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.
Les persones amb insuficiència renal que entren en programa d'hemodiàlisi tenen una funció inferior al 10% de la funció normal. Amb xifres superiors de funció, generalment no és necessària l'hemodiàlisi.Cal practicar l'hemodiàlisi de forma periòdica, en sessions d'unes quatre hores i generalment tres cops per setmana, tot i que la durada i la freqüència depenen de cada pacient i de cada circumstància.El fonament de l'hemodiàlisi és biofísic, en el sentit que la sang quan passa per un filtre, intercanvia substàncies amb el líquid que hi ha present a l'altra banda del filtre i que és mogut en circulació per una màquina. Per a l'intercanvi, la sang s'allibera de la urea, del potassi, del fòsfor, i de diferents substàncies que s'acumulen pel dèficit del funcionament renal. El pas de les substàncies a través de la membrana es fa en part espontàniament, per què hi ha diferents concentracions de les diferents substàncies i la tendència és a igualar-se, i també per mitjà de canvis en la pressió que exerceix la màquina d'hemodiàlisi.Possibles complicacions de l'hemodiàlisi, són la infecció del catèter o l'esgotament dels accessos vasculars en pacients que estan durant anys amb hemodiàlisi.Tot que l'hemodiàlisi pot durar anys, generalment és un pas intermedi entre la insuficiència renal i el trasplantament.
People with obsessive compulsive disorder have persistent and recurring thoughts which are generally unpleasant, known as obsessions.
These thoughts lead people to carry out repetitive actions or rituals which help them cope with the obsession. These are known as compulsions. Examples of compulsions would be: excessive hand washing, religious behaviour (such as saying a prayer exactly 15 times to stop something bad happening), counting and checking things (e.g. making sure the door is closed, the gas is off, etc.).
People with OCD very often feel that something bad will happen if they don’t carry out these compulsive actions and so they feel "obliged" to do them. This creates a great deal of anxiety and distress, as they feel it is their responsibility to stop bad things happening.
They may withdraw from the activities of daily life or completely avoid them due to fears produced by their obsessions or compulsive behaviours.
They may also have difficulty with daily tasks such as cooking, cleaning, washing themselves, etc. and experience a high level of anxiety.
Following specific recommendations can help you to live with or overcome obsessive compulsive disorder.
However, if this advice is not enough and the disorder gets worse, you should speak to a PSYCHOLOGIST AND/OR A PSYCHIATRIST, who can complement it with other types of treatment such as cognitive behavioural therapy or medication.
To try to reduce or eliminate compulsions or rituals:
Legionnaire's disease is a disease caused by the bacteria Legionella pneumophila, that lives in contaminated water circuits such as water pipes, water tanks or reservoirs, cooling towers, swimming pools and jacuzzis.
It is contracted through the inhalation of contaminated water droplets, whether physically in the water or merely close by, due to the fact that it can spread from the water to the surrounding environment.
It normally causes a respiratory infection similar to pneumonia which if not diagnosed and treated early can be serious and life-threatening.
Legionnaire's disease causes the same symptoms as pneumonia (fever, chest pain, difficulty breathing), along with severe muscle pain and major impact on the feeling of general wellness.
Legionnaire's disease can affect anyone who has come into contact with the bacteria which cause it, but it is more common among the elderly or people with a compromised immune system who have either come into contact with or breathed the vapour of water contaminated with legionella.
A diagnosis is reached through detection of the bacteria or its antibodies in the blood, once suspected due to the clinical characteristics of the patient (age of onset, fever, major impact on general wellness, muscle pain) or radiographies (indirect pulmonary pneumonia indirectly affecting the lungs). Isolation of the bacteria is relatively recent, as it requires special culture processes.
In fact, legionella was not identified as the cause of respiratory infection until 1976 during a pneumonia epidemic in the American Legion Convention in Philadelphia, to which it owes its name.
Legionnaire's disease responds well to specific antibiotic treatment.
Early treatment is very important.
Chest x-ray, determination of legionella antibodies in the blood, specific cultures for the identification of legionella.
Epidemiological surveillance of detected cases (water pipes, air conditioning towers, swimming pools or jacuzzis involved) is very important for disinfection.
