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.
Multiple sclerosis is a progressive disease of the central nervous system, disabling, chronic and with a high degree of complexity and heterogeneity. Specialised multidisciplinary care is therefore required during diagnosis, follow-up and treatment.
Current evidence is insufficient to give advice on preventing multiple sclerosis. It is, however, advised that your have a healthy lifestyle and carry out activities as normal. Multiple sclerosis affects women more than men, often appears in young adults and is the second biggest cause of non-traumatic disability.
When agreeing with the patient to start them on a drug to treat symptoms or multiple sclerosis itself:
The symptoms of multiple sclerosis can vary greatly, so you are advised to consult specialists when you feel:
Although there is no scientific evidence that allows us to make concrete recommendations to prevent or change the course of the illness, there is a whole host of advice about diet, habits and physical exercise that patients and, in general, the entire population, should bear in mind:
You are also advised, should you suffer fatigue, to continue daily activity and stay active, combining moments of activity with moments of relaxation as well as to seek energy-saving strategies.
Vitamin D has an important role to play in relation to the illness, which is being researched intensively. Often, people affected present a deficiency of this vitamin, so you are advised to take a supplement under instructions and supervision by your specialist.
Multiple sclerosis is a complex and chronic illness, so it is recommended that those around the person affected are given adequate and comprehensive information. It is also a good idea to have access to ongoing advice whenever necessary.
The family or professional carer, where necessary, may need training and practical advice on topics such as diet, hygiene and the patient’s mobility.
Health education in the diagnosis, at the beginning of the treatment and for the mobilisation of the disabled patient.
Ampullary epidermolysis is a group of genetic disorders that may present themselves in various ways, from milder forms to more severe ones: affecting the skin and mucous membranes, involving the formation of blisters and vesicles after the slightest trauma. They can also affect other organs, in different ways.
The best thing is if the patients, their families and their caregivers receive comprehensive health education, especially when they are first diagnosed, during the baby’s first few days, when skin lesions can already begin to occur.
The education aimed at preventing the evolution and complications of the disease will be given by professionals from the following disciplines:
Skin affected by ampullary epidermolysis is very sensitive to the slightest pressure or friction, which then causes a blister to form. To avoid damage, bear in mind the following recommendations:
Amyotrophic lateral sclerosis (ALS) causes muscular degeneration that can affect motor autonomy, oral communication, swallowing and breathing, but the senses, intellect and eyes muscles remain intact. It can therefore affect the respiratory muscles, which is why respiratory care is essential for patients’ quality of life.
In order to improve the respiratory difficulties in patients, ventilation therapy can be used through non-invasive ventilation.
Ventilation therapy refers to breathing support using a ventilator, usually at night during sleep, to achieve:
Ventilation is carried out non-invasively, by means of a patient-adjusted mask (nasal or full face) connected by a tube to the ventilator or respirator.
When patients need this therapy, the place and time it is started, whether outpatient or hospital admission, is planned in a personalised way with the consent of the patient and the person caring for them.
Education for the patient and their main carer should begin as soon as possible, both from the point of view of managing secretions and the resulting care, as well as the emotional support they need to receive. This means that during the patient’s admission or outpatient visit, the patient and their carer will be trained in:
The patient and the carer must take care to keep the airway in good condition to allow secretions to be managed. It is important to preserve the ability to cough where possible, but if coughing is no longer effective, the patient and carer will need to start learning how to use mechanical aids (cough assist or mechanically assisted cough). In certain cases secretion suction may also be used.
To improve the quality of life of patients it is important to follow the advice below:
A stroke is a clinical syndrome characterised by rapid development of signs of neurological involvement lasting more than 24 hours. Vascular in origin, a stroke is considered a medical emergency that requires immediate diagnosis and treatment.
The person who has suffered a stroke usually needs further rehabilitation but, in general, it is important to respect their initiative and autonomy, even if it takes them longer, and to avoid overprotection.
Recommendations and treatment for relatives and carers
Autoinflammatory syndromes are a group of conditions characterised by spontaneous, recurring or persistent episodes of multi-systemic inflammation. They are caused by changes to innate immunity that cause deregulation of the immune system. Autoinflammatory conditions, due to various genetic mutations, cause a pathological hyperactivity in this structure, which unleashes abnormal, continuous inflammatory activity. The number of conditions the group includes has increased since then, due to the advances in genetics and immunology.
The main symptom of many of the conditions included in the group is repeated episodes of fever, which spontaneously disappear after a few days, only to reappear again cyclically after a variable period of time. This fever is not caused by an infection and, therefore, does not respond to treatment with antibiotics or antiviral medication. Depending on the genetic defect, these conditions may be associated with a wide diversity of other manifestations, including skin, abdominal, joints, eyes or lungs.
All the conditions within the group are infrequent and have an incidence of less than 5 cases per 10,000 inhabitants, for which reason they are considered to be rare conditions. The majority appear in infancy or adolescence.
Recent progress with research has clearly shown that some fevers where the cause is not found are provoked by a genetic defect.
Depending on whether or not they have a genetic cause, they can be classified as follows:
The diagnosis is based on the clinical features of each patient’s clinical picture. Blood tests are important in diagnosing the various autoinflammatory conditions, as they enable detection of the existence of inflammation. These analyses are repeated when the child is asymptomatic to see if they have normalised. Molecular or genetic analysis enables detection of the presence of mutations involved in the development of autoinflammatory conditions which are studied in patients suspected of suffering from them according to the features of the clinical picture. The diagnosis is confirmed when the patient shows evidence of being a mutation carrier and it is often necessary to study family members too.
Treatment fundamentally depends on the type of condition and the response to the therapy chosen. For example, for familial Mediterranean fever, the treatment of choice is colchicine. Other treatments used on the various autoinflammatory conditions are cytokine inhibitors, such as IL-1 or the tumour necrosis factor α. Close monitoring of the patient is essential to prevent complications arising in the long term.
Informació pràctica com a CSUR de malalties autoinflamatòries
Juvenile idiopathic arthritis (JIA) is a chronic disease characterised by persistent inflammation of the joints that begins before the age of 16.
There are various types of JIA which can be identified by the number of joints affected and the presence of symptoms such as fever and skin manifestations, amongst others. The diagnosis is made by observing the symptoms during the first 6 months of the disease.
The main symptoms are pain, swelling and increased heat in the joints, with stiffness and difficulty moving. Sometimes the beginning is slow, insidious and progressive. The child may be tired or irritable, if they are younger. Older children may notice stiffness when moving their joints when they get up in the morning. At other times, the beginning is acute and serious, with the presence of general symptoms such as general malaise, fever, blemishes on the skin and several swollen joints.
JIA is a relatively rare condition that affects 1 or 2 children in every 1,000.
JIA diagnosis is based on the presence of persistent arthritis and carefully excluding any other condition by using the clinical history, physical examination and blood tests.
JIA is considered where the condition begins before the age of 16, the symptoms last for more than 6 weeks and other conditions that may be responsible for arthritis have been discounted.
The treatment must be put in place early and each child must be considered individually, which means that the therapy will have different levels of intensity depending on the type, time and seriousness of the condition.
Its aim is to care for the child’s all-round physical and psychological development, to try and improve all aspects of their quality of life.
To ensure that there are no after-effects, or that these are minimised, there must be ongoing effort and close collaboration between the child and their parents or family and the various specialists. It is essential that the family understands this disease. The child will begin to learn about it according to their age.
When it comes to diagnosis, certain analytical tests are valuable, along with examinations of the joints and eye tests for a better definition of the type of JIA and identification of the patients at risk of developing specific complications, like chronic iridocyclitis.
The rheumatoid factor (RF) test detects this autoantibody which, if positive and found persistently in high concentrations, indicates a subtype of JIA.
Antinuclear antibodies (ANA) usually test positive in tests on patients with early onset oligoarticular JIA. The population of patients with JIA has a greater risk of developing chronic iridocyclitis and, therefore, eye tests using a slit lamp should be scheduled (every three months).
HLA-B27 is a cellular marker which tests positive in up to 80% of patients with arthritis associated with enthesitis. In contrast, it is only positive in 5%-8% of healthy people.
Other examinations are valuable, such as the erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP), as these measure the degree of general inflammation. Nevertheless, diagnostic and treatment decisions tend to be based more on the clinical manifestations that appear rather than the analytical tests.
