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.
Pulmonary atresia with ventricular septal defect is a rare heart condition characterised by a lack of connection between the right ventricle and the pulmonary arteries.
This is a rare congenital heart defect characterised by no connection between the right ventricle and the pulmonary arteries. It is an extreme type of Tetralogy of Fallot in which blood enters the lungs to be oxygenated by bypassing the heart.
Blood can reach the lungs via the pulmonary arteries themselves, which are not connected to the heart, or via the collateral arteries, which originate from the thoracic aorta and directly supply the lung. There are significant anatomical differences between vessels which must be studied in each individual child.
This condition is very heterogeneous, which creates the variability seen in the pulmonary arteries. Two groups can be distinguished:
The prognosis of this disease depends on the growth of the pulmonary arteries to be able to surgically repair the condition.
It is a rare congenital heart condition which makes up 1-2% of all congenital heart defects.
In most cases, diagnosis is via foetal echocardiogram. This ultrasound will show the lack of connection between the heart and the pulmonary arteries, as well as the presence of VSD. Through this test the size and position of the pulmonary arteries can also be measured.
When a child is born, it has a certain quantity of oxygen, known as “saturation”, in its blood which is around 80-90% of the normal level, although this is enough for the child to develop normally.
Childhood dystonia is progressive and debilitating, but it can be prevented with an early diagnosis and the use of specific therapies that target the genetic defect identified. Currently, several different treatments are used.
Levodopa trial
In children with isolated dystonia, a one to three-month long trial with levodopa must always be carried out. This medication can completely reverse symptoms when the dystonia is caused by a defect in dopamine synthesis. This is called dopa-responsive dystonia.
Such defective dopamine synthesis can be caused by alterations in the genes and proteins that regulate dopamine metabolism. This neurotransmitter is essential in learning, behaviour, and motor function.
Treatment with botulinum toxin
Botulinum toxin is effective at controlling focal dystonia, which affects a muscle group carrying out a specific action, such as, for example, writer’s cramp, or dystonia triggered by walking, treatment for which consists of correcting the abnormal foot or leg position when walking.
In children with generalised dystonia, botulinum toxin can also relieve pain in muscle groups that are particularly affecting the patient’s quality of life.
Treatment with various pharmaceuticals
To treat generalised dystonia in children, different drugs are administered to reduce the tremors, muscle tone, and painful spasms. These include benzodiazepines, GABA antagonists (baclofen), anticholinergics, and α-2 adrenergic receptor agonists. In some patients with paroxysmal dystonia, which is characterised by brief, repetitive involuntary movements at night, anti-epileptics are prescribed.
Intrathecal baclofen pump
When oral medications are not enough, there is a surgical option: the intrathecal baclofen pump. This internal device administers the medication baclofen through a catheter placed in the epidural space (which contains the liquid that surrounds the spinal cord). This helps control generalised dystonia, reducing pain, muscle tone, and spasms and thus improving patients’ quality of life.
This device is used to treat secondary dystonia or dystonia associated with other neurological problems (whether neurometabolic, neurodegenerative, or acquired through brain damage at birth).
Deep brain stimulation or pallidal stimulation
This consists of placing two electrodes in the pallidal nuclei of the brain via a stereotactic procedure, to improve the patient’s motor function and quality of life. Patients who are candidates for pallidal stimulation are those with primary dystonia who have no structural brain lesions in the central nervous system.
Together with haemodialysis, peritoneal dialysis is an extra-renal filtration procedure. Kidney failure is treated with dialysis, a word that means “pass through”, and which uses the patient’s peritoneum as a filter. The peritoneum is the membrane that lines the abdominal cavity and it has a large surface area of around one square metre. This peritoneal membrane can filter out substances that need to be removed from the body (urea, potassium, phosphorus and many others) when filled with a glucose-rich dialysis fluid that encourages waste to be passed from the patient’s blood into it.
The procedure is as follows: a catheter is inserted into the navel for introducing the dialysis fluid. This fluid is left in the peritoneal cavity for some time and then exchanged for new fluid. This is repeated several times.
Peritoneal dialysis can be performed at the patient’s home and also at night, which is an important factor to maintain the patient's quality of life.
Possible complications of peritoneal dialysis are peritonitis or infection of the dialysis fluid which can lead to infection and inflammation of the peritoneum. Treatment with antibiotics is effective for this complication.