When a case of Legionnaire's disease is detected, public health authorities must initiate an investigation in order to find the source and eradicate it.
Legionella is not resistant to high temperatures and can usually be eliminated by intermittent increasing of the temperature of the pipes. This should always be carried out by a professional to ensure the proper elimination of the bacteria.
Infectious endocarditis involves the presence of a microbial infection in the endocardial surface (internal surface of the heart). It is the most frequent cardiovascular infection and it is very important because of its potential severity and its different forms of presentation.
Infectious endocarditis mainly affects cardiac valves, whether natural or artificial, although sometimes it can occur in other structures of the heart.
It is classified according to the time the infection has been established (days, weeks or months) and according to the bacteria or microorganism (yeast, fungus) that causes it.
The characteristic lesion of infectious endocarditis is endocardial vegetation. It is made up of the completely abnormal presence of an aggregate of platelets, fibrin, bacteria and inflammatory cells that adhere to the internal surface of the heart, usually on the surface of a cardiac valve, and which is susceptible to breaking off, causing an infectious embolism at a distance in another organ (skin, nervous system, limb).
It is considered a serious illness and although in most cases it is cured, it also has significant complications and mortality despite treatment. In many cases, patients must be subjected to surgical intervention in order for it to be definitively cured, eliminating the affected tissue and inserting a new artificial heart valve.
In its most acute form infectious endocarditis can produce high fever, chills, prostration and severally affect the patient's general condition in a short time period (hours-days). In subacute forms it may evolve over weeks or months, with a clinical presentation of tiredness, lack of appetite and low-grade fever. In these cases, infectious skin manifestations may also occur as nodules or characteristic spots, which do not always appear.
In patients with severe cardiac valve involvement, the valves themselves may not function correctly, which may result in symptoms of heart failure such as severe shortness of breath and swelling of the lower limbs
Infectious endocarditis has a global incidence of 2-3 cases per 100,000 population per year, and so it is estimated that in Catalonia around 200 cases are diagnosed every year. Its incidence increases greatly with age, reaching 15-30 cases/per 100,000 population/year in over 65s, or 10 times higher than that of the younger population.
The cause of infectious endocarditis has changed a lot in recent decades. In recent years the most frequent causal bacterium has been streptococcus, especially a species called viridans. There is currently a great variety of causal agents, although staphylococci are the most frequent, followed by streptococci and enterococci. It is, however, advisable to note that any microorganism that circulates through the blood can adhere to a heart valve, especially if it has previous injuries or is an artificial valve.
The diagnosis of endocarditis is based essentially on:
- blood cultures to identify the bacterium that causes the infection and allow the most suitable specific antibiotic treatment to be chosen.
- echocardiogram that allows the endocardial vegetations typical of the disease to be located. It also informs doctors about the function of the valve affected and contributes significantly to assessing the need for surgical treatment in some patients.
- in some cases it is necessary to carry out other explorations (such as CAT or scintigraphy) to rule out the existence of peripheral embolisms, which are very common at the time of diagnosis or during the course of treatment of the disease.
The treatment of infectious endocarditis is antibiotic, but specifically targeting the microorganism that causes it. The doses are high and prolonged over time because the vegetations typical of the disease are not very vascularised and antibiotics must penetrate through diffusion from circulating blood. In patients who do not respond adequately to this antibiotic treatment or who have major valve damage as a consequence of the infection, it is necessary to assess the need for valve replacement surgery.
Blood cultures and echocardiogram, both at the time of diagnosis and to monitor the evolution of the illness.
When an alteration of a person's heart valve is recognised, antibiotic prevention must be administered before any dental or gum treatment is given, following specialised consultation.
Preventive measures must also be taken in the case of endoscopes, especially of the upper gastrointestinal tract (gastroscopy), with the antibiotic and guidelines indicated by the doctor.
This prevention is very important because the presence of bacteria in the blood, as a result of the intervention or exploration, carries a significant risk of infectious endocarditis.
Prostate cancer is one of the most frequent cancers in the male population. This is the most frequent malign tumour in the male urogenital system and the second cause of death from cancer in men after lung cancer, with a mortality rate of 12%.
