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.
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.
Acute hepatitis consists of an acute inflammation of the liver that makes the liver not work properly. This is normally brought on by a virus, pharmaceuticals or other toxins.
The symptoms are very varied and often go unnoticed. The most common are fatigue, poor appetite, nausea, muscle pain and fever. Occasionally, a yellow tinge appears in the whites of the eyes and the skin (jaundice), and urine becomes dark in colour (choluria). Symptoms may persist for one to three months before recovery. Hepatitis B and C may become chronic.
Hepatitis A affects children and young people. Thanks to improvements in health and hygiene in our country, the disease now quite rare. It may be found in patients who have recently visited countries with greater incidence of the disease and in people who have had contact with them. As previously mentioned, the means of transmission is faecal-oral and it generally clears up with no complications.
Hepatitis B is transmitted in the majority of cases through sexual contact or by exchange of blood (drug addicts use of needles). Transmission via blood transfusion is currently very regulated and virtually never happens. In areas where the disease is very prevalent (mainly Asian countries) the most common means of transmission of hepatitis B is from mother to child during pregnancy or childbirth (vertical transmission). In these cases of vertical transmission, if adequate treatment is not administered, hepatitis B becomes chronic in more than 90% of cases.
Toxic hepatitis is caused by exposure to substances which are harmful to the liver. These toxins may be pharmaceuticals, natural products or others. In some instances the connection between the toxin and the hepatitis is very well documented and is predictable. In other instances an unexpected reaction takes place (idiosyncrasy). Finally, there are pharmaceuticals that do not produce hepatic toxicity unless they are used in much higher doses than normal (for example paracetamol).
Diagnosis is mainly clinical (observation of jaundice, dark urine) and from lab results (elevated liver enzymes and positive viral detection).
In addition, during the development of the disease the appearance or development of antibodies specific to each virus is detected, which determine the response of the patient and whether or not the condition becomes chronic.
An abdominal ultrasound allows us to see if there are any complications stemming from the acute hepatitis and to exclude other causes that might produce similar symptoms.
In general no specific treatment is needed for acute hepatitis except in some cases produced by hepatitis B and C viruses. Extreme personal hygiene is important to avoid contagion to others.
No specific diet is recommended (alcohol must always be avoided). Nor is total bed rest necessary (physical activity should be adapted to the patients general condition).
Basically these consist of analyses to show the status and development of the liver and how the patient is responding to treatment. Blood analyses can also reveal to what extent the condition is becoming chronic.
The best possible treatment for the A and B viruses is vaccination (included in the routine vaccination schedule). No vaccine is currently available for the C virus.
Hepatitis A is transmitted by faecal-oral contact (contaminated food and drink and from person to person). Food hygiene is fundamental here.
Barrier contraception methods (the condom) can prevent the transmission of sexually transmitted diseases (including hepatitis B and C).
In countries where the disease is very prevalent, many pregnant women may have the disease and transmit it to their child during the final phase of the pregnancy or the delivery. The use of +/- gamma globulin early vaccination against the hepatitis B virus can prevent infection in children.
Toxic hepatitis is prevented with caution to the exposure of the various toxins involved.
Sun exposure is the major predisposing factor in all types of skin cancer, although in the case of melanoma there may also be a genetic predisposition.
The skin is exposed to all external factors, acting as a barrier and protection. Ultraviolet rays from solar radiation have the capacity to alter skin cells and transform them into cancer cells. There is a correlation between the degree of exposure to ultraviolet rays and the probability of having skin cancer. People with fairer skin also have greater predisposition than those who tan well after sun exposure.
Skin cancer is the most common type of cancer. The main types of skin cancer are:
Basal cell carcinoma (or basal cell cancer) shows slow local growth and, if not treated properly, it can infiltrate the underlying tissues requiring complex interventions. Squamous cell carcinoma (squamous cell carcinoma of the skin or spinocellular carcinoma) can also be locally invasive and in 5% of cases it spreads to the lymph nodes and to other organs.
Melanoma is much less common than other types of cancer, but there is greater risk of it spreading to other parts of the body. It is the main cause of death due to dermatological disease.
