource of a great number of nurses who became the pride of nursing profession. Generations of nurses were educated on their example. In 2004 the annual award "Dusica Spasic" was established which is awarded to the best medical nurse is Serbia. Dusica Spasic was a medical nurse that died at her workplace, when aged 23 years, nursing the sick from variola.

Doppler assessment of splanchnic arterial flow in patients with liver cirrhosis: correlation with ammonia plasma levels and MELD score.

PURPOSE: To assess the clinical significance of blood flow velocity and resistance index (RI) in the visceral arteries of patients with liver cirrhosis with respect to plasma ammonia (NH3) level and liver function. METHODS: We included 80 patients with liver cirrhosis (58 men) and 20 healthy controls (11 men). Duplex Doppler ultrasonography was used to assess flow velocity and RI in the hepatic (HA), right (RRA), and left renal (LRA), and splenic (SA) (LA) artery. Plasma NH3 was measured by biochemistry. Liver function was assessed by MELD score (model of end-stage liver disease). RESULTS: HA, LRA, and SA systolic flow velocities were greater, whereas RRA diastolic velocity was lower in patients with liver cirrhosis than in controls RI was higher in LRA, RRA, SA, and HA in patients with liver cirrhosis than in controls. NH3 levels were significantly elevated in all patients with liver cirrhosis (p < 0.05) and significantly correlated with RI of RRA, LRA, and SA. CONCLUSION: We found greater renal, hepatic, and LA RI in patients with liver cirrhosis than in healthy controls. The correlation we found between elevated renal artery RI (≥0.70) and MELD score emphasizes the risk of renal dysfunction during progression of liver cirrhosis.

[Cystic dystrophy of the duodenal wall in ectopic pancreas].

INTRODUCTION: Cystic dystrophy of the duodenal wall is a rare complication of the ectopic pancreas that is characterized by cyst/s formation within thickened duodenal wall. CASE OUTLINE: A 61-year-old male with recurrent abdominal pain, weight loss (about 25 kg) who had been moderate alcohol abuser and heavy smoker was presented. On ultrasonography, very thickened duodenal wall (2.5 cm), an enlarged head of the pancreas with cyst of 3 cm in diameter as well as dilated pancreatic duct (< 6 mm) were seen. Barium meal showed stenosis of the first and second part of the duodenum. CT and endoscopic ultrasound confirmed the ultrasonographic finding.The patient underwent surgery. The pathologic finding was established only on first two portions of the duodenum and limited part of the head of the pancreas along duodenum while the rest of the pancreas was normal. Due to poor general condition, gastrojejunostomy was performed. Although some improvement was evident, the patient did not become asymptomatic, and, therefore, four months later a cephalic duodenopancreatectomy was carried out which made him fully asymptomatic. A year later, the patient was symptom-free and in good health. Histologic examination showed a cystic dystrophy of the duodenal wall in the ectopic pancreas. CONCLUSION: Unless there are strong contraindications, cephalic duodenopancreatectomy is best treatment of the disease.

[Solid solitary hamartoma of the spleen].

INTRODUCTION: Hamartoma of the spleen is a rare, sometimes asymptomatic similar to hemangioma benign tumor of the spleen, which, owing to the new diagnostic imaging methods, is discovered with increasing frequency. It appears as solitary or multiple tumorous lesions. CASE OUTLINE: We present a 48-year-old woman in whom, during the investigation for Helicobacter pylori gastric infection and rectal bleeding, with ultrasonography, a mass 6.5x6.5 cm in diameter was discovered by chance within the spleen. Splenectomy was performed due to suspected lymphoma of the spleen. On histology, tumor showed to be of mixed cellular structure, with areas without white pulp, at places with marked dilatation of sinusoids and capillaries to the formation of "blood lakes" between which broad hypercellular Billroth's zones were present. Extramedullary hematopoiesis was found focally. The cells that covered vascular spaces were CD34+ and CD31+ and CD8- and CD21-. CONCLUSION: Hamartoma has to be taken into consideration always when well circumscribed hypervascular tumor within the spleen is found, particularly in children. Although the diagnosis of hamartoma may be suspected preoperatively, the exact diagnosis is established based on histological and immunohystochemistry examinations. Treatment is most often splenectomy and rarely a partial splenectomy is possible, which is recommended particularly in children.

[Mucinous cystadenomas of the liver].

INTRODUCTION: Biliary cystadenomas of the liver are rare benign tumors prone to malignant alteration so that a total excision is recommended. OBJECTIVE: The aim of the paper is to present our experience in treatment and to evaluate whether a simple ablation represents the appropriate treatment. METHODS: Over a 10-year period 25 patients (24 women) of the average age of 58 years suffering from cystadenomas of the liver, 18 in the right, 4 in the left and 3 in both lobes of the liver were operated. Twenty-three patients had a single lesion, while two patients had 3 and 6 lesions, respectively. Pain was present in 20, occasional vomiting in 4, discomfort in 2 and a sense of fullness in 2 patients.Three patients were jaundiced, 1 due to cystadenoma of the liver, 2 due to concomitant tumors of the head of the pancreas, while 5 patients had concomitant diseases. RESULTS: A total ablation was performed in 22 patients, left lateral bisegmentectomy in 1 and partial excision in 2 patients. Six additional procedures were performed. Five cystadenomas of the liver had,,ovarian like" stroma, all in women. A focal malignant alteration was found in 2 patients aged 66 and 79 years, respectively. Recurrence was registered in 1 female patient in whom a partial excision had been done. Two patients with concomitant malignancy and 1 patient who developed malignant histiocytosis six months after surgery, died after 1, 2 and 3 years, respectively. CONCLUSION: Biliary cystadenomas of the liver may be misdiagnosed as simple liver cysts, so that ,,frozen section" histology is highly recommended. In most cases the tumor may be successfully treated by ablation up to the healthy liver tissue. Major liver resections are rarely necessary.

