Adolescent gynaecology is increasingly recognized as an area in which specific knowledge and expertise is required to ensure the best outcome. Gynaecological problems in adolescents are common and, although serious disease is rare, distress and discomfort can be significant. Adolescent girls are under great pressure, particularly in terms of examination performance, and problems such as menstrual dysfunction can be particularly difficult to manage. Careful and sympathetic assessment is crucial, and simple treatment remedies may be sufficient. Complex and rare medical conditions can also occur and must not be missed. Some congenital disorders present for the first time in adolescence. Early detection and appropriate treatment ensures the best possible outcome in terms of sexual function and potential fertility. © 2008 Elsevier Ltd. All rights reserved.

Transfusion-related lung injury (TRALI) is the leading cause of mortality following transfusion of blood products. Despite increasing awareness, the condition often remains unrecognised and therefore underreported. A 28-year-old with moderate preeclampsia had a post-partum haemorrhage following emergency caesarean section. Shortly after receiving three units of packed red cells she went into respiratory failure, which progressed to cardiac arrest. She was successfully resuscitated and made a slow but full recovery. Investigation through the National Blood Service confirmed the diagnosis of TRALI. TRALI is an increasingly common life-threatening complication of blood transfusion and should be included in the differential diagnosis of collapse in an obstetric patient who has recently received a blood product transfusion. © 2007 Elsevier Ltd. All rights reserved.

Objective: To establish the spectrum of presentation, natural history and gynaecological outcomes in women with Swyer syndrome. Design: Retrospective notes review. Setting: Tertiary referral centre for disorders of sex development. Population: A total of 29 adult women with Swyer syndrome. Methods: Information was collected on age at diagnosis, biometric characteristics, timing of gonadectomy, histology of gonad, bone mineral density, uterine size and fertility. Main outcome measures: Age at diagnosis, risk of gonadal malignancy, bone mineral density, uterine size. Results: With regard to presentation, 26/29 (90{%}) women in this series presented with delayed puberty, and the median age at diagnosis was 17.2 years (range 0-55 years). The median age at gonadectomy was 18 years (range 9-33 years). Histology of the gonad was available in 22 women and demonstrated streak gonads with no evidence of malignancy in 12, dysgerminoma in 7 and gonadoblastoma in 3. The youngest patient diagnosed with dysgerminoma was 10 years old. The median height of the women was 1.73 m (range 1.54-1.95 m). Twelve out of the 20 (60{%}) women had evidence of osteopenia on dual energy X-ray absorptiometry scan. The uterine size and shape was assessed in eight women after completion of induction of puberty, and the uterine cross-section was found to be significantly lower than that in normal controls. Fertility was achieved with ovum donation in three women, all of whom had live births and one subsequently had a second successful pregnancy. Conclusion: Early diagnosis of Swyer syndrome is necessary in view of the risk of dysgerminoma that can develop at an early age. Adequate hormone replacement is required to maintain bone mineral density and may improve the uterine size and shape. © 2008 The Authors.