Depending on the treatment, patients may need periodic tests (such as haemograms, liver function tests, or urine tests) to check for treatment side effects and any pharmacological toxicity that may not show any symptoms. Joint inflammation is mainly assessed by clinical examination and, sometimes, using imaging studies, such as ultrasound. Periodic X-rays or magnetic resonance (MRI) scans can be helpful in assessing bone health and growth and in personalising the treatment.
Associació Espanyola de Febre Mediterrània Familiar i Síndromes Autoinflamatoris
FEDER
Lliga Reumatològica Catalana
Sarcomas are an uncommon type of cancer that account for only 1-2% of all tumours in adults. They also represent a complex entity, given that there are more than 70 types, with differences in terms of their diagnosis, prognosis and treatment. Accordingly, sarcoma patients need to be assessed by multidisciplinary committees with vast experience in this disease.
Sarcomas are a set of rare tumours whose origin lies in the soft tissues of the body or the bones.
Soft tissues include muscles, nerves, vessels and fat. These tissues may also form part of organs.
The infrequency of sarcomas makes it necessary to handle clinical cases and their treatment on an individual basis, which generally involves a decision-making process that is shared by several professionals with expertise in this disease and the patients themselves.
The correct diagnosis of a sarcoma and its specific type is the first critical step to be taken, as it will form the basis of the clinical handling of the patient, as well as the precise information about the nature of their disease.
In contrast to many cancers, sarcomas do not usually generate symptoms in their early stages of growth. This is because they develop in areas of the body in which they can progressively grow by pushing against structures and organs.
The first symptom may be a painless lump. The majority of lumps are benign, but if it grows quickly, hurts, is deep and/or measures more than 5 centimetres, it is more likely to be a sarcoma. Sometimes the symptoms may appear as a result of excessive compression of the body’s various tissues and organs.
There is no clear factor that triggers a sarcoma. Certain inherited genetic syndromes may predispose a person to being more likely to develop a type of sarcoma, such as Li–Fraumeni syndrome, neurofibromatosis or familial adenomatous polyposis.
One of the most important steps is to confirm the clinical suspicion of sarcoma and identify its specific type. This requires a biopsy to obtain a fragment of the tumour so it can be studied by Pathological Anatomy.
It is sometimes diagnosed with molecular techniques in association with radiological tests like x-rays, computed tomography (CT), magnetic resonance imaging (MRI) or PET-CT.
The treatment of all sarcoma patients is always agreed by multidisciplinary committees composed of professionals with expertise in sarcomas from a variety of the services of our centre: Medical Oncology, Radiation Oncology, Traumatology, General Surgery, Radiology and Pathological Anatomy.
Given that sarcomas may arise in any part of the body, occasionally other specialists may also participate.
The treatment of sarcoma patients may include:
The most suitable procedure depends on a number of different factors in addition to the specific type of sarcoma. Targeted therapy and immunotherapy play a very important role in certain types of sarcoma. Finally, there are also clinical trials that experiment with new therapies.
The commonest are radiological tests like those described above (x-ray, CT, MRI and PET-CT).
As there is no specific cause of sarcomas, in the majority of cases there are no specific measures that can be taken beyond the usual healthy living habits recommended by the World Health Organization.
Patients with inherited genetic syndromes, however, are advised to undergo monitoring in specialist units.
Cervicalgia is the name given to pain that appears in the area of the cervical spine, the posterior part of the neck. Sometimes, this pain can radiate to the head and arms, or also towards the dorsal (middle back) area. The cervical spine has a dual role: it needs to be stable enough to support the weight of the head, but also flexible enough to allow for a wide range of movement and to function properly. In addition, the cervical spine contains the spinal cord, from which the nerves that control the upper extremities branch out.
The cervical spine is made up of seven vertebrae, which are separated by fibrocartilaginous cushions called intervertebral discs. From the age of 35 onwards, as a consequence of thousands of movements, including flexion, extension, and rotation, neck pain and/or discomfort may appear.
To keep the head in a normal position, the muscles in the back of the neck must work properly, since the head and neck do not come together at a central point, but rather, the neck supports the posterior part of the head. The muscular tension required to maintain the head in a correct position, as well as damage to the small joints between these cervical vertebrae (osteoarthritis), are common causes of neck pain.
Mechanical and postural causes are often responsible for cervicalgia. These changes can produce compression lesions on the nerve structures that pass through the cervical region. The intervertebral discs can slide forward or backward, and even herniate, affecting the nerve structures.
