Documento descargado de http://www.revistaneurocirugia.com el 12/03/2015.

Copia para uso personal, se prohbe la transmisin de este documento por cualquier medio o formato.

/HVLyQ PHVHQFHIiOLFD FRQWUDODWHUDO SRU KHUQLD FHUHEUDO ,PDJHQ HQ 5HVRQDQFLD

0DJQpWLFDGHOD+HQGLGXUDGH.HUQRKDQ.HUQRKDQV1RWFK

-*LPpQH]3DQGR-0&DEH]XGR$UWHUR,)HUQiQGH]3RUWDOHV-$5RGUtJXH]6iQFKH]/*yPH]3HUDOV
//RUHQ]DQD\)8JDUUL]D

6HUYLFLRGH1HXURFLUXJtD&RPSOHMR+RVSLWDODULR,QIDQWD&ULVWLQD%DGDMR]

5HVXPHQ 5HVRQDQFLD0DJQpWLFD50

 3UHVHQWDPRV XQ FDVR GH KHPLSDUHVLD LSVLODWHUDO &DVRFOtQLFR

D XQ KHPDWRPD H[WUDGXUDO WUDXPiWLFR FRPR FRQVH
FXHQFLD GH OD GHQRPLQDGD +HQGLGXUD GH .HUQRKDQ  3UHVHQWDPRV HO FDVR GH XQ SDFLHQWH YDUyQ GH  DxRV
.HUQRKDQVQRWFK'RFXPHQWDPRVODOHVLyQPHGLDQWH
LPiJHQHVD[LDOHV\FRURQDOHVHQUHVRQDQFLDPDJQpWLFD
3$/$%5$6 &/$9( +HPDWRPD H[WUDGXUDO +HQGLGXUD
GH .HUQRKDQ +HUQLDFLyQ FHUHEUDO .HUQRKDQV QRWFK
5HVRQDQFLDPDJQpWLFD
&RQWUDODWHUDO PHVHQFHSKDOLF LQMXU\ GXH WR WHQWRULDO
XQFDO KHUQLDWLRQ 0DJQHWLF UHVRQDQFH LPDJLQJ RI WKH
.HUQRKDQVQRWFK
TXHVXIULyXQWUDXPDWLVPRFUDQHRHQFHIiOLFRSRUXQDFDtGD
DFFLGHQWDO(VHQFRQWUDGRHQHVWDGRGHFRPDFRQXQDSXQ
WXDFLyQGHSXQWRVHQOD(VFDODGH&RPDGH*ODVJRZ/D
H[SORUDFLyQQHXUROyJLFDDOLQJUHVRPRVWUDEDXQDDQLVRFRULD
SRU PLGULDVLV L]TXLHUGD \ XQD UHVSXHVWD H[WHQVRUD ELODWH
UDO /D 7& FUDQHDO UHDOL]DGD REMHWLYy XQD IUDFWXUD GH
OD EyYHGD FUDQHDO WHPSRUDO L]TXLHUGD \ XQ YROXPLQRVR
KHPDWRPD H[WUDGXUDO IURQWRWHPSRURSDULHWDO L]TXLHUGR GH
XQRV FF GH YROXPHQ TXH SURGXFtD KHUQLDFLyQ VXEIDO
FLDO \ XQD GHVYLDFLyQ GH OD OtQHD PHGLD GH XQRV PP
6XPPDU\
 :H UHSRUW D FDVH RI D WUDXPDWLF HSLGXUDO KHPD
WRPDZLWKLSVLODWHUDOKHPLSDUHVLVGXHWRWKHVRFDOOHG
.HUQRKDQVQRWFK:HGRFXPHQWWKHLQMXU\ZLWKD[LDO
DQGFRURQDOPDJQHWLFUHVRQDQFHLPDJLQJ
.(< :25'6 &HUHEUDO KHUQLDWLRQ (SLGXUDO KHPDWRPD
.HUQRKDQVQRWFK0DJQHWLFUHVRQDQFHLPDJLQJ
,QWURGXFFLyQ
FRQ REOLWHUDFLyQ GH ODV FLVWHUQDV EDVDOHV )LJXUDV  \ 
/RVHVWXGLRVGHQHXURLPDJHQFHUYLFDOIXHURQQRUPDOHV(O
SDFLHQWH IXH LQWHUYHQLGR LQPHGLDWDPHQWH SUDFWLFiQGRVH
XQD FUDQHRWRPtD \ HYDFXDFLyQ GHO KHPDWRPD (Q HO
SRVWRSHUDWRULR HO SDFLHQWH UHFXSHUy XQ QLYHO QRUPDO GH
FRQFLHQFLDDSUHFLiQGRVHHQWRQFHVXQDWHWUDSDUHVLDLQWHQVD
PD\RUHQKHPLFXHUSRL]TXLHUGR\XQDSDUiOLVLVGHO,,,SDU
L]TXLHUGR $QWH ORV KDOOD]JRV FOtQLFRV QR H[SOLFDGRV SRU
ODV OHVLRQHV REMHWLYDGDV HQ OD 7& FUDQHDO \ FHUYLFDO 
GtDVGHVSXpVGHOWUDXPDWLVPRVHUHDOL]yXQD50FHUHEUDO
TXH SXVR GH PDQLHVWR XQD OHVLyQ HQ SHG~QFXOR FHUHEUDO
GHUHFKR DG\DFHQWH DO ERUGH GHO WHQWRULR KLSHULQWHQVD HQ
 .HUQRKDQ\:ROWPDQGHVFULELHURQHQXQDOHVLyQ
GHOSHG~QFXORFHUHEUDOTXHVHSURGXFHHQHOVtQGURPHGH
HQFODYDGXUDSRUKHUQLDFLyQWUDQVWHQWRULDOGHOXQFXVGXUDQWH
HO FXDO KD\ XQ GHVSOD]DPLHQWR \ FRPSUHVLyQ GHO ODGR
FRQWUDODWHUDO GHO PHVHQFpIDOR FRQWUD HO ERUGH WHQWRULDO
&OtQLFDPHQWHVHWUDGXFHSRUXQDIRFDOLGDGLSVLODWHUDO\HQ
DSDULHQFLDLQFRQJUXHQWHDODOHVLyQRULJLQDO(VWDOHVLyQ
DQDWRPRSDWROyJLFD GHQRPLQDGD +HQGLGXUD GH .HUQRKDQ
VHFXHQFLDV SRWHQFLDGDV HQ )/$,5 \ 7 )LJXUDV  \ 
VLHQGR LVRLQWHQVD HQ ODV VHFXHQFLDV SRWHQFLDGDV HQ 7
'LFKD LPDJHQ WUDGXFH XQD OHVLyQ FRPSUHVLYD SURGXFLGD
SRU OD LPSURQWD GHO ERUGH WHQWRULDO VREUH HO PHVHQFpIDOR
FRQWUDODWHUDODODKHUQLDFLyQGHOXQFXV$ODVFXDWURVHPD
QDVHOSDFLHQWHVRODPHQWHWHQtDXQDSDUHVLDL]TXLHUGDUHVL
GXDOKDELHQGRUHFXSHUDGRWDPELpQODSDUiOLVLVGHO,,,SDU
L]TXLHUGR
.HUQRKDQV QRWFK GHELGR D VX DSDULHQFLD GH PXHVFD R
VXUFRHVWiELHQGRFXPHQWDGDSHURH[LVWHQSRFRVDUWtFXORV
TXH PXHVWUHQ VX FRUUHODFLyQ LFRQRJUiFD HQ LPDJHQ GH
1HXURFLUXJtD5HFLELGR$FHSWDGR

