We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
It is a cancer that develops in muscle and soft tissue. It can therefore be found in any part of the body, although most commonly in the head and neck, including the eye sockets. Despite being a rare cancer, as are all tumours in children, it is the most common cancer of the soft tissue found in childhood. This disease is more common in boys than in girls.
Although mainly found in the head and neck, it may also occur in the genitourinary system such as the bladder and prostate in boys and the vagina or uterus in girls. It may also appear in other places such as the limbs (arms and legs) and, less commonly, in the abdomen and around the genitals and anus. Symptoms vary depending on the location of the tumour.
More than half of all soft tissue sarcoma found in children are rhabdomyosarcoma. Most children are diagnosed under nine years old, but this type of cancer can appear at any age.
Different symptoms are produced depending on where tumours are located.
Malignant neoplasms are rare, but they are one of the most important causes of morbidity and mortality in this age group. Around 1,000 patients under 14 years of age are diagnosed with cancer every year in Spain. Rhabdomyosarcoma represents 6% of cancers in children meaning there are 60 new cases every year in Spain.
The child’s doctor will perform a very careful examination and to reach a diagnosis the doctor will request several tests, which may include:
These tests will help to determine the size and location of the tumour and whether it has spread to any other part of the body.
Rhabdomyosarcoma is a highly malignant type of tumour and must therefore be treated with a combination of therapies including surgery, chemotherapy and radiotherapy.
Each of these treatments is administered depending on the condition of the tumour and the age of the child.
There are currently no known measures to help prevent this type of tumour.
ECMO is a technique used in critical patients suffering from extremely serious respiratory and/or cardiovascular diseases where conventional life support is insufficient. The machine temporarily replaces lung or heart function, enabling the organs to rest while the underlying illness is treated.
The machine removes blood through a thick tube inserted into a major vein and transfers it to a centrifugal pump. The pump pushes it through an oxygenator, where oxygen is added and carbon dioxide removed. Subsequently, it is reintroduced into the patient’s body. If this is done through another vein, it is known as veno-venous (VV) ECMO and provides respiratory support. Where it is done via an artery, this is known as veno-arterial (VA) ECMO and provides support for both the heart and lungs.
ECMO is not a treatment per se but rather a support mechanism. It optimises organ recovery but does not resolve the underlying problem. In fact, one of the reasons to use the procedure is its reversibility for patients. The system is highly effective in replacing vital organ function. However, it is currently a last option for a specific patient group given its complex nature and associated risks, such as bleeding, thrombosis and infection.
Regardless of the support strategy chosen, this is a highly complex technique associated with a high risk of serious complications. That is why, in order to ensure excellent care, a well-organised programme is required, with optimal material and sufficient numbers of properly trained staff. Cases need to be clustered at leading centres and units with the necessary resources and material to ensure effectiveness, as well as a highly trained multidisciplinary team.
The Extracorporeal Life Support Organization (ELSO) is the benchmark international scientific association for ECMO. It establishes care and organisational guidelines, coordinates teaching activities and promotes research in the field. The organisation has a multi-centre database with information on over 200,000 patients. Although patients receive optimal care through ECMO with excellent survival rates, they often have later side effects due to the seriousness of their illness and the intense nature of their care, both during ECMO and with prior treatment.
Vall d’Hebron is home to two ECMO programmes. One is for adult patients and led by Dr Jordi Riera, and the other is for children and new-born patients, led by Dr Joan Balcells.
Our programmes follow ELSO guidelines at all levels, from lifelong, multidisciplinary and skill-based training for ECMO teams to filling in records for continuous assessment, as well as optimised protocols that align with our context and setting.
Our programmes take a long-term outlook, focused on getting patients back to their daily lives with maximum functional recovery. In this sense, we prioritise minimal deep sedation and safe early physical rehabilitation, even where recovery of the failed organ is still ongoing. ECMO support makes this possible by substituting heart and lung functions. Moreover, patients are able to directly interact with professionals and family members.
