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.
Below we will list the departments and units that form part of Vall d’Hebron Hospital and the main diseases that we treat. We will also make recommendations based on advice backed up by scientific evidence that has been shown to be effective in guaranteeing well-being and quality of life.
Vols saber com serà la teva estada a l’Hospital Universitari Vall d’Hebron? Aquí trobaràs tota la informació.
Colposcopy allows an in-depth examination of the uterus, or cervix, for early identification of possible lesions that could be precursors to cancer or cancerous lesions. This is done using a special microscope called a colposcope, which is used to find out the cause of an "abnormal" cytology. During the exploration, gynaecologists study the cervix and decide whether a biopsy should be taken and from what area. They can also remove certain tissues, if necessary. For the biopsy, a small sample is taken and sent to the laboratory to examine the cells. From this examination, the doctors can diagnose and decide on treatment, if necessary.
This technique is used for early detection of lesions that could trigger cancer of the cervix and also to take samples to diagnose and even remove tissues.
This exploration also lets us diagnose other sexually transmitted infections in addition to HPV.
To perform the test, the patient should be placed on the gynaecological stretcher with legs in stirrups.
The doctor then inserts a device inside the vagina, the speculum, which separates the walls, and then brings the colposcope, which lets them see the area to be examined. If they detect anomalous areas during examination, they can decide whether to take a biopsy of the tissue that must be analysed later with a microscope in the laboratory.
Anomalies detected in a cervical biopsy are called cervical intraepithelial neoplasms (CIN) and are classified as:
Possible discomfort while taking the sample and, sometimes, light bleeding that can last up to 3 or 4 days.
Cervicovaginal cytology, also called a Pap smear test, is used to take a sample of cells from the wall of the uterus, or cervix, to be analysed to detect abnormal changes in the cells there due to the human papillomavirus (HPV), before cancer or infections develop. If the test shows the presence of HPV, the doctor may request other tests, such as a colposcopy (link to colposcopy).
Cervical-vaginal cytology is used to detect cervix cancer early on, as well as other precancerous abnormalities of the cervix to help us provide early treatment, which increases the chances of recovering from the disease.
The patient lies on a stretcher with their legs in stirrups for gynaecological examination, as the doctor performing the test inserts a speculum into the vagina. This device allows us to separate the walls of the vagina to see the cervix.
The doctor performing the test can then extract a sample of the walls of the vagina or vaginal exudate at the back of this area. A second sample is taken from the external part of the cervix, the ectocervix, and another sample from the cervix canal that connects the interior of the uterine cavity with the vagina, also called the endocervix.
Finally, these samples are sent to the laboratory, where they will be analysed with a microscope.
To do this test, no preparation is necessary beforehand, though it is recommended that the patient not be on her period, to avoid possible errors.
There are no risks, though sometimes bleeding may occur when the sample is taken, but this will not usually last more than one day.
The patient should try to remain relaxed during the test, since if the vagina contracts, the test can cause some discomfort.
Gynaecological ultrasound is a technique that uses ultrasound to visualise the inside of women’s genitalia.
The ultrasound plays a fundamental role in detecting benign and malignant pathologies in gynaecology: such as endometrial pathology, myomas, adnexal lumps, urinary incontinence and oncological pathology. At Vall d'Hebron, this Unit is part of the Gynaecology Department. Early diagnosis is essential, as in ovarian cancer.
It is performed preferably via the vagina or abdomen, the transperineal or transrectal method being less frequent.
The Ultrasound should not be performed every year, the frequency will be determined by the gynaecologist and can be of use to all units in the Gynaecology Department: Oncology, General Gynaecology, Pelvic Floor, Laparoscopy and Endoscopy. The Doppler allows us to analyse vascularisation of suspected malignant tissue, in cases of abundant vascularisation and low resistance rates.
It is essential for patients to actively participate in the monitoring and treatment of their disease to increase their personal satisfaction and autonomy. Having reliable, verifiable information is also of great help in managing the disease.
Hereditary angioedema is such a rare disease that it is little-known even among healthcare workers. This means that in this case the patients themselves particularly need to know how to act in the event of an emergency, especially when they are not in their usual environment or are far away from their medical team.
It is advisable, as far as possible, to avoid possible triggers or aggravators of attacks:
The following symptoms indicate a suspected case:
The doctor must make a correct differential diagnosis in order to rule out other causes, such as appendicitis.