'LVFXVLyQ
 .HUQRKDQ \ :ROWPDQ GHVFULELHURQ XQD OHVLyQ GHO
SHG~QFXOR FHUHEUDO FRQWUDODWHUDO D XQD OHVLyQ H[SDQVLYD
VXSUDWHQWRULDOTXHWUDGXFHODFRPSUHVLyQGHOPHVHQFpIDOR
Documento descargado de http://www.revistaneurocirugia.com el 12/03/2015. Copia para uso personal, se prohbe la transmisin de este documento por cualquier medio o formato.

1HXURFLUXJtD
/HVLyQPHVHQFHIiOLFDFRQWUDODWHUDOSRUKHUQLDFHUHEUDO,PDJHQHQ5HVRQDQFLD0DJQpWLFDGHOD+HQGLGXUDGH.HUQRKDQ  

)LJXUD  7& 7RPRJUDD &RPSXWDUL]DGD FHUHEUDO VLQ )LJXUD  7& 7RPRJUDD &RPSXWDUL]DGD FHUHEUDO VLQ
FRQWUDVWH PRVWUDQGR XQ KHPDWRPD H[WUDGXUDO IURQWRWHP FRQWUDVWH HQ XQ FRUWH EDVDO GRQGH SRGHPRV REVHUYDU HO
SRURSDULHWDOL]TXLHUGRGHXQRVFPGHJURVRUFFGH GHVSOD]DPLHQWR GHO PHVHQFpIDOR GH L]TXLHUGD D GHUHFKD
YROXPHQFRQ]RQDVKLSRGHQVDVHQVXLQWHULRUVXJHVWLYDV
GHiUHDVGHVDQJUDGRKLSHUDJXGR6HDSUHFLDXQDLPSRU
WDQWH KHUQLDFLyQ VXEIDOFLDO \ XQD GHVYLDFLyQ GH OD OtQHD
PHGLDGHXQRVPP
FRQ REOLWHUDFLyQ GH ODV FLVWHUQDV EDVDOHV 7DPELpQ DSUH
FLDPRVGLODWDFLyQGHODVWDWHPSRUDOGHOYHQWULFXORODWHUDO
GHUHFKR FRQVHFXHQFLD GH OD KHUQLDFLyQ VXEIDOFLDO H[LV
WHQWH\YHPRVODSDUWHPiVEDVDOGHOKHPDWRPDH[WUDGXUDO
HQHOODGRL]TXLHUGR

)LJXUD505HVRQDQFLD0DJQpWLFDFHUHEUDOHQVHFXHQ

FLD)/$,575\7(FRUWHFRURQDOGRQGHH[LVWH
XQDOHVLyQKLSHULQWHQVDGHXQRVPPHQHOSHG~QFXORFHUH )LJXUD505HVRQDQFLD0DJQpWLFDFHUHEUDOHQVHFXHQ
EUDOGHUHFKRDG\DFHQWHDOERUGHOLEUHGHOWHQWRULR7DP
ELpQ SRGHPRV DSUHFLDU XQD SHTXHxD OHVLyQ KLSHULQWHQVD
FyUWLFRVXEFRUWLFDOHQUHJLyQLQVXODUGHUHFKDMXQWRFRQORV
UHVWRVGHOKHPDWRPDH[WUDGXUDOLQWHUYHQLGRFRPSUREDQGR
ODUHVROXFLyQGHODVKHUQLDFLRQHVVXEIDOFLDO\XQFDO
FLD 7 75  \ 7(  FRUWH D[LDO PRVWUDQGR XQD
OHVLyQ KLSHULