Our experience of 90 hepatectomies (HE) and examinations of 64 cadaver livers resulted in the elaboration of a simplified technique for the exposure of hepatic pedicles (HP) and the rapid selective ligation without significant normothermal ischemia of the retained parts of the liver. The method comprises 4 consecutive steps: 1) a superficial T-shaped incision of Glisson's capsule at the site of HP projection on the liver's inferior surface, 2) introduction of the surgeon's forefinger into the liver parenchyma, controlled by clamping the hepatoduodenal ligament, the fingertip finding a tubular structure well distinguished by its smooth elastic surface from the friable parenchyma and bending the finger to hook the pedicle, 3) drawing the hooked pedicle downwards through the slit in the capsule and temporarily clamping it, while releasing the hepatoduodenal ligament so as to restore blood supply to the retained parts of the liver, 4) checking for correct ligature position on the HP before its final ligation by matching the actual ischemic area with the intended line of resection and moving the clamp proximally or distally along the exposed pedicle for the release or clamping of lateral branches as necessary. Whereupon resection can be performed by any of the known methods. This method has been used in 8 major HE, allowing to reduce intraoperative blood loss from 2200±247 ml to 1000±225 ml and reducing general liver ischemia from 10 minutes and more to 2–3 minutes.

AIM: to present clinical variability of perianal infection (PI), developed in the debut of oncohematological disease and to determine the factors that impede PI relief and time of antitumor treatment initiation, as well as the causes of complications during chemotherapy (ChT).PATIENTS AND METHODS: the analysis included 8 patients with an infectious process in the perianal region developed in the debut of hemoblastosis and aplastic anemia (before ChT).RESULTS: in 5 of 8 patients there was a long time between start of PI and the start of ChT for hemoblastosis, from 18 to 49 days. The impediment for a favorable time to start ChT were not clarified diagnosis of hemoblastosis (acute myeloid leukemia – 2 cases, multiple myeloma – 1, lymphoma – 1) and the ongoing infectious process in patients with severe granulocytopenia (GCP). Usually undetected hematological malignancies were observed in patients with compensated data of haemogram. Complications during ChT were associated with recurrence of PI in the area of surgery (palliative drainage of anorectal abscess and fistula-in-ano) and of the sepsis with persisted inflammation in the postoperative wound on the background of GCP.CONCLUSION: PI is one of the infectious complications peculiar for the debut of oncohematological disease. Therefore, a general blood test with leukocyte formula should be performed before surgery in all patients with paraproctitis to exclude hemoblastosis. The unknown diagnosis of hemoblastosis and the ineffectiveness of surgical treatment of paraproctitis in patients with severe GCP were the main reasons for the delay in the beginning of antitumor treatment in this study. Persistent infection (fistula-in-ano) and the persistent inflammation in the wound on the background of the GCP has resulted in the recurrence of PI and sepsis during chemotherapy.

Breast implant-associated anaplastic large-cell lymphoma will be identified as a separate nosological entity in the 2017 adapted WHO classification due to differences in its clinical presentations, pathogenesis, and prognosis with those of nodal and cutaneous anaplastic large-cell lymphomas. The paper gives a review of the literature and describes the authors' own clinical case of common breast implant-associated anaplastic large-cell lymphoma involving breast tissue, axillary lymph nodes, anterior chest muscles, and bone marrow. The treatment policy chosen by the authors could achieve complete remission.

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