If there is any suspicion, due to symptoms or high PSA levels, a rectal examination will be performed along with a new serum PSA analysis. If the rectal exam is positive (if a nodule or hardening of the prostrate is detected) a biopsy will be carried out. If the rectal examination is negative, the PSA levels will be assessed, to determine whether to carry out a biopsy or not. The PSA is used as a filter for the general population, in order to enable early diagnosis of prostate cancer.
It is a good tumour marker, because it increases when the prostatic glands break down due to tumour growth. As it is also present in normal prostates and it also increases in the benign growth of the prostate, it must always be interpreted in each patient's individual context. An increase in PSA is not a synonym for prostate cancer, and a rectal examination and ultrasound scan should always be carried out. The final diagnosis is given only by a biopsy.
It is often asymptomatic and the first warning sign is high PSA levels. Patients may also present tiredness, loss of appetite and weight loss. Local alterations are also frequent: urinary obstruction, urinary retention, presence of blood in the urine, urinary infections. In the case of spreading, bone pain is frequent.
The typical profile is a male between 50 and 70 years old, in whom benign prostate growth may coexist.
Diagnosis of prostate cancer is carried out using serum PSA, rectal examination and an ecodirected prostate biopsy.
When prostate cancer is localised and low-risk, it can be treated through extirpation and radiotherapy. In the case of spreading, treatment through radiotherapy and hormones will be assessed, in order to stop tumour growth. Occasionally, if the patient is elderly, the development of the cancer will be closely monitored before extirpation, as in some cases, it poses no short-term threat to their survival.
Rectal examination, determination of serum PSA, prostate biopsy.
Survival rates for prostate cancer depend on the state at the time of diagnosis; it is quite favourable in local states, less so in advanced states and worse once it has spread. Periodic prostate evaluation by primary care doctors is therefore indicated.
Multiple myeloma is a type of blood cancer that originates due to an abnormal proliferation of plasma cells (one type of leukocyte, the body’s defence). These plasma cells can cause bone lesions, growing profusely and causing anaemia. At the same time, they are able to produce immunoglobulins. These are proteins that, in excess, can affect the kidneys and increase the risk of infection.
Multiple myeloma is a type of bone marrow cancer that comes about due to the proliferation of clonal plasma cells and the abnormal production of immunoglobulins (Ig), which are a component of the immune system and can be found in blood and/or urine.
The annual incidence in adults is 4-6 new cases per 100,000 of the population per year, which represents 1% of all cancers and 10% of blood cancers. These figures mean the condition is considered rare. It often affects predominantly older people, with the average being around 70 years.
Excess Ig interferes with the properties of the blood, affecting normal kidney function and increasing the risk of developing infections (as normal Ig are not produced). If there are also excess plasma cells, the bones containing bone marrow may be damaged, with possible fractures and pain. It can also make the normal production of red blood cells, white blood cells and platelets more difficult, leading to increased risk of anaemia, infection and bleeding.
The classic symptoms of myeloma are given by the initials of the affected organs: “CRAB” (Calcium, Renal failure, Anaemia, Bone lesions). These may, however, lead to other symptoms:
In a routine analysis, it is common to find a monoclonal gammopathy, anaemia or to diagnose a fracture after the persistence of bone pain that does not stop with conventional analgesia.
To confirm the diagnosis and establish the extent and treatment needs, a full blood count needs to be conducted with a special protein study, a urine analysis to rule out abnormal protein excretion by the kidneys, a bone marrow aspirate or biopsy to confirm excess plasma cells in the bone marrow (if possible with cytometric and genetic study) and imaging tests to rule out bone lesions.
Treatment of multiple myeloma has changed significantly in the last decade and above all in recent years with the appearance of new drugs and action mechanisms.
The aim of treatment is to control the condition for the longest amount of time possible with minimal side effects and to achieve a good quality of life.
Treatment of multiple myeloma includes drugs that can be classified according to their mechanism of action:
· Proteaosome inhibitors
· IMiDs
· Alkylating agents
· Corticosteroids
· Monoclonal antibodies
As well as the drugs and combinations used, a treatment plan may also take into account the possibility of one (or two) bone marrow transplants.
