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.
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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.
This is a malformation of the aortic valve that progresses over time and obstructs blood flow out of the left ventricle. Aortic stenosis is often associated with more than one kind of obstruction, such as mitral valve stenosis, coarctation of the aorta, and supravalvular aortic stenosis. This means it can occur as part of hypoplastic left heart syndrome.
Aortic stenosis makes up 3% to 6% of congenital heart diseases detected during childhood. In occurs in 3% to 4% of men and women.
Patients are usually children who do not show any symptoms and develop normally but who are discovered to have a heart murmur during a routine examination. Aortic stenosis may also be detected through the following tests:
Echocardiogram: this is the most effective way to confirm diagnosis. This also enables the valve morphology to be defined and the level of severity evaluated.
Stress test or ergometry: this shows whether the child has symptoms such as high blood pressure, angina, syncope and signs of ischemia, which help to determine the severity of the condition.
The type of treatment will depend on the severity of the condition.
If the percutaneous or surgical valvotomy does not manage to stop the insufficiency or obstruction, then valve replacement is performed. This replaces the aortic valve with a graft from the same patient’s pulmonary valve, or one from a donor.
Patients who have undergone this treatment have a similar quality of life to the rest of the population. Despite this, however, around 20 % will live with mild stenosis for 30 years and 20 % will require surgery on the valve.
It is a chronic inflammatory disease of the oesophagus caused and prolonged due to an allergic reaction. It is typified by difficulty swallowing (dysphagia) any food blockages in the oesophagus (food impaction) and rupturing of the oesophageal wall (oesophageal perforation).
The most common symptoms are:
If the inflammation of the oesophagus and related symptoms are left untreated, they will continue from childhood to adulthood. This inflammation causes structural changes to the oesophagus by remodelling the tissue. This can lead to fibrosis and oesophageal stricture. This means functional deterioration that significantly affects the patient’s quality of life.
From the first recorded case in 1993, eosinophilic oesophagitis has been found to affect 45 out of every 100,000 people, and has an incidence rate of 3.7 cases for every 100,000 people a year. This makes it the most common cause of dysphagia, spontaneous oesophageal perforation and food impaction in young patients.
For appropriate diagnosis, a gastroscopy must be carried out to take multiple biopsies from the oesophagus, since inflammatory alterations can be distributed unevenly. This technique also allows the response to treatment to be assessed.
Endoscopic analysis of the oesophageal mucous membranes is not sufficient to reach a firm diagnosis, as 10-15% of patients will have normal results of a endoscopy.
Treatment for EoE is based on three alternative therapies:
Early diagnosis is important to prevent complications arising from EoE. Early treatment and clinical and endoscopic monitoring is also essential.
Multiple sclerosis is a chronic disease affecting the central nervous system. The immune system reacts against the body’s myelin, a substance that covers the neurones and that transmits nerve impulses. This reaction causes them to slow and be interrupted. MS is a degenerative disease and the second most common cause of neurological impairment in young people (20-40 years old). Neither the cause nor any cure have yet been discovered.
Although the cause is still unknown, the immune system is understood to react in a way that damages the body’s myelin. Loss of myelin causes alterations to brain function, the spinal cord or the optic nerve, and may cause the loss of neuronal tissue. Long term, it can also directly destroy the neurones themselves.
Areas where myelin is lost, called “lesions”, or “demyelinated plaques” appear as hardened areas in nervous tissue. These lesions can appear in multiple locations in the brain, the spinal cord or the optic nerve.
There are multiple symptoms that can appear in two contexts: in the form of specific episodes and/or with increasing disability.
Flare-ups are periods of clinical changes lasting more than 24 hours and that tend to diminish with time, although in some cases there may be lasting effects. If the disease progresses, however, then symptoms appear gradually and accumulate fairly progressively and slowly. Some people only suffer a period of flare-ups, in others the disease is only progressive, and for others it may become progressive following a period of flare-ups.
Depending on the areas affected, symptoms can include:
Balance and coordination may also be affected, as well as urinary function and sexual function.
The number of cases of multiple sclerosis is on the increase worldwide, and has reached a figure of 230 in every 100,000 people in some regions. In Spain, its prevalence is around 100 cases for every 100,000 people. 2.3 million are estimated to be affected around the world, of whom 45,000 were diagnosed in Spain and 7,500 in Catalonia. It is more common in women; two to three women are diagnosed with MS for every man affected. It is usually diagnosed in young adults. Although genetic factors do play a role, it is not considered an inherited disease. Studies show that the increase in cases diagnosed could be due to improvements in diagnostic methods and the quality of epidemiological studies, but also due to the increased risk posed by environmental factors. Vitamin D deficiency is currently associated with the disease.
Diagnosis is complex and carried out by studying the patient's medical history, neurological testing, MRI scan, lumbar puncture and evoked potentials.