In all cases the diagnosis and treatment processes are very important.
Faced with recently appearing skin lesions, growth, bleeding or any change that can be seen, the dermatologist will guide diagnosis through clinical history, physical examination and in most cases a small skin biopsy.
A biopsy makes it possible to distinguish benign and malignant lesions and within these the subtypes of cancer that may have different treatments. Any pigmented skin lesion that has appeared recently or that changes in a short time must be assessed by a dermatologist to rule out melanoma. Fortunately this is not the norm, but it should always be considered because of its severity.
Skin cancer is very common and non-melanoma skin cancers have a very good prognosis. There is increased risk of suffering some types of skin cancer with age, possibly due to the fact that sun exposure accumulates over the years. Hence the importance of sun protection, especially starting early in life, given that the accumulation factor of repeated exposure to ultraviolet rays from the sun adds up.
Diagnosis is done by a dermatologist through inspection andbiopsy. You should consult a dermatologist when a skin lesion is persistent or if a pigmented area changes shape or colour.
In the case of basal cell carcinoma or squamous cell carcinoma, treatment is preceded by a biopsy to be followed by local removal surgery, destruction with cold (cryotherapy) or heat (electrocoagulation) and in some cases it may be sufficient to apply a medical treatment in the form of ointment with different active ingredients. Sometimes radiotherapy is also useful.
ºThe case of melanoma is very different because after the biopsy, the extent of the cancer must be evaluated and local treatment (surgery) or general oncology treatment administered to treat possible spread to other organs (metastasis).
In the case of non-melanoma skin cancer, the most common test is a skin biopsy. In the case of melanoma an investigation into the extent may be indicated to rule out other organs being affected (sentinel node biopsy and imaging tests).
Adequate protection from the sun's rays is very important to prevent skin cancer. You are advised to limit direct exposure to a few minutes or by using physical means (shirt, hat) or using creams or lotions with high sun protection factor (greater than 30), but these creams do not by any means offer total protection.
Pneumonia is an infection of the lung tissue.
Depending on the extent of pneumonia in the respiratory tract, different types are identified:
It can be caused by many different microorganisms, although the most common causes are S. pneumoniae (pneumococcus) and Mycoplasma.
Other microorganisms that can also cause pneumonia include Haemophilus, Klebsiella, Staphylococcus aureus, Legionella pneumophila, Chlamydia pneumoniae and some viruses.
Characterised by high fever, coughing, with or without sputum, and often chest pain, which may increase with respiratory movements. Sometimes sputum has a brownish or rusty appearance, which points to pneumonia caused by pneumococcus.
The so-called atypical pneumonia, caused by Mycoplasma or Chlamydia among others, is often characterised by fever with very few respiratory symptoms.
Pneumonia is a very common disease (350,000 cases/year in Spain) and is a significant cause of mortality in the general population. It can affect all age groups.
In previously healthy people it is a disease of mild or moderate severity. It can even be treated at home or in outpatient care, but in patients with previous pathology (immunocompromised, heart failure, previous respiratory failure), it is generally serious.
The appropriate use of antibiotics, together with occasional respiratory support measures (oxygen therapy or even intubation), contributes significantly to improving the chances of cure in the most severe cases.
It is performed based on the patient's clinical history (age, previous pathology, evolution time and type of symptoms), auscultation, chest radiography and blood and sputum cultures to identify the causative organism.
Antigens can also be detected in urine for pneumococcus and Legionella.
The treatment is antibiotic, based on a clinical estimate of the possibility of it being caused by one germ or another (in many cases treatment is started immediately without knowing the causal organism). Treatment is later maintained or changed according to the cultures and the patient's evolution.
The criterion for inpatient or outpatient treatment depends on the estimation of the risks that may occur (older age, previous pathology, impairment of respiratory function).
In a previously healthy patient, treatment may be in outpatient care.
Chest x-ray, blood and sputum or respiratory secretion cultures and determination of antigens in urine.
There are two very different types of otitis, both of which children can suffer from: external otitis and middle ear infection.
External otitis affects the auditory canal and is above all related to exposure to swimming pool, bath and fresh water in general. It is most common in summer.