There is currently an exponential increase in the development of new treatments for multiple myeloma. New drugs are being developed with different mechanisms of action. In some cases, these new drugs or potentially beneficial combinations may be offered as part of clinical trials.
Suicide is a common cause of death. Every year, around one million people across the world die of suicide. It remains the biggest external cause of death in our country (Spanish National Institute of Statistics - INE, 2017). It is estimated that suicide attempts (SA) are 10-20 times more common than suicide. Within a broad spectrum of suicidal behaviour, we find highly lethal SAs (those which are closest to suicide).
Medically serious suicide attempts (MSSA) or highly lethal suicide attempts (SA) are characterised by the fact that they present a serious organ compromise, regardless of their psychiatric severity.
MSSAs, in the broad spectrum of suicide attempts, are the closest to consummate suicide, being two populations with overlapping characteristics. MSSAs also have greater risk of death by suicide compared to low lethality suicide attempts.
An important aspect to bear in mind is that assessing survivors of serious suicidal behaviour allows us to obtain information directly from the survivor, unlike consummate suicides, in which the assessment is performed indirectly through third persons (psychological autopsy). The fact that we are able to assess people so close to suicide is hugely valuable to find out more about the psychological mechanisms of serious suicidal behaviour and the warning signs, in order to avoid suicide.
In a large proportion of these people, a prevalence of psychiatric pathology has been observed. These mainly consist of affective disorders (depression), followed by personality disorders and other disorders related to the consumption of substances. There are also other socio-environmental, non-psychiatric risk factors that should be assessed: presence of serious/chronic medical pathology, functional limitations and their adaptation (people with some sort of physical disability or older people) and social support.
Most patients present clinical depression that does not always coincide with the presence of a stressful event. They may have a history of suicide attempts. Prior to the MSSA, they may have shown thoughts of wanting to die or a more structured idea of how they would commit suicide.
People with an unstable/untreated psychiatric disorder: Unipolar affective disorders (depression) may have a greater predisposition towards suicidal behaviour.
The presence of an underlying psychiatric disorder should be assessed and treated following an MSSA.
Once the patient has recovered from a life threatening situation, a comprehensive approach should be taken, focused on clinical and socio-environmental aspects. The presence of a psychiatric pathology should be assessed and treated. It is also important, following medical discharge, to refer the patient to the mental health network and activate the Suicide Risk Code, allowing follow-up after hospitalisation.
Medical and psychiatric history and psychological assessment.
Avoid the myths that proliferate the social stigma surrounding suicide and assess the presence of suicidal thoughts with clinical and socio-demographic risk factors.
Venous thromboembolic disease refers to the process characterised by the formation of a thrombus (blood clot) in the deep vein system that can grow or fragment, interrupting the normal circulation of blood and causing various alterations.
The main manifestations of thromboembolic disease are deep vein thrombosis (DVT) and pulmonary embolism. DVT occurs when a thrombus or blood clot forms inside a deep vein, usually in the legs (although it can also occur in the arms, abdomen, ilium, vena cavas, etc.), obstructing normal blood circulation in these veins.
A thrombus that forms in a deep vein can become fragmented or rupture and break off. The detached embolism travels through the veins towards the heart, reaching the lungs through the pulmonary veins. The clot stops in the lungs and obstructs the interior of one or more pulmonary arteries, preventing blood from passing. This process is known as pulmonary embolism (PE).
Vein trombosis:
- Swelling or inflammation of the affected leg
- Pain or sensitivity in the leg, often starting in the lower leg
- Increased temperature in the leg
- Changes in skin colour (reddened or bluish, shiny)
Pulmonary embolism :
- Shortness of breath or sudden onset drowning (dyspnoea).
- Increased breathing rate
- Increased heart rate
- Acute chest pain
- Dry cough with blood
- Loss of consciousness (syncope)
Incidence (number of cases/year) of venous thromboembolic disease in the general population, including any of its manifestations, is estimated to be between one or two cases for every 1,000 people in Spain. This means that there are more than 80,000 cases a year in Spain, with about 70% of these being deep vein thrombosis and the rest being pulmonary embolism.