Treatment for multiple sclerosis is divided into treating the cause and treating the symptoms.
Treating the cause is based on administering drug treatments orally, endovenously or subcutaneously to try to slow the progression of the disease. Nowadays, a series of drugs of varying efficacy, safety and tolerability are available. The current challenge is to provide the right drug for the right patient; an approach known as “personalised” or “precision medicine”, in addition to quickly detecting patients who do not respond well to a given treatment.
Treating the symptoms: drug treatments are available for some symptoms but not others. A holistic approach to multidisciplinary rehabilitation is used where drug treatments are not available. This type of treatment has been shown to be effective at reducing the impact of the disease on patients’ social life and activities.
Although there are no specific recommendations to prevent the disease, a healthy lifestyle is important (healthy diet, not smoking, moderate exercise, etc.). This will encourage better brain health and can prevent the disease worsening.
It is a chronic brain disorder that can affect people of any age. It is characterised by recurring convulsions caused by excessive electrical impulses in groups of brain cells. The consequences can be neurological, cognitive, psychological and social.
In 2005, epilepsy was defined as “a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures”. Epilepsy is therefore diagnosed when patients experience two or more seizures, separated by a period of time that can last from 24 hours to 10 years.
Epilepsy causes brief absence seizures, involuntary movements, repetitive reflexes such as sucking movements, loss of consciousness, and so on. It can originate in one area of the brain (focal seizure) or the brain as a whole (generalized seizure). Seizures are sometimes accompanied by loss of consciousness and/or loss of bowel control. Their frequency can vary from only just one over a ten year period to several per day.
Seizures (absence seizures, muscle contractions, etc.) are the main symptom and may vary depending where in the brain the epileptic seizure begins.
For example, in tonic-clonic seizures (GTCS), it is common to observe twitching, muscle contractions, jerking, etc. These movements are called “myoclonus” and may be symmetric or asymmetric and are accompanied by rolling of the eyes. They are followed by a spasm with clenching of the teeth, laboured breathing and an epileptic shout.
Epilepsy affects the entire population, regardless of age, from whilst still in the womb right up to people in their nineties. It is estimated that 8 in 1000 people have the condition.
Related factors:
In some cases the cause of epilepsy may be unknown, as although we can see an epileptic seizure occurring in the brain, current technologies do not reveal what causes them. Epilepsy may also be genetic.
It is the second most common neurological disorder (after stroke) seen in accident and emergency departments. An estimated 3,000 patients are seen in our centre every year. 3% of the population will attend a medical centre at some point during their lifetime to determine whether their symptoms are caused by epilepsy.
Diagnosis requires:
It is advisable to avoid all situations that may create:
When faced with a seizure, a series of recommendations should be followed to avoid injury to the person having the seizure.
Hypoplastic left heart syndrome (HLHS) encompasses a series of anomalies that all have a very small, or “hypoplastic”, left ventricle, which is incapable of pumping the required amount of blood to supply all the organs and tissue in the body. In this situation, the right ventricle keeps blood circulating. Children with this type of anomaly tend to have other structures of the left side of the heart that are also smaller. Often the mitral valve, the aortic valve or the aorta itself are smaller than they should be. Hypoplasia of the left chambers is one of the most serious heart defects, although very good outcomes are achieved in centres with experience of the condition such as ours.
It is often diagnosed in the foetus during an echocardiogram. This test can identify which structures are affected by the syndrome in order to decide the best treatment.
These anomalies are usually treated with surgery during the first week of the baby’s life. This operation connects all the vessels coming out of the heart into just one, to ensure blood flows to the body. This procedure is known as “the Norwood procedure”.
In this first surgery, blood reaches the lungs via a conduit that exits the aorta (systemic-pulmonary fistula). Two further procedures will be needed. The aim of this surgery is to make the heart work solely with the oxygenated blood it receives from the lungs, and to pump it to the tissues of the body. Blood flows to the lungs through the network of veins that transport unoxygenated blood (Glenn and Fontan procedure).
Children who have had this heart defect must have their neurodevelopment closely monitored by experts in this field, to evaluate the child’s educational development and growth. Close monitoring is necessary from a cardiological point of view, above all during the first few days of a child’s life. Monitoring the patient will show when surgery is necessary, how they should be managed medically, and how to treat complications, should any arise.
Unfortunately, there are currently no measures that can be taken to prevent these anomalies.
Sepsis is a potentially fatal condition that occurs when the body responds to an infection and attacks its own tissue and organs. On some occasions it produces organic dysfunction (for example, hypertension), which produces an anomalous response to infection and translates into a very serious medical condition.
Septic shock occurs when abnormalities in the circulation, cells or metabolism are so severe that they increase the risk of mortality. This can be identified by persistent hypertension that requires vasopressors to maintain arterial pressure and serum lactate levels. With these criteria, and even with the necessary volume replenishment, hospital mortality rates are over 40%.