Neck pain is one of the most frequent reasons for a visit to the doctor's surgery. We know that up to 70 % of the population will suffer from this problem at some point in their lives.
Bad posture, the use of new technologies, work habits, traffic accidents, population ageing, stress, and worry all contribute to this high incidence.
Diagnosing this condition is based on the characteristics and mechanisms of the pain, as well as the results of a physical examination.
Neck pain can be either mechanical or inflammatory in nature. Mechanical causes are the most common; this kind of pain gets worse with movement and improves with rest. This kind of pain is caused by wear, practising sport, some types of work that cause mechanical stress on the neck, previous trauma, and degenerative disorders.
Inflammatory-type pain suggests the presence of inflammation, infection, and/or tumours. It is a continuous pain that does not improve with rest nor medication. It is usually accompanied by other symptoms such as fever, impaired general condition, neurological symptoms, etc. The physician will evaluate the need to carry out any tests and determine which one is most suitable for each case.
Generally speaking, mechanical neck pain improves in 2-3 weeks.
Treatment should include:
Taking pain relievers like paracetamol can help control the pain. Other treatments, such as taking anti-inflammatory medications or muscle relaxers, will be prescribed as needed by your physician. If the pain persists or new or different symptoms appear, talk to your doctor.
It is important to keep your head in a good position and to correct your posture. For this, exercises that strengthen the posterior cervical muscles (the extensors) are very useful, as they will help you maintain a correct, straight posture. This will prevent the pain from reappearing or becoming chronic.
Generally, acute neck pain does not require any diagnostic tests. With a conventional X-ray, the cervical vertebrae can be evaluated and a diagnosis can be made using just this, in most cases.
On another note, it is very common to find signs of osteoarthritis, such as impingement, on X-rays; these do not require any kind of treatment.
If the clinical case warrants them, your physician will decide (based on the symptoms) whether to carry out neurological tests like a CAT (computerised axial tomography) scan, NMR (nuclear magnetic resonance) scan, or an EMG (electromyogram). These tests are intended to diagnose more severe injuries or to assess nerve damage in the cervical spine.
Osteoporosis, which means "porous bone", is a skeletal disease in which the density and quality of the bone decrease. Due to this, the skeleton offers less resistance and is more likely to fracture, even with minor trauma like a fall from standing height or a light blow. These are called fragility or osteoporotic fractures. It is very prevalent. Worldwide, it is estimated that 1 out of every 3 women and 1 out of every 5 men will suffer an osteoporotic fracture during their lifetime.
This is a silent disease, because it shows no symptoms until the first fracture. Having suffered a first fracture makes the patient more likely to have subsequent fractures. These almost always occur in the spine, wrist, or hip, but they can happen in other places. Fractures of the spinal column are especially detrimental, because they can cause pain, deformity, and a loss of height. This is also true of hip fractures, which require hospital admission and entail a loss of quality of life and autonomy as well as a high socioeconomic cost.
The skeleton is a living tissue that is in a constant process of destroying old bone and forming new bone. With age, this destruction gradually outpaces the formation of new bone. It especially affects women after menopause, since during menopause this destructive process becomes faster due to the loss of the protective effect of oestrogens. This predisposes them to what is called postmenopausal osteoporosis. In addition, this is aggravated by the fact that women, in their youth, reach a lower peak bone mass than men do. Early menopause (before 45 years of age) is a risk factor. In men, bone loss generally only becomes important around the age of 70.
Thus, age has an influence on the loss of bone mass, but it can also affect children, teens, and premenopausal women. There are many other risk factors for osteoporosis, like having a family history, taking certain pharmaceuticals (corticosteroids, drugs used for prostate and breast cancer, etc.), tobacco use, excessive alcohol, being sedentary, and certain pathologies, such as rheumatic inflammatory diseases, endocrine diseases, liver diseases, blood diseases, kidney diseases, intestinal malabsorption problems, and inadequate calcium intake, among others.
The diagnosis must be made considering the risk factors that may trigger osteoporosis, which health professionals must evaluate.
A blood analysis must be carried out to detect possible abnormalities, as well as a DEXA (dual energy x-ray absorptiometry), which uses small doses of radiation. The hip and spinal column are evaluated. In general, the reference measurement comes from the bone density in a population of young adults (called the T-score). Thus, the WHO has established that osteoporosis should be diagnosed when the T-score for a person is under -2.5 SD. Osteopaenia means that the loss of bone mass cannot yet be called osteoporosis, and this is when the T-score is between -1 and -2.5 SD.