DVT:
The patient’s symptoms are analysed, as well as conducting a blood test and imaging tests. The most commonly used test of choice is Doppler ultrasound (eco-Doppler), an imaging technique that allows the deep veins to be seen and confirms or rejects the diagnosis.
PE:
If suspicions point to a possible pulmonary embolism, the diagnosis will be confirmed using tests such as a chest CT (scan) or pulmonary scintigraphy.
When a clot is produced, whatever type it may be, the main aim of treatment is to dissolve the thrombosis and re-establish blood flow to avoid further complications.
Anticoagulants are the treatment of choice for venous thromboembolic disease. Anticoagulants are medication that modify blood clotting so that a thrombus or clot does not form inside the blood vessels, helping to break up clots that have already formed.
Laboratory tests such as D-dimer. Imaging tests such as Doppler ultrasound, CT and pulmonary scintigraphy.
THROMBOPHILIA BLOOD TEST in some cases, a blood test is also performed to determine if the patient has any alterations in their clotting proteins that may predispose them to thrombosis.
Knowing the risk factors of venous thromboembolic disease is crucial to be able to act and control this risk. One of the cheapest and most effective recommendations that helps to prevent possible thromboembolic episodes is walking, as moving around helps avoid clot formation.
Asthma is a disorder of the passage of air through the respiratory tract, particularly in small-calibre bronchial tubes. It causes difficulty breathing and the patient feels like they are drowning and must increase their effort in an attempt to breathe better.
Asthma is a chronic inflammatory disorder of the airways that results in variable airflow obstruction. It often changes throughout the day (it can get worse at night) and improves with treatment and then reappears later.
The illness is basically caused by an inflammatory mechanism.
Three phenomena occur in the airways of patients with asthma:
1. Decreased bronchial diameter, which restricts air flow.
2. Inflammation, with increased thickness of the bronchial wall, which also contributes to restricting air flow.
3. Increased activity in the glands that produce mucus, with increased secretions contributing further to breathing difficulty.
Cells that circulate in the blood are involved in the local inflammation observed in asthma: T lymphocytes, mast cells and eosinophils. These cells are responsible for the body’s normal defence and their activity is increased in asthma. Medication for asthma attempts to regulate this activity.
According to the degree of restriction, the person affected will experience breathing difficulty and a sensation of lack of air. Also characteristic of asthma are wheezing, which is the sharp whistle-like sound of the air as it passes through the smaller airways, and increased bronchial secretion.
Asthma can affect all age groups and sometimes overlaps with bronchitis. On many occasions it can be allergic in origin or come as a result of exposure to an environmental or chemical agent.
Spirometry, chest x-ray, allergy tests.
Some basic questions for diagnosis:
1) Have you ever had a whistling sound in your chest?
2) Have you been coughing, especially at night?
3) Have you had a cough, whistling sound, difficulty breathing at some times of the year or in contact with animals, plants, tobacco or whilst at work or after exercise?
4) Have you had colds that last more than 10 days or are "chesty"?
5) Have you used inhaled medication?
Treatment is based on using bronchodilators, in the form of an inhaler or tablets. Anti-inflammatory drugs also have an important role.
The most common diagnostic tests for asthma are based on:
1) Spirometry: Measures air flow on inhaling and exhaling and detects any restrictions in the airway, one of the characteristics of asthma.
2) Bronchodilator test: Tests if spirometry improves with drugs to dilate the airway.
3) Bronchial challenge test, the same test in the opposite direction with drugs that cause a slight airway obstruction, detected by spirometry.
To prevent asthma, it is fundamental not to smoke and avoid exposure to allergens that precipitate it, which are detected with the allergy tests that form part of the asthma exam.
The Inherited Heart Disease Unit is basically devoted to providing care. We have a team of two cardiologists, three interns and two nurses, one full-time and one part-time. This Unit addresses all myocardiopathies in general, and inherited cases in particular.
Myocardiopathies are diseases where the myocardium is weak, dilated or has some other structural problem. Often, the heart is unable to pump or work properly. In the case of inherited myocardiopathies, due to the fact they are often treated as part of uncommon diseases, specialist management is not within the scope of all clinical cardiologists. It requires specific treatment and involves specific technology.
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