Middle ear infection is related to infections in the upper respiratory tracts, and can be self-limiting (it resolves itself in most cases) or purulent requiring antibiotic treatment It is most common in winter.
b) Middle ear infection: there is usually a history of catarrh in the respiratory tract, suddenly accompanied by pain (in small children this can manifest as intense crying), with or without fever. It does not hurt when the external ear is touched or moved. Sometimes the ear drum may be perforated due to inflammation and pressure, which may result in a purulent secretion, generally associated with the pain (and crying) disappearing.
In both cases, diagnosis is clinical: medical history, assessing symptomatology and exploration using an otoscope.
Otoscope exam. Occasionally, if there is suppuration, cultivation of the pus.
Scleroderma is an autoimmune disorder characterised by increased collagen in various body tissues, structural alteration of microcirculation and certain immune abnormalities. The term scleroderma comes from the Greek “skleros”, which means hard, and “derma”, which means skin. This indicates that skin hardening is the most characteristic feature of the condition. As well as the skin, it can also affect the digestive tract, lungs, kidneys and heart. The prognosis varies. There is currently no cure, but the condition can be treated with general measures and treatment of symptoms, depending on the organs affected.
Raynaud syndrome: one of the most characteristic manifestations of the condition (97% of cases), it is the first clinical expression in most patients. It is caused by vasoconstriction of the capillaries. Patients report that with the cold their fingers change colour and turn pale (like wax) first, then turn blue after a while and finally turn reddish. The presence of Raynaud syndrome is not always an indication of scleroderma. In reality, only 5% of people with Raynaud syndrome later develop the condition. Almost half of sufferers may have digital ulcers, as an expression of a severe microcirculatory injury.
The most peculiar manifestation of the disease is the way it affects the skin. It is hard, tight and wrinkle-free (hard to pinch). The extent of the skin condition varies and is related to the prognosis. Two clinical forms are distinguished: limited (distal skin condition to elbows and knees) and diffuse (distal and proximal skin condition to elbows and knees, and torso). The face can be affected equally in both clinical forms. The limited subtype has a better prognosis than the diffuse one. Reduced aperture of the mouth (microstomy) may also be seen. In the skin there are hyperpigmented and coloured areas, telangiectasia (accumulation of small blood vessels) and sometimes subcutaneous calcium deposits can be felt (calcinosis).
Most patients experience joint and muscle pain, and in extreme cases contraction and retraction of the fingers are observed. When the digestive tract is affected, which often happens, the patient complains of a burning sensation and difficulty swallowing, as the oesophagus has lost its ability to move food towards the stomach. Pulmonary disease is the leading cause of death and may occur in the form of fibrosis or pulmonary hypertension; coughing, choking and heart failure are the main manifestations of lung involvement. When the heart is affected, heart rhythm disturbances and in some cases symptoms of angina pectoris are detected, due to the involvement of the small coronary vessels. In a small percentage (about 5%) scleroderma alters the kidney (scleroderma renal crisis) and manifests itself as malignant arterial hypertension and kidney failure.
It should be noted that not all patients with scleroderma present all the manifestations described above. It can also be concluded that there is great, almost individual, variability in the clinical expression of the disease.
Scleroderma is a rare disease with an incidence of 4-18.7/million/year and a prevalence of 31-286/million. It is more common in females, with a variable ratio, depending on the series, ranging from 3:1 to 14:1 (female/male). The age at which it presents is around 30-40 years.
When the above symptomatology is clear, the diagnosis does not offer too much room for doubt. Various complementary tests are helpful in confirming diagnosis and in assessing the degree of involvement of the various organs that may be affected.
“An incurable, but not untreatable condition”. There is currently no treatment for scleroderma that has satisfactory results, but this does not mean that it cannot be treated. Treatment is symptomatic, depending on the organ affected. For Raynaud syndrome: vasodilators, antiplatelets; gastro-oesophageal reflux: proton pump inhibitors; renal crisis: angiotensin converting enzyme inhibitors/dialysis; pulmonary fibrosis: immunosuppressants/lung transplant; pulmonary hypertension: vasodilators/lung transplant. In patients with the diffuse form and less than three years of evolution, immune modulators such as mycophenolate sodium (or mycophenolate mofetil) or methotrexate may be indicated as a basic treatment.