If the DEXA shows osteoporosis as a result, this doesn't mean that there necessarily has to be a fracture. Other risk factors must be evaluated and the overall clinical picture determined. Osteopaenia is very frequent and when treatment is initiated will depend on whether there are important risk factors and/or if there have been fractures. We have tools to calculate fracture risk that take into account all of the characteristics of each patient.
The objective is to avoid the loss of bone mass and reduce the risk of fractures. Having a healthy lifestyle is essential.
Pharmacological treatment:
There are various types of pharmaceuticals and the prescription will depend on the profile and individual risk of each patient, depending both on the location of the fracture and other medical conditions. The duration of treatment is also variable.
We currently have a large selection of pharmaceuticals that have been proven safe and effective to reduce the risk of fracture in patients with osteoporosis. Most have an "anti-resorptive" effect, because they stop the loss of bone mass, and are also an anabolic treatment, since they stimulate the formation of bone.
The word scoliosis comes from Greek and means “curvature”. It is not considered a disease, but rather, a three-dimensional deformity. This is why the Scoliosis Research Society (SRS) defines it as a lateral curvature of the spine with a rotation of the vertebrae inside the curve of more than a 10º Cobb angle.
It is important to distinguish structural scoliosis from non-structural scoliosis, also known as pseudoscoliosis. In structural scoliosis, the spine shows a lateral deviation (the severity of which can be measured using the Cobb angle, which quantifies spinal deformities) and a rotational deformation that is measurable via the Adams Forward Bend Test and a scoliometer. In non-structural scoliosis, the lateral deviation does not involve vertebral rotation and this condition can be corrected via postural training.
Scoliosis, in turn, is divided into the idiopathic and secondary types. Idiopathic scoliosis is that for which no cause can be established.
Idiopathic scoliosis in adolescents is a three-dimensional structural abnormality, with lateral deviation and a rotation in the curvature of the spine that affects the health of young people around the age of puberty. This diagnosis is established only when other potential causes of scoliosis, such as vertebral deformities, neuromuscular abnormalities, or other syndromic disorders, have been ruled out. If any of these are the cause, it is called secondary scoliosis.
Idiopathic scoliosis is classified according to the age at which it appears: infantile (0-3 years old), juvenile (3-10 years old), and adolescent (over 10 years old).
Idiopathic scoliosis affects between 2% and 3% of young people between 10 and 16 years old (the age range with the most risk). Recently, in China, the percentage of children in this age range who suffer from this deformity has been shown to be up to 5.14%.
In scoliosis, as the severity of the curve increases, the number of sufferers decreases. Scoliosis with curvatures above 20 degrees affects between 0.3% and 0.5% of these individuals, and it is estimated that the proportion of patients who require surgical treatment does not exceed 0.1%.
Detecting scoliosis is generally done using the Adams Forward Bend Test, which, as its name implies, consists of the patient bending their torso forward, allowing a “hump” to appear, which is subsequently measured with a scoliometer. However, a definitive diagnosis cannot be made without measuring the angle on an X-ray in which the patient is standing up.
The most common forms of secondary scoliosis are those associated with neuromuscular diseases. Sometimes, the first sign of some of these diseases is scoliosis, and until it manifests, the scoliosis can seem idiopathic, but in reality, it is secondary.
Children and adults of all ages.
The paediatrician will be able to detect this condition, and then the rehabilitation specialist will be in charge of making the diagnosis and evaluating treatment options, in collaboration with the orthopaedic team and the physiotherapist, who will be the ones to follow up and monitor the progression of this deformity.
In adolescents, the progression of the curve is prevented using conservative treatment based on observation and the use of a corrective brace if the curvature progresses and surpasses 25 degrees.
To treat small curves that are at low risk of progression, physiotherapy is recommended.
Surgical treatment is only used in specific cases, such as adolescents who have a primary structural curve greater than 45 degrees and adults who do not respond to conservative treatment.
To diagnose scoliosis, imaging tests such as conventional X-rays are carried out. Using these, the degree of the curvature can be precisely quantified. If another clinical symptom is associated with the deformity, an MRI will be requested.
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