Haemodialysis is usually considered to an intermediary step between advanced kidney failure and a kidney transplant.
Haemodialysis is an extra-renal filtration procedure that replaces kidney function using an external system. It acts as a filter for the patient's blood by connecting to the patient’s circulatory system via a catheter or by being directly inserted into the vein, usually in the arm. In other cases, an arteriovenous fistula may be created, connecting an artery to a vein beneath the skin on the arm. When an artery is connected to a vein, pressure in the vein increases, strengthening the vein walls. This stronger vein is able to withstand the needles used in haemodialysis and greater blood flow is achieved.
People with kidney failure starting a haemodialysis programme typically have less than 10% of normal kidney function. Above this figure, haemodialysis is usually not necessary.
Haemodialysis must be performed regularly in four-hour sessions, usually three times a week, although the duration and frequency will depend on the patient and their circumstances.
Haemodialysis is based on biophysics in the sense that the blood passes through a filter and exchanges substances with the fluid on the other side of the filter, which is circulated by a machine. The exchange gets rids of the urea, potassium, phosphorus and other waste substances that build up due to lack of kidney function. These substances partly pass through the membrane by themselves, as there are different concentrations of the substances and they tend to equalise, and is also due to the changes in pressure exerted by the haemodialysis machine.
Possible complications of haemodialysis are the infection of the catheter or being unable to find a viable vascular access site in patients who have had dialysis for many years.
Haemodialysis may continue for years, although it is usually an intermediate step between kidney failure and transplant.
There are four basic parts to treating renal insufficiency.
Controlling arterial pressure, if it is high; levels of urea; the balance of mineral salts (sodium, potassium, calcium, phosphorus, magnesium); acidity and anaemia. Analytical testing provides a lot of information which enables the origin and severity of the kidney disease to be established.
A kidney biopsy allows a microscopic study that is often essential. Genetic testing also provides very important information.
There are three different levels of treatment:
a) medical, with the use of medication or hormones to substitute the alterations mentioned. A diet that creates little urea or that contains low levels of potassium, drugs to control excess or lack of sodium, potassium, calcium, phosphorus, magnesium or acidity. And medication to treat anaemia.
b) extrarenal purification methods: haemodialysis (passing the blood through an external circuit to purify it and filter out toxic substances using a suitable filter), and peritoneal dialysis, during which a solution is circulated inside the patient's peritoneal cavity and is then extracted, taking the toxic substances usually expelled through urine with it.
c) kidney transplant from a living or deceased donor. In this instance, the new kidney takes over the functions of the diseased kidney. How long a kidney graft lasts varies and relies on controlling episodes of organ rejection that may occur after transplant. A young patient with kidney insufficiency may require more than one kidney transplant over their lifetime, although the useful life of these grafts is increasing day by day thanks to new immunosuppressant drugs.
In treating diphtheria, time is key. For this reason, it is important that it be administered within the first 48 hours after the symptoms appear, without waiting for confirmation of the diagnosis, which must be done in the laboratory.
The treatment uses diphtheria antitoxin and antibiotic treatment using penicillin G procaine.
The lung transplant consists of replacing one or two sick lungs with healthy lungs. In general, transplants are carried out when there is a disease that involves severe and progressive chronic respiratory failure. Lung transplants started in 1981 in California. In Catalonia, this type of intervention is carried out exclusively at Vall d'Hebron University Hospital, for both children and adults.
Currently, 4,000 lung transplants are carried out every year around the world, including children and adults, especially in Europe, the United States, Canada and Australia. In the case of Catalonia, nine lung transplants are carried out per million inhabitants, a figure that puts us at the top of the tables. Our experience ranges from month-old babies to 70-year-olds.
Normally, it is a pneumologist with a patient with chronic respiratory insufficiency who contacts the Lung Transplant Unit for both adults and children at the Vall d'Hebron Hospital. From that first point of contact, the patient will be assessed by a multidisciplinary team in order to offer the best option, which might involve a transplant or simply medical treatment. It is important to remember that people who undergo lung transplants need to be strong enough to both wait for the operation and recover from it. This is a fundamental, complex requirement that must be met if the transplant is to provide benefits for the patient.