The most common tests to confirm and/or assess the degree of involvement of the various organs are: general analyses and immunological data (specific antinuclear antibodies); capillaroscopy, high-resolution computerised axial tomography scan of the chest, respiratory functional tests, oesophageal manometry and echocardiogram. In the follow-up for these patients, respiratory functional tests and an echocardiogram should be performed annually.
Chronic obstructive pulmonary disease or COPD is a respiratory disease that leads to obstruction of airways. The main symptoms are coughing, hawking and difficulty breathing, requiring particular effort. Although it can be due to other reasons, it is mainly caused by exposure to tobacco smoke. The main treatment is bronchodilators administered using an inhaler.
COPD is a respiratory disease that mainly appears in smokers or ex-smokers and causes the airway to become obstructed or blocked.
The main symptoms are coughing, hawking and difficulty breathing, requiring particular effort. Patients with COPD can also present with infection or worsening of symptoms, known as exacerbation.
The illness mainly affects smokers and ex-smokers. It is also associated with exposure to other sources of smoke, such as biomass smoke. In a small proportion of cases it may be due to genetic causes. The prevalence of COPD is up to 10% of the adult population aged over 40 in Spain.
Diagnosis of COPD is confirmed using a respiratory test: spirometry. This is a very simple test that can be conducted in a primary care centre (CAP). This test should be performed on all individuals over the age of 40 with a history of smoking who have respiratory symptoms such as breathlessness or coughing.
Typical treatment for COPD involves using bronchodilators administered via an inhaler. There are two different types of bronchodilator that may be administered together or separately, depending on each patient’s needs. The aim of this treatment is to reduce the sensation of breathlessness and the number of exacerbations and improve lung capacity. In some patients, administering corticosteroids via inhaler may also be necessary. The best treatment for COPD is stopping smoking.
As well as spirometry, other tests that may be required include chest x-ray, CAT scan, sputum culture or other more complete breathing tests. A blood test is normally performed to rule out genetic causes.
As tobacco is the main risk factor, the best prevention for COPD is not smoking. Exposure to environmental pollution and passive smoking should also be avoided.
Rare factor deficiencies are a group of inherited clotting disorders caused by a deficiency of one or more clotting factors. Clotting factors are involved in a series of reactions to prevent bleeding. Within this set of deficits, factors I, II, V, V + VIII, VII, X, XI or XIII are considered to be affected.
Although in general they do not usually produce spontaneous bleeding, surgery or invasive procedures require prior evaluation of the patient and consideration should be given to administering the appropriate treatment according to the type of procedure and the type of deficit.
It should be noted that most factors usually have a good correlation between factor levels and clinical signs, for example, in factor deficits FI, FII, combined deficit of FV and FVIII, deficit of FX and deficit of FXIII. In the case of VF and VII, however, the correlation is not so clear and with FXI there is usually no correlation between levels and clinical signs.
In general, there is usually bleeding after invasive procedures such as tooth extraction, caesarean section, surgery, epidural anaesthesia, etc. Patients may also present with mucosal bleeding, nosebleeds, heavy-flow menstrual periods, intestinal bleeding, etc.
As it is a genetic disorder, it can appear at all ages. Generally, with a factor level of >20%, haemostasis is ensured in order to conduct a normal daily life, although it is necessary to personalise treatment according to the deficit factor and the characteristics of each patient.
Diagnosis is made in the haemostasis laboratory:
Treatment will depend on the patient’s clinical signs and symptoms, the haemostatic levels required to perform surgery, etc. In mild cases, administration of antifibrinolytics may be sufficient, and in others administration of recombinant factor if available; otherwise plasma or APCC may be used.
The aforementioned laboratory tests.
Arthrosis is a degenerative process characterised by lesions of the cartilage in joints. A joint is the area where a bone connects with another bone, allowing movement. Cartilage is a tissue that covers the joints, acts as a shock absorber for impacts, and also allows the joints to move without friction. Normally, this condition appears in the spinal column, neck, hip, knees, and hands.