Sepsis arises from an infection which changes the body and unleashes signs that may be associated with organic dysfunction or systemic hypoperfusion. These symptoms are:
Every year there are on average 212.7 sepsis patients for every 100,000 citizens in the Catalan healthcare system. To be precise, between 2008 and 2012, 82,300 people were diagnosed with severe sepsis and in 2012 there were 20,228 recorded cases.
At Vall d’Hebron, 232 patients were admitted to Intensive Care with this condition in 2010, amounting to 25.2% of all admissions to this department.
The following diagnostic tests are used for sepsis:
Early treatment can improve prognosis. Sepsis Coding is used for this reason:
To prevent this condition, early detection of patients with a history suggestive of infection and organic dysfunction is vital. In some cases, vaccination is necessary.
Constipation is a disorder of the bowel habits characterised by emptying the bowels less often or hard stools that are difficult to expel. It affects women more than men, and in most cases there is pain or abdominal discomfort. This condition has very important repercussions on the patient’s personal life, health and social life.
In most cases, the cause of constipation is unknown, with no organic or anatomical injury to explain it, and is defined as functional or primary constipation. In other cases, constipation is the result of certain illnesses or medications, known as secondary constipation.
There are several variants within primary constipation:
Secondary constipation due to taking certain medication, above all opioids for pain, and due to neurological, metabolic, or infectious diseases (Chagas) or cancer, amongst others.
The most frequent symptom is difficulty evacuating the bowels.
If there is an alteration in rectal evacuation, symptoms may be:
This is a very common condition in adults and children and affects 10-30% of the world population. 69% of patients say that it affects their performance at work or school, and 40% of patients with constipation have consulted a doctor at some time for this reason. In Spain, between 2005 and 2006, twenty-three million units of laxatives where prescribed in a year.
In general, there are no routine tests on patients with chronic constipation as long as there are no causes for concern such as fever, weight loss or rectal bleeding. On the other hand, if constipation has started recently with no apparent cause, or does not respond well to treatment, it must be investigated via different tests such as:
Constipation must be treated in a personalized way and the causes of it starting or worsening must be analysed. Dietary and hygiene habits and any medication being taken must also be looked into.
The lack of response to this treatment should be assessed by specialists.
There are several ways to prevent constipation:
Human papillomavirus (HPV) is generally spread through sexual intercourse and mainly infects the skin (penis, vulva, anus) or mucous membranes (vagina, cervix and rectum) of the genitals in both men and women. Likewise, it can also appear in the mouth and the pharynx and tonsils.
This is a frequently transmitted disease and in most cases it does not result in any pathology. It can, however, release a benign disease in the form of warts, or less commonly, different types of cancer. In women, HPV can cause cervical cancer.
HPV is spread via direct skin to skin contact during sex, and not through fluids. In around 90% of cases it disappears spontaneously, but it can be transmitted whilst the virus is present.
HPV is classified in terms of whether or not there is a risk of cancer developing:
It should be said that it is possible to be infected with more than one type of HPV. In addition, persistent infection can result in developing cancer of the cervix, vulva, penis, anus or oropharynx.
Specifically, the virus initiates dysplastic changes in the epithelial cells which continue to evolve until they produce an invasive cancer. This is a progressive process and the time from infection until developing the disease can be up to twenty years.
Genital warts or small protuberances or groups of different sizes and shapes may appear in the area of the genitals.
In the case of cancer, there are no symptoms until it is very advanced. In the case of cervical cancer, symptoms show up as:
In Catalonia, cancer of the womb occurs in 7.2 out of every 100,000 women per year (2003-2007). This represents 2.8% of all female cancers. Between the ages of 35-64 this figure rises to 16.1 cases for every 100,000 women. Furthermore, the risk of developing this disease for women who live to 75 is one in 106.
Anal cancer has an annual incidence rate of 1.8 cases for every 100,000 people, but in the case of men engaging in same-sex relations and infected with HIV, this rises to 70 or 128 cases for every 100,000.
When there is evidence of warts, diagnosis is usually clinical or by biopsy. Cancer is detected by cytology tests, which allow anomalous changes in the cells to be seen before they develop. If the test comes back anomalous it can be complemented by a colposcopy that allows magnified examination of the cervix and samples to be taken.
HPV detection is the main component of a preventative strategy to detect the virus before it reaches the point of disease.
There is no specific antiviral treatment for HPV.
In the case of warts, in most cases they can be eliminated through surgery, ointments or other treatments.
If cancer does develop, treatment will depend on the stage at which it is diagnosed. For example, if it is detected early in the cervix this can involve removing the damaged tissue, whilst in more advanced stages it may require a hysterectomy, radiotherapy or chemotherapy.