In this case it is important to remain calm and follow the doctor’s instructions. Here is some general advice:
1. Ask someone to help you explain what is happening to you.
2. Have the clinical report issued to you by your doctor at the ready.
3. If you have rescue or emergency medication (intravenous Berinert® or Cinryze®, or subcutaneous Firazyr®):
a) If you have been taught how, self-administer it in accordance with the instructions.
b) If you cannot administer it yourself, take it with you to the health centre.
4. Go to your nearest health centre for emergency treatment.
5. Make an appointment with your specialist once the immediate crisis has been dealt with.
In the case of a significant symptom burden in type I and II angioedemas, C1-INH may be administered as a prophylaxis.
TRANSFUSIONS – CAN I GIVE BLOOD?
It is not advisable for patients with hereditary angioedema of any type or acquired C1-inhibitor deficiency to donate blood.
LONG OR FOREIGN TRIPS
We recommend you take an up-to-date copy of the clinical report issued by your doctor with you. It is a good idea to have the report translated into the language of your destination or English.
Find out where the nearest healthcare centre is.
Always carry rescue or emergency medication with you and make sure it has not expired. Have your medical report to hand at security controls at airports or railway stations to avoid problems.
DIET
You do not have a follow a special diet because it is not an allergic oedema and it is not caused or triggered by a food allergy.
Diet does not have any impact on the evolution of the disease. You should, of course, follow the healthy diet recommendations issued to everyone.
Les pràctiques saludables per evitar les infeccions de transmissió sexual (ITS) es basen, per un costat, en un comportament sexual de menys risc amb l’ús del preservatiu i, per l’altre, en l’educació, el diagnòstic, el tractament precoç, la detecció de les infeccions asimptomàtiques, l’estudi de les parelles sexuals i la immunització amb vacunes. És essencial la recerca activa de contactes per tallar la transmissió i prevenir la reinfecció.
La societat demana cada vegada més informació sobre les infeccions de transmissió sexual: l’única manera d’evitar-les és amb la prevenció, però també és important proporcionar informació sobre pràctiques de sexe segur.
Les infeccions de transmissió sexual figuren entre les cinc categories principals per les quals els adults cerquen atenció mèdica. Comprenen una sèrie de patologies, d’etiologia diversa, en les quals la transmissió sexual és rellevant des del punt de vista epidemiològic. Tot i això, de vegades pot haver-hi altres mecanismes de contagi, com ara la transmissió perinatal o parenteral.
Les intervencions d’assessorament i els enfocaments conductuals representen la prevenció primària contra les ITS, que inclouen:
Així mateix, l’assessorament pot millorar la capacitat de les persones per reconèixer els símptomes de les ITS, amb la qual cosa augmentaran les probabilitats que aquests sol·licitin atenció i animin les seves parelles sexuals a fer-ho.
Malauradament, la manca de sensibilitat de la població i l’arrelat estigma generalitzat vers les ITS segueixen dificultant l’eficàcia de les intervencions sanitàries.
L’estudi dels contactes en les ITS és el procés pel qual les parelles sexuals d’un pacient diagnosticat amb una ITS són identificades i informades del risc de contraure aquesta infecció, i se’ls ofereix atenció i tractament per un professional sanitari. L’estudi de les parelles té beneficis clínics i de salut pública per tres raons:
L’epidemiologia de les ITS està canviant en els últims anys i s’observa una nova emergència d’aquestes infeccions. Aquest fenomen va associat a les noves pautes de comportament: l’ús de noves tecnologies per a la cerca de parelles sexuals, l’alta mobilitat de la població, la relaxació en l’ús del preservatiu, etc.
El panorama anterior fa inqüestionable l’adopció de noves estratègies de control i prevenció, entre les quals hem d’incloure els estudis de contactes i tota la seva riquesa metodològica basada en l’evidència científica.
Hereditary angioedema is a rare genetic disease that affects approximately one in 50,000 people. It is usually an inherited disorder and is characterised by the accumulation of fluids outside the blood vessels, causing swelling of the face, hands, feet, extremities, genitals, gastrointestinal tract or the upper respiratory tract. Because it is a low-prevalence disease with symptoms similar to those of other diseases and is therefore difficult to diagnose, it is important for there to be reference centres so that suspected and diagnosed cases can be centralised.
The inflammation that hereditary angioedema causes does not present associated itching and may last for 1 to 5 days. These symptoms are developed as a result of the malfunction of certain proteins that help maintain the normal flow of fluids through the blood vessels (arteries, veins and capillaries).
The seriousness of the disease shows a significant degree of variance. Angioedema episodes may be extremely incapacitating and have a serious effect on the patent’s quality of life. When it occurs in the region of the mouth or neck, the sufferer may die of asphyxia if they are not given preventive treatment.
