Early thrombosis of a polytetrafluoroethylene (PTFE) graft used for hemodialysis vascular access can result from technical error or hypotension and hypovolaemia in the immediate postoperative period. Massaging a graft to dislodge a freshly formed thrombus with a view to restoring blood flow can lead to acute limb ischaemia from embolisation of the artery as a result of migration of the thrombus from the arterial end of the graft, hence massaging of thrombosed grafts should be avoided. This report describes the management of a 35-year-old diabetic male who developed acute ischaemia of hand due to embolisation of the radial artery following massage of a thrombosed brachio-basilic forearm PTFE loop graft.

Natural orifice transluminal endoscopic surgery (NOTES), which utilises natural anatomical passages for gaining access to the intra-abdominal organs for surgical interventions, that result in scarless surgery, is a recent advancement in the specialty of minimally invasive surgery and has gained significant momentum, It has been postulated as a promising alternative to laparoscopic surgery in the fi eld of minimal invasive surgery. Signifi cant advantages over conventional open surgery, such as less postoperative pain, a shorter hospital stay, early return to activity, avoidance of woundrelated complications and better cosmesis have been demonstrated. This article provides an update in the development, principles, practice and future applications of NOTES. Keywords: natural orifice, minimally invasive, scarless, endoscopic surgery.

General Surgery is a broad surgical specialty that focuses on diseases related to abdominal organs,skins and hernias, both in elective and emergency settings. With the prevalent trend for increasingsubspecialisation in today's surgical practice, general surgery has lost some of its former glory andscope. This has led to suffering of the image of the general surgeons (GS) in the eyes of trainees,peers, the public and even GS themselves. A comprehensive review of literature is presented toaddress the controversy surrounding the role and future of general and specialist surgeons in thecurrent perspectives.Key Words: emergency, general surgeons, specialists, surgery