The use of condoms is essential to prevent HPV. There is also highly effective vaccine used as a way to prevent cervical cancer. Regular cervical smear tests (Papanicolau test) are also carried out as a form of screening. This strategy, however, is changing due to the techniques used to detect the virus which, together with the smear test, are enabling the different stages of the disease to be monitored (acquisition, persistence, progression to precancerous lesions and invasion).
Migraine is a type of chronic headache characterised by repeated episodes of intense pain that can prevent those affected from going about their daily life.
According to the WHO, it ranks 7th in the list of most debilitating illnesses as it can result in years of inactivity, in suffering and a lack of productivity.
Migraine is the result of activation or irritation of the trigeminal nerve fibres. This nerve has three branches that transmit sensation in the head. The fibres of the first branch surround the blood vessels found in the membranes known as the meninges.
The meninges are made up of different layers of tissue that lie over the brain and it is in these structures where we feel the pain. It is the membrane covering it, not the brain itself, where the pain is felt.
During a migraine, the meninges become inflamed as a consequence of inflammatory substances being released from the trigeminal fibres. This inflammation, or non-infectious “meningitis” is responsible for producing the pain and means that it increases or worsens when upon moving the head. For this reason, resting and staying still brings relief.
A migraine attack may last from 4 to 72 hours. This type of headache may occur any number of times, from once a year to several times in succession.
This condition is three times more common in women than men. It generally starts before thirty years of age and no later than fifty.
There is often a family history of migraine. It can be triggered by various stimuli such as food and drink (cheese, red wine, chocolate), intense odours, bright lights, changes in the weather, changes in sleep patterns, hormonal changes and stress.
The symptoms a patient describes must be taken into account when making a diagnosis. A detailed physical and neurological examination should then be carried out, which should be normal in a person with migraine.
After this first stage, the health professional will decide whether additional examinations are necessary to confirm it is migraine and not another illness.
Certain conditions require further medical investigation such as when:
Although there is no cure for migraine, the right treatment can relieve the pain and prevent it occurring.
The first group includes anti-inflammatories, paracetamol, ergotamine and its derivatives, and drugs generically known as triptans. Preventative treatment is advisable when migraines are very frequent and do not respond well to symptomatic treatment.
The choice of a symptomatic or preventative treatment should be decided and monitored by a doctor. It is very important not to self-medicate to avoid chronic headaches that may be triggered by abusing analgesic medication. If used often or in large doses, both prescription and non-prescription medications can cause other problems.
One way to prevent migraine is to try to avoid the things that trigger it. However, some trigger factors are outside our control, such as migraine caused by menstruation or certain weather conditions.
Keeping a regular schedule and avoiding certain food and drink that may cause migraine, as well as getting enough sleep, are important to prevent it. It is important to have a balanced lifestyle with regular mealtimes and bedtimes.
Frequent and gentle exercise also helps reduce the illness.
You can find more information on the blog Midolordecabeza.org
Crohn's disease is a chronic inflammatory intestinal disease that causes recurring lesions anywhere in the gastrointestinal tract. It particularly affects young people who present episodes of stomach symptoms such as diarrhoea, abdominal pain, fever, blood in faeces or fistulas. Crohn's disease can cause various health problems that may result in changes to the patient's personal, social and family life.
Changes in health directly depend on:
All these changes may make the patient feel their quality of life is getting worse and that they should see their doctor often.
Caring for patients with this disease requires a multidisciplinary approach centred around their needs in order to avoid repeat visits. For this reason patients are treated in specialised unit, such as the Crohn’s-Colitis Unit at Vall d’Hebron Hospital.
The disease manifests as flare-ups. In other words, there are periods when symptoms are active and the patient feels unwell (“flare-ups”) and others when the disease calms down (“periods of remission”).
The most common symptoms during a flare-up are:
The incidence rate of Crohn's disease is 1-10 patients/100,000 people a year and its prevalence is 300 per every 100,000 people. It can appear at any age, but is most common in young adults aged 20-40. It affects men and women equally, and factors leading to a predisposition to the disease include smoking, first degree family members with the disease or changes to the faecal microbiota.
Diagnosis is based on the doctor's assessment of the combined symptoms and subsequent complementary tests that identify and locate lesions in the intestine.
The most important test is the colonoscopy, which consists of inserting a flexible tube into the rectum to see inside the intestine, and through which biopsies can be obtained. Radiological tests can also be used such as MRI or CT scans. The results of the biopsies are used to confirm diagnosis.
Recovery begins with pharmacological treatment, which has vastly improved in recent years, and adopting a healthy lifestyle.
There are several treatment options such as corticosteroids, immunosuppressants, and biological agents, which are used depending on the activity and location of the disease, and taking into account any complications that may arise. Once treatment is agreed it is very important not to stop it, as this would result in a relapse and lack of control over the disease.
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