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Dysphasia has many causes, most commonly cerebrovascular accident or transient cerebral ischaemia. Four patients presented with acute dysphasia to the Department of Emergency Medicine at Fremantle Hospital within four months. Although the aetiologies were diverse and unusual, in each case the speech disturbance resolved completely with appropriate treatment.

Paraduodenal hernia is a rare congenital internal hernia which arises from an error of rotation of the midgut with entrapment of the small intestine beneath the developing colon. It is important as it usually presents as intestinal obstruction, and before laparotomy is often misdiagnosed. Mortality increases significantly with delays in surgical treatment. Two cases are presented: an 8 year old boy and a 52 year old man. Both presented with a short history of abdominal pain and an acute abdomen. With prompt surgical treatment, they recovered rapidly.

OBJECTIVE To describe the incidence and natural history of bites from the quokka, a small wallaby. DESIGN A prospective case series. SETTING Rottnest Island Nursing Post, a small hospital staffed by registered nurses on call 24 hours a day, located on Rottnest Island 18 km off the coast of Western Australia near Perth. PATIENTS All patients presenting after a bite from a quokka. RESULTS Seventy-two patients (30 males and 42 females) presented after a bite. All but two patients were patting or feeding a quokka at the time of being bitten, and all but two were bitten on a finger or the thumb. Sixty-one per cent of patients were followed up; all wounds healed without complications. No wound pathogens were cultured from either wound swabs or swabs of the mouths of quokkas. CONCLUSIONS Bites from quokkas heal without complications, usually in two to three weeks. Simple first aid and tetanus prophylaxis where appropriate are all that is required. Antibiotics are not indicated.

Summary This report presents studies of a case of hypoproteinemia, chylous ascites, steatorrhea, and protein-losing enteropathy due to chronic inflammatory obstruction of major intestinal lymph vessels. These studies provide further evidence in support of lymphatic obstruction as an important factor in the pathogenesis of hypoproteinemia with protein-losing enteropathy in some patients.