Veno-Arterial (VA) and Veno-Venous (VV):
The VA option provides heart and lung support by taking over organ functions. It is used when there is a cardiorespiratory problem, such as a heart attack or myocarditis (inflammation). The VV option is used to provide respiratory support and takes over lung function. It is used where there is a breathing issue, such as pneumonia or an acute blockage in the airways.
Peripheral or central line:
Patients are normally connected to an ECMO machine through cannulae (thick tubes) in the neck or groin. This is known as a peripheral line. At times, the machine needs to be directly connected to a patient’s heart or very close to the heart through the chest. This is known as a central line.
Special scenarios:
ECMO is an effective system but can pose major risks for patients. In terms of frequency and potential seriousness, these risks include bleeding and infection.
Bleeding is due to the fact that patients are often treated with blood thinners. Infection is due to receiving highly invasive therapy and the severity of the illness.
In order to minimise these risks, it is essential to have a properly trained multidisciplinary ECMO team, cluster ECMO cases and resources, and ensure robust records comparable to other consolidated external records.
Paediatric oncological surgery is the branch of paediatric surgery that is dedicated to the surgical treatment of paediatric oncological and haematological diseases and their complications. It is one of the basic pillars for the treatment of solid paediatric tumours.
These are illnesses that, due to their severity, complexity, and rareness, must be centralised in hospitals that are equipped with experienced multidisciplinary teams and the technology and medical experience necessary. The evolution of this unit has often gone hand-in-hand with the surgical advances achieved in solid organ transplants, which has allowed it to develop advanced techniques that now make enormously difficult cases operable.
Paediatric surgery is the only medical speciality exclusively dedicated to diagnosis, treatment, and post-operative care for problems which occur during the life stage between the foetal period and adolescence and which need to be treated surgically. The surgical pathologies, physiology, doctor-patient relationship, and needs of the paediatric patient are very different from those of an adult. Due to the complexity of the pathologies treated and the special needs of the paediatric patient, this type of surgery is usually restricted to tertiary centres.
VHUH’s Paediatric Surgery Department is the reference centre in Catalonia for the surgical treatment of most problems in paediatric patients, and in some procedures, it is the reference centre for the entire country, covering all areas of paediatric surgery (from organ transplants to foetal surgery, and every sub-speciality in between).
Neonatal Surgery is the sub-discipline within paediatric surgery that deals with surgically treating congenital and acquired illnesses in newborns and infants up to one month old.
This is a highly complex sub-speciality that only exists at tertiary paediatric centres. The past few decades have brought about important advances, thanks to improvements in diagnostic techniques, neonatal intensive care and anaesthetics, and surgical techniques and materials. These have radically changed the prognosis for both birth defects and acquired surgical pathologies in newborns.
Neonatal surgery requires detailed knowledge of complex pathologies in patients who also have special conditions that are different from other paediatric patients. The Neonatal and Foetal Surgery Unit covers practically every surgical neonatal pathology, and it is a reference centre both nationally and on a European level. It is part of ERNICA, the European Reference Network (ERN) for Rare Inherited and Congenital Digestive Disorders. In recent years, the Unit has been firmly committed to introducing minimally invasive surgical techniques, achieving excellent results.
The Paediatric Surgery Unit is divided into the surgical sub-specialisations of digestive surgery, neonatal and foetal surgery, maxillofacial surgery, surgical oncology, thoracic surgery and urological surgery. We are a leader in paediatric surgery in Catalonia and perform the highest number of surgical procedures in Spain. This foremost position would not be possible without the work of other hospital professionals such as anaesthetists, paediatricians, radiographers and specialists, nurses and other professionals.
Pediatric Surgery Training Itinerary
We offer residents the opportunity to master infant surgical pathology, physical examination and interpretation of clinical symptoms in patients who are often unable to express themselves or explain their medical history due to their age.
We train residents in the most common surgical techniques in the specialisation from general surgery, hepatobiliary and pancreatic surgery, colorectal surgery, oesophagogastric surgery, and paediatric digestive surgery. Our residents also carry out neonatal surgery, paediatric thoracic and surgical oncology, paediatric urology, paediatric maxillofacial surgery and paediatric plastic surgery.
Residents take part in duty shifts in all the subspecialisations of paediatric surgery with the support of the paediatric surgery staff and a resident medical intern. Laparoscopy is currently commonly used by different areas and units within the Digestive System Department, such as neonatal care and urology.
During the first two years of the residency, rotations are carried out in General Surgery, on the paediatric surgery ward, in Outpatient Surgery and Digestive Surgery. The remaining three years are spent in Urology, Oncology and Thoracic Surgery, Neonatal and Research, Maxillofacial and Plastic Surgery. The final year of training is dedicated to optional rotations, Transplant Surgery and a stay at a hospital abroad, with the option to repeat one of the previous rotations.
Residents are obliged to undertake duty shifts during their training period. Apart from the months during the general surgery rotation, duty shifts in Paediatric Surgery are carried out at the Maternity and Children's Hospital.
As far as research is concerned, participation in the department’s active lines of research is stimulated, as well as proposals for any research project that may or may not be related to them and which may result in a doctoral thesis.
The Vall d’Hebron Research Institute maintains different well-established lines of paediatric research, in areas such as experimental surgery, and foetal surgery in particular. In 2015 we created the Congenital Defects Surgery Cellular Therapy bioengineering group , which currently carries out research on spina bifida focusing on prenatal and perinatal aspects. In addition we undertake research on amniotic bands, gastroschisis, oesophageal atresia, congenital diaphragmatic hernias, diaphragmatic and labio-palatine fissure reconstruction, and research into treatments for premature birth.
In terms of clinical research, our Department has pioneered coordination of the first randomized multi-centre study on treatment of parapneumonic empyema (during which video-assisted thoracoscopic surgery is compared with drainage and fibrinolytics), and which was later published in the study “Urokinase Versus VATS for Treatment of Empyema: A Randomized Multicenter Clinical Trial”. Paediatrics.
Why should I specialise at Vall d’Hebron?
It is a cancer found in the bones and soft tissue. Ewing's sarcoma is the second most common cancer in children, and normally occurs between ten and twenty years old. It is also more common in males than in females. Ewing's sarcoma and primitive neuroectodermal tumours (PNET) are cancers encompassing different types of malignant tumours that share a common chromosomic abnormality. Ewing’s tumours are made up of small undifferentiated cells and tend to be most commonly found in the long bones of the leg or arm, in the flat bones of the ribs and pelvis, or in the spine. They may also occur in any other bone or in soft tissue.
Ewing's tumours located in soft tissue are called extraskeletal Ewing’s sarcoma. They tend to be found in the thigh, pelvis, parts of the spine, the chest wall and the foot.
Primitive neuroectodermal tumours in bones and soft tissue are the least common type of Ewing’s sarcoma. They are made up of immature nerve cells.
The most common symptoms of Ewing’s sarcoma are:
There may also be a lump or swelling around the affected bone or tissue. During diagnosis it is very common to discover a pathological fracture (a non-traumatic fracture) due the fact that the tumour has weakened the bone. Weight loss and fever are other very common symptoms of this kind of tumour.
Malignant neoplasms in children and teenagers are rare, but they are one of the most important causes of morbidity and mortality in these age groups. Ewing’s sarcoma represents 3 % of cancers diagnosed in children throughout Spain. Every year there are around 30 new cases in children under 14 years of age.
If a child shows symptoms of this sarcoma, the doctor will carry out several diagnostic tests which may include:
These tests will help to determine the size and location of the tumour and whether it has spread to other parts of the body.
Three kinds of treatment are often used to treat Ewing’s tumours. Chemotherapy is always used. In addition, surgery (whether to save or amputate the limb) and radiotherapy are used for local control of the tumour. The type of treatment depends on the child's age, the location of the tumour and whether it has spread to other parts of the body.
There are currently no measures to prevent this kind of tumour.
Epidermolysis bullosa (EB) encompasses a range of genetic diseases characterised by excessive fragility of the skin and mucous membranes when subjected to minimal trauma. The disease appears at birth or during the first few years of life, and lasts a lifetime. Prognosis is variable, but tends to be serious. Life expectancy is 50 years, and the disease brings with it complications related to infections, nutrition and neoplastic complications. There is currently no effective treatment available.
Depending on the area of skin where blistering occurs, the disease can be divided into four main groups, and subsequently 32 subgroups.
The most common cutaneous symptoms are blisters in the areas of greatest friction such as on the hands and feet. They are skin lesions that bleed and may form scabs that are easily infected and that itch constantly. Scratching contributes to new lesions and secondary infections of already affected areas.
Once blisters have healed, millium cysts appear, atrophic or hypertrophic scars that produce webbed hands and feet, joint contractures, as well as aesthetic and functionally limiting deformities in the hands or that affect walking. All this leads to loss of independence.
In addition, the chronic wounds may produce highly aggressive skin carcinoma.
Aside from this, extracutaneous manifestations may result, such as involvement of the skin annexes, teeth and the gastrointestinal systems, the urinary tract and the respiratory epithelium.
The disease has a low prevalence rate and affects one in every 17,000 live births worldwide.
The main method of diagnosis is mapping using immunofluorescence and electron microscopy techniques. In addition, genetic diagnosis is mandatory for these patients as the disease may have different evolutions and prognoses.
Although it is being researched, at the moment there is no cure for this disease, but preventative and symptomatic treatment of skin lesions can be carried out, as well as treatment for systemic complications. When the disease appears it is vital to act quickly as patients’ life expectancy and quality of life depends on it.
Currently, new cellular and molecular therapies are being researched to combat the disease.
Neuroblastoma is one of the most common cancers in children under five, and makes up half of all cancers in babies. It is very unusual for this type of cancer to occur in older children or teenagers. Neuroblastoma starts in embryo cells made up of ganglia from the sympathetic nervous system and adrenal medulla, and therefore may appear in different locations and with many different clinical presentations.
It is not currently known what causes them, but they are understood to often be hereditary. Approximately two thirds of neuroblastoma occur in the adrenal glands (found above the kidneys) or near the spinal cord in the nerve cells that control the heart beat, blood pressure and digestion. Neuroblastoma may also appear in the chest, neck or pelvis. During diagnosis they are often found to have already spread; there may be metastasis in the lymph nodes, liver, bones, bone marrow or other organs.
Neuroblastoma may be divided into two types of tumour:
The first symptoms of neuroblastoma may be imprecise and include fatigue, weight loss or weight gain.
Abdominal tumours may cause abdominal pain or difficulty urinating or with bowel movements.
Tumours pressing on the spinal cord may cause weakness in the arms and legs and the patient may find it difficult to move their arms or to walk.
If the tumour has spread to the bones, it may cause pain and, if it has spread around the eyes, it may cause bulging eyes and dark circles. There may also be inflammation or a lump around the affected tissue. Other less common symptoms are weight loss and fever.
Malignant neoplasms in children and teenagers are rare, but they are one of the most important causes of morbidity and mortality in these age groups. Around 1,000 patients under 14 years of age are diagnosed with cancer every year in Spain. Neuroblastoma makes up 10% of cancers in children.
If the doctor believes the child may have a neuroblastoma, he/she will carry out a very precise examination and request several diagnostic tests to determine the size and location of the tumour. The most common tests are:
Treatment is administered taking into account the state of the disease, the child’s age and the location of the tumour.
Some low-risk neuroblastoma may disappear without treatment, and others can be cured with surgical treatment alone. However, many tumours in the “high-risk” category will already have spread tumour cells to other parts of the body, and in these cases it is necessary to use a combination of chemotherapy, surgery, radiotherapy, bone marrow transplant and immunotherapy.
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