The survival rates for lung transplants are very positive. More than half of all patients are still alive after five years of the operation, and one in three patients after ten years. However, the goal of specialists is to continue researching to improve these results and prevent chronic rejection, and all the factors that lead to this complication.
Patients undergoing lung transplants must take an immunosuppressive therapy and prophylactics for an extended period of time. Most of these treatments are oral and in some cases may be inhaled.
In order to prevent complications, the medical advice given by your doctor should be followed precisely, avoid stress or over-exertion and make sure you follow the medication plan exactly. Aside from that, you can expect to lead a normal life.
A heart transplant is when a new heart is implanted. When the organs to be transplanted are the heart and the lungs, this is known as a “cardiopulmonary” transplant. This procedure is necessary when the patient suffers from a heart failure that limits their daily activity and all other treatment options have been exhausted.
The purpose of the transplant is to implant a heart from another person (usually from a donor in a state of brain death) to take over the functions of the heart of the sick person. Sometimes, heart disease causes lung problems or vice versa: pulmonary disease can cause heart disease. In these cases, the heart and the lungs must be transplanted, which is called a "cardiopulmonary transplant". Depending on the type of illness, one or both organs will be transplanted, whatever offers the maximum benefit at the lowest risk.
Before the intervention, a team of professionals must study the patient following a clinical and surgical protocol in order to guarantee success.
The operation is performed under general anaesthesia. During the process of heart transplant, the sick heart is removed and in its place a new one is implanted. Sometimes, it is also necessary to transplant the lungs.
In order to perform these operations, a multidisciplinary team of highly specialised and experienced professionals is required, as well as advanced technology and appropriate facilities.
Post-operative care is handled by the Intensive Care Unit, where intensive doctors, cardiac surgeons, cardiologists and pulmonologists take care of the patient until they are stable, when they are then moved on to a conventional hospital ward.
During this process, the doctor indicates personalised immunosuppressive therapy programme and infection prevention to be followed by the patient, along with any appropriate modifications that might be needed during the post-operative period.
Chemotherapy consists of combining different types of medications that destroy cancer cells in different ways. It acts on these cells that are rapidly reproducing, cancer cells and healthy cells, too.
Chemotherapy is administered in different ways and for various reasons:
The human body is made up of different cells that each have a certain function. Cancer begins when a group of cells reproduces very quickly and uncontrollably. This affects the cells’ function and, therefore, stops the body functioning normally.
Chemotherapy acts on these cells, which may or may not be cancerous, that are rapidly reproducing. This causes side effects, which will depend on the medication, dose, duration and each individual person.
Chemotherapy can be intravenous or oral, meaning it can be administered by the vein or by the mouth. The first option is the most common.
To administer this treatment, sometimes a catheter is left in place that is then connected to a disc below the skin. The medication is administered through this device. This catheter is called a port-a-cath, although there are more types of catheters. The way the vein is accessed depends on the characteristics of the person and the duration of the treatment.
Chemotherapy is applied at intervals and the duration depends on the type of programme, control and treatment.
Chemotherapy can produce the following side effects:
Laparoscopic myomectomy is a surgical intervention used to remove uterine fibroids (or myomas), which are almost always benign tumours that appear inside the wall of the uterus.
The prevalence of uterine fibroids is high, around 30%. In most cases, they are asymptomatic and no treatment is necessary.
In those patients where fibroids do cause symptoms, these include hypermenorrhea, pain and infertility. Myomectomy is a valid treatment option.
Until recently, a laparotomy was the usual procedure. The indication of laparoscopic myomectomy as an alternative to laparotomy has been assessed in various studies. It requires seasoned surgeons with experience in the technique and expert handling of the endoscopic suture.
Laparoscopic myomectomy offers advantages over the laparotomy, such as: reduced postoperative recovery times, decreased postoperative pain and shorter hospital stays. However, it entails longer surgery and requires adequate preoperative evaluation, since the size, number and location of the fibroids can be a limiting factor when choosing a laparotomic approach.
Since June 2009, at the Vall d'Hebron University Hospital we have the Da Vinci robotic system that has been important in assisting in the suture of fibroids in hard-to-reach places, or when the endometrial cavity is affected and must be repaired. In these cases, the Da Vinci system has meant we have been able to offer greater numbers of closed surgeries on our unit.
This treatment is offered by the Gynaecology Department.
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