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The surgeons that ensure humanitarian assignments (in non-governmental organizations) must operate, most often in difficult material conditions, injured and ill patients whose conditions belong the most various fields of surgery, in both war and peace practice. The evolution of surgical training towards overspecialization proves to be less and less compatible with the requirements of such assignments.

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The number of preoperative studies is soaring due to the increase in paraclinical investigational means. Some of these assessments are regarded as superfluous. Since the future evolution of technology will inevitably further increase this item of Health costs, we should consider our possibilities for action within the limits of professional liability case law.

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History case of a patient treated for a bilateral orbital inflammatory pseudotumor has been rehospitalised for generalised lymphoma, despite the histological features of this tumor which evoked a pseudo-tumor. This error seems to be frequent because of the difficulties for the histological investigation of the tumor. Actually the application of immunohistochemical techniques and the study of immunoglobulin gene DNA rearrangement patterns allows the diagnosis. Often most of the orbital lymphomas, though apparently isolated, represent a localization of a systemic disease. Their treatment consists in either of radiotherapy in low grade malignancy localized cases or in chemotherapy in the others sometimes associated to radiotherapy.

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The authors report three cases of streptococcal cellulitis of the hand with gangrene. The severity of this disease is underlined. Occasionally, segmentary amputation may be necessary. Onset of gangrene may be explained by a double mechanism : streptococcal infection may induce vasculitis obliterans of the regional vessels, extensive edema with ecchymosis may be a factor of segmental compression. Treatment should include excision of the entrance door, antibiotherapy and fasciotomy as needed.

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The treatment of pain after digital amputation consists of surgical treatment if the pain is due to excessive nociception on the nerve. With micro-surgical technique, it is possible, like Samii, to suture some of the fascicles into central direction with the other nerves fascicles, after resection of the nervroma; or to anastomose the nerve with the other nerve, if we have two nevromas on the same digital amputation stump. Results of this technique are generally progressive disappearance of the pain.

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Twenty-five out of 26 consecutive wrist fusions carried out by means of staple fixation alone had follow-up for an average of 40 months. This technique avoids corticocancellous bone grafting, achieves good stability in variable wrist positions with minimal splintage, and seems to avoid serious complications. Fusion occurred in 25 cases in an average of 3 1/5 months with complications in three cases and uneventful results in 22 cases (88%). Two patients were operated on a second time. Fifty-six percent of this patient population requested removal of the staples. This technique does not shorten the time to fusion, but it does obviate extensive plaster immobilization and the morbidity rate of bone grafting.

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A case of ulnar artery occlusion following repeated micro-trauma to one hand is reported. Following resection of the diseased portion of the artery and reconstruction with an interposition vein graft. The patient recovered normal use of the hand. Pathologic examination of the artery confirmed the operative findings. This case is typical of the vascular problems of the hand associated with certain occupations.

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Sixty-four patients with a Pouteau-Colles fracture of the wrist were reviewed. Different aspects of mal-union are correlated with subsequent function. A suitable classification is proposed.

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Authors report two new cases of oculo-dento-digital syndrome, besides the classical findings concerning the eyes, nose and upper extremities, they noted a relative shortening of the skeletal structure of the ocular maxillary region. This syndrome is thought to be an hereditary disease compatible with autosomal dominant inheritance.

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