Symptoms
The most common manifestation is pain that improves with rest, stiffness when initiating movement, deformities, and difficulty moving the affected joints. There can be a certain degree of inflammation, which will cause swelling due to the excessive accumulation of liquid in the joint.
However, it must be differentiated from arthritis, which is a rheumatic inflammatory disease rooted in joint inflammation that can cause pain which does not improve with rest. Arthrosis is often also called osteoarthritis, which can create some confusion.
Prevalence
This disease is very prevalent and has a high social and health impact. The EPISER2016 study, by the Spanish Society of Rheumatology, showed that the prevalence in the population over 40 years of age is 29%.
Causes
Age is the main risk factor. It is more frequent in women. A deterioration of the cartilage is clearly associated with obesity and a lack of regular physical exercise. A misaligned joint or poor posture can also be predisposing factors. Sometimes the cause is a traumatic injury or previous disorder of the affected joint. It has a genetic component (especially arthrosis of the hands).
Diagnosis
A diagnosis is obtained by looking at the symptoms, physical examination, and the imaging tests.
Treatment
Treatment for this disease is aimed at improving symptoms and quality of life for patients while slowing down its clinical evolution. A treatment plan must be individually prepared for each patient and type of joint.
Non-pharmaceutical treatment is essential. We recommend:
Pharmacological treatment normally consists of conventional pain relievers such as paracetamol, which is the analgesic treatment of choice. There are slow-acting treatments, such as chondroitin sulphate (taken orally) or hyaluronic acid (given as an injection), which can improve pain, especially in arthrosis of the knees. Surgery (joint replacement) is reserved for cases in which the joint is destroyed and other measures have failed.
A rare chronic blood disease that is slow to develop. It is characterised by increased platelet production and is associated with greater risk of thrombosis (clotting) and bleeding. Patients with essential thrombocythemia are usually asymptomatic and it is detected during routine blood tests. There is currently no cure for this condition and treatment is targeted at preventing complications. It is included within the group of chronic myeloproliferative disorders, which are a type of blood cancer that is slow to develop. Its cause is not known, although there are mutations known to be associated with the condition in 80% of cases. It is not hereditary, but some families may have several members affected by it.
It is characterised by increased platelet production and is associated with greater risk of clotting in the arteries and veins, or in some cases with bleeding.
It is a chronic illness that cannot currently be cured, with a normally benign evolution. It can be effectively controlled over long periods and generally has little impact on daily activities and work. Patients with this condition have increased risk compared to the general population of developing other blood diseases, such as acute leukaemia or myelofibrosis.
Useful contacts
MPN voice http://www.mpnvoice.org.uk/
Gemfin: https://www.gemfin.es/informacion-pacientes/
Many patients show no symptoms, either when they are initially diagnosed or as the condition evolves. Different combinations of symptoms may appear, such as tiredness, itching, night time sweating, aching bones and headaches.
The severity of symptoms varies a lot depending on the patient.
It is considered a rare disease, with a low incidence of 1.5-3 cases per 100,000 inhabitants. It mainly affects people aged 60-70 years and to a lesser extent young people. It is more common in women
It is normally diagnosed through blood tests that show a sustained increase in platelet count.
A bone marrow biopsy can be performed for diagnosis, which, together with the analysis, will allow the determination of risk factors for the progression of the disease, which in turn guide treatment.
It is usually associated with genetic mutations that support diagnosis.
Administering antiplatelets or drugs to reduce the number of platelets is not always indicated.
The aim of treatment is to prevent complications due to clotting and bleeding, as well as controlling the symptoms related to this condition. Depending on the risks and symptoms, the haematologist will therefore determine when to start treatment.
There are special circumstances, such as pregnancy, in which a multidisciplinary approach is required.
It is usually controlled by analysis.
The most important thing is to prevent clotting complications associated with this condition by controlling cardiovascular risk factors (high blood pressure, dyslipidaemia, smoking, obesity, sedentary lifestyle) and following the treatment recommended by your haematologist.
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