Portal hypertension caused by postoperative superior mesenteric arteriovenous fistula.

INTRODUCTION: Arteriovenous fistula of the superior mesenteric blood vessels is a rare complicaton in abdominal surgery. CASE REPORT: We presented a 49-year-old man with cramp-like abdominal pain, abdominal distension and weight loss symptoms, with a history of previous small bowel resection and right colectomy, due to Crohn disease, 16 years ago. Clinical examination revealed a paraumbilical pulsation with systolic murmur and thrill. Ultrasonography and computed tomography revealed cystic dilatation of the superior mesenteric vein, hepatomegaly and ascites. Upper endoscopy revealed grade I esophageal varices with portal hypertensive gastropathy. The diagnosis of arteriovenous fistula between superior mesenteric artery and vein was confirmed by angiogram of the superior mesenteric vessels and resection of the fistula was performed. Control examination after nine months showed no signs of portal hypertension. CONCLUSION: Early diagnosis and treatment of mesenteric blood vessel arteriovenous fistula prevents portal hypertension development and its complications.

[Giant haemorrhagic (pseudo)cyst of the pancreas of unknown aetiology].

INTRODUCTION: Cystic lesions of the pancreas are frequent. Most frequently their aetiology can be easily established. It is very rare that the nature and aetiology of these lesions cannot be reliably established. CASE OUTLINE: A 40-year-old male without trauma, alcohol abuse, acute or chronic pancreatitis in illness history was successfully operated on for a haemorrhagic (pseudo)cyst of the back wall of the pancreas tail containing 4.5 litres of haemorrhagic content. The cyst did not contain either epithelium or tumour stroma, and the pancreas did not show any changes of acute or chronic pancreatitis. Hystology did not show signs of angiectatic pseudocyst. CONCLUSION: In spite of all efforts, the authors could not establish the real nature of the (pseudo)cyst of the pancreas or find a similar case described in the literature. Nevertheless, the authors believe that it was probably an angiectatic cyst.

[Choledochoduodenal fistula of ulcer etiology].

INTRODUCTION: Choledochoduodenal fistulas are very rare and in most cases are caused by a long-lasting and poorly treated chronic duodenal ulcer. They may be asymptomatic or followed by symptoms of ulcer disease, by attacks of cholangitis or bleeding or vomiting in cases of ductoduodenal stenosis. The diagnosis is simple and safe, however treatment is still controversial. If surgery is the choice of treatment, local findings should be taken into consideration. As a rule, intervention involving closure of fistula is not recommended. CASE OUTLINE: The authors present a 60-year-old woman with a long history of ulcer disease who developed attacks of cholangitis over the last three years. Ultrasonography and CT showed masive pneumobilia due to a choledochoduodenal fistula. As there was no duodenal stenosis or bleeding, at operation the common bile duct was transected and end-to-side choledochojejunostomy was performed using a Roux-en Y jejunal limb. From the common bile duct, multiple foreign bodies of herbal origin causing biliary obstruction and cholangitis were removed. After uneventful recovery the patient stayed symptom free for four years now. CONCLUSION: The performed operation was a simple and good surgical solution which resulted in complication-free and rapid recovery with a long-term good outcome.

Hepatic radionuclide angiography and Doppler ultrasonography in the detection and assessment of vascular disturbances in the portal system.

BACKGROUND/AIMS: The aim of the study was evaluation of the morphology of the blood vessels, blood flow velocity and direction with Doppler ultrasound (D-US) and correlation with the relative liver parenchymal perfusion assessed by hepatic radionuclide angiography (HRA). METHODOLOGY: Real-time, D-US and HRA were performed in 108 patients. RESULTS: In patients with portal venous aneurysm, hepatopetal blood flow was increased, while portal perfusion did not differ from controls. In portal hypertensive patients, D-US detected dilatation of the portal system veins, with decreased blood flow. In comparison to the portal perfusion in controls and portal venous aneurysm, values were significantly (p < 0.01) lower in chronic active hepatitis and liver cirrhosis and differed between themselves (p < 0.01). In the groups of cirrhotic patients with esophageal varices, sclerosed esophageal varices, recanalized umbilical vein, partial portal thrombosis and cavernous portal vein with hepatofugal, hyperkinetic or slow blood flow, and very low velocities beside the thrombi, portal perfusion was lower (p < 0.01) than in controls, portal venous aneurysm, chronic active hepatitis and liver cirrhosis without collaterals. In complete thrombosis, minimal collateral flow was found with D-US, while HRA proved no portal supply. CONCLUSIONS: D-US and HRA are complementary for the estimation of various liver vascular disorders.

Primary amyloidosis presenting with cholestasis and hyperkinetic portal hypertension.

Amyloidosis is not a single disease, but a series of diseases in which there is extracellular deposition of a protein in an abnormal fibrillar form. We report a 48-year old woman with subicteric coloration of scleras and hepatomegaly. Functional liver tests evidenced a high level of alkaline phosphatase and serum gamma-glutamyl transpeptidase with mild increase of bilirubin level. Color Doppler ultra-sonography, showed a hyperkinetic portal hypertension. The liver biopsy found amyloid in sinusoids subendothelially. Immunohistochemical staining for anti lambda light chain immunoglobulin was positive. Bone marrow morphology and immunohistochemistry confirmed lymphoplasmocytic lymphoma with amyloidosis.