In most cases symptoms start to manifest in childhood and/or puberty and continue throughout adult life.
There are different types of hereditary angioedema and they are classified according to whether or not they present a deficiency of the C1 component of the complement (C1-INH).
Swelling of the subcutaneous tissue in any part of the body, although it is most commonly found in:
Depending on the affected area, the symptoms may range from local discomfort to invalidity of the affected extremity, discomfort or pain when swallowing, voice changes, loss of voice, or dyspnoea (shortness of breath).
At one time of their life up to 50% of patients may present an episode that affects the throat, which if not immediately treated could lead to asphyxia.
Hereditary angioedema affects people who exhibit a mutation in certain genes, such as SERPING1, F12, PLG, KNG1 and ANGPT1. As it is a dominant autosomal disease, an affected patient has a 50% chance of passing it on to their children. Given that it is a genetic disorder, it is common to find that more than one member of the family is affected.
Depending on the type of mutation, it may affect men and women equally (types I and II) or women more frequently (HAE-nC1-INH). Cases of hereditary angioedema without C1-INH deficiency are usually associated with hyperoestrogenic states, such as pregnancy or the consumption of contraceptives that contain oestrogens.
The Allergology Clinic first assesses patients who present with recurring angioedema episodes and cases in which there are family members who also suffer them. Subsequently, a blood analysis is requested to determine the levels of the components of the complement, including the inhibitor of component C1 (C1-INH) and, finally, the diagnosis is completed with a genetic study.
Treatment depends on the number of attacks, the severity of the symptoms and the degree to which quality of life is affected. Treatment is always on a case-by-case basis and may be acute, which means the subcutaneous of intravenous administration of medication at the time of the angioedema attack, or preventive, to stop attacks occurring so frequently. The latter treatment is usually recommended for the patients who suffer the most episodes.
Angioedema treatments can be self-administered by the patients.
In the case of surgery, endoscopies, tooth extractions or certain dental procedures, treatment must be given in advance to prevent an attack.
Blood analysis normally forms part of the diagnostic procedure. Depending on the treatment, during monitoring it may be necessary to perform an abdominal ultrasound and draw blood for analysis.
Factors known to possibly trigger attacks should be avoided as far as possible:
Cancer is characterised by excessive and uncontrolled cell growth that invades and damages tissues and organs. It is a multi-factor illness that is caused by a combination of genetic and environmental factors. Most cancers are sporadic, but some 5 to 10% of cancer diagnoses involve a hereditary genetic origin. This means that specific genes, called cancer susceptibility genes, present germ cell abnormalities (found throughout the body) that increase the risk of developing cancer. It's important to point out that cancer is NOT hereditary, but the predisposition to developing it is. Having genes that are associated with cancer susceptibility simply means you have a higher risk of having the disease, not that you will have cancer for sure. This genetic predisposition can be transmitted from parents to offspring, normally following an autosomal dominant inheritance pattern, meaning that there is a 50% chance of passing the gene to descendants. In some cases, the genetic susceptibility is individual and caused by a combination of multiple genetic differences (a combination of low-risk polymorphisms or allele variants). Identifying a genetic abnormality known to increase the risk of developing cancer in a family allows its members to benefit from early cancer detection and prevention measures, as well as to seek specific, targeted treatments against that type of cancer.
There are different genes associated with an increased risk of falling ill with cancer. Among the most frequent and well known are the genes:
The genes APC and MUTYH, linked with familial adenomatous polyposis –the formation of a large number of adenomatous polyps (non-malignant tumours) in the colon– and colon cancer.
There are different clinical criteria that may arouse the suspicion that an individual has a hereditary genetic abnormality that predisposes them to certain kinds of cancer, such as:
When these criteria are detected, they are referred to the genetic assessment unit specialising in cancer, where the need to perform a genetic study to rule out the possibility of a hereditary predisposition to cancer will be determined. This multi-disciplinary unit is staffed by physicians who are specialists in hereditary cancer and genetic counsellors. Here, an individual risk assessment, genetic tests, and follow-up for the carriers of the gene are carried out.
There are different syndromes that involve a genetic predisposition to developing cancer. For example, there are different genes that can make someone have a genetic predisposition to breast cancer.The most common are:
The genetic predisposition to developing colon cancer can be divided into two types: polyposic and non-polyposic.
There are different types of polyposic colon cancer. Familial adenomatous polyposis (FAP) presents the highest risk for developing colon cancer. It is characterised by hundreds or thousands of polyps in the colon, and sometimes also throughout the entire digestive tract. These polyps are not malignant lesions, but they can degenerate and develop into cancer.Thus, individuals with FAP end up developing colon cancer if these polyps are not removed. Pathogenic alterations in the APC gene are responsible for this condition. In addition, carriers of APC gene mutations are also at risk for other tumours or conditions (hepatoblastoma, thyroid tumours, and desmoid tumours).
The main syndrome entailing a predisposition to non-polyposic colon cancer is Lynch syndrome. This syndrome entails a high risk of developing colon and endometrial cancer, along with a risk of developing ovarian, bile duct, urinary tract, and gastric cancer. It is caused by mutations in the genes that are in charge of DNA repair, specifically, those tasked with mismatch repair, namely MLH1, MSH2, MSH6, PMS2, and EPCAM.
We can also find a genetic predisposition to endocrine tumours. Pheochromocytomas and paragangliomas are rare tumours that are caused by a hereditary genetic abnormality in 40% of cases. These can be caused by abnormalities in the succinate-dehydrogenase-encoding genes (SDHx), RET gene (MEN2 syndrome), MEN1 gene, NF1 gene (neurofibromatosis type 1) or FH gene, among others.
A genetic diagnosis is usually done with a blood sample, but a saliva sample or skin biopsy can also be used. DNA (present in the nucleus of our cells) is extracted from this sample for analysis.
There are different techniques for carrying out genetic studies. Currently, at our centre, we perform gene panel studies. This entails analysing different genes linked with the genetic predisposition to cancer to rule out any abnormality in them; this is also called gene sequencing.
When a genetic abnormality is found in a family, a predictive study is carried out. This kind of study determines if an individual also presents the genetic abnormality detected in the family.
Depending on the genetic change found, different measures for early detection and prevention can be recommended. For example, individuals with a mutated BRCA1/2 gene should begin to undergo an annual breast check-up, with a breast MRI and a mammogram, from the time they are 25-30 years old. Individuals with Lynch syndrome should get annual colonoscopies from the age of 25 onward.
Depending on the type of genetic disorder, risk reduction surgeries can also be an option. For example, in individuals diagnosed with FAP, depending on the number of polyps they have, a prophylactic colectomy (removal of the colon) can be performed to reduce their risk of developing colon cancer.
Follow-up and prevention measures are determined on an individual basis in the corresponding specialist's medical consultation. Additionally, at the medical office in charge of hereditary cancer, a reproductive genetic assessment is offered, depending on the genetic abnormality.
A urinary tract infection is defined as the presence of invasive bacteria in the urinary system, together with signs of inflammation, such as high temperature and local pain.
Urinary tract infections may be located in the lower urinary tract (bladder and urethra), or the upper urinary system, affecting one or both kidneys. A kidney infection is also known as pyelonephritis.
Infections of the lower urinary tract are characterised by localised pain, which increases when urinating, and sometimes by cloudy or dark urine, usually without high temperatures.
Kidney infections (pyelonephritis) are characterised by high temperatures, acute local pain in the lower back, and pain or irritation when urinating.
Urinary tract infection is characterised by the presence of local pain (lower abdomen or lumbar region), which increases when urinating. The urine is often cloudy, or dark if it contains blood. There may be high fever, especially in the case of pyelonephritis (an infection of the upper urinary tract).
It can affect people at any age, from early childhood to old age. It is more frequent among women and there are factors that make people vulnerable to it (pregnancy for women and enlarged prostate for men) as well as urological anomalies (pre-existing malformation or presence of kidney stones).
Urinary infections are diagnosed by examining urine under the microscope (sediment) to see whether it contains white blood cells and/or bacteria, and by cultivating the bacteria in a microbiological culture to identify the strain and determine the most appropriate antibiotic for treatment (antibiotic susceptibility testing).
Urinary tract infections are usually treated with antibiotics. Treatment is oral in the case of lower-tract infection.
For upper-tract infections (pyelonephritis) it is usually intravenous, although in some cases outpatient oral treatment may be administered.
The standard tests are urine sediment and culture (urine culture with antibiotic susceptibility testing). An ultrasound scan may be indicated for examining the kidney and urinary tract and identifying obstructions or kidney stones that may have brought about the infection.
Ultrasounds are also used to assess the state of the kidneys. A general analysis may also be indicated to see how the urinary tract infection is affecting the rest of the body, and specifically the renal function.
Urinary tract infection can be prevented by frequent urination (every 2 to 3 hours) and, above all, by avoiding the habit of holding in urine, and by going to the toilet whenever the bladder feels full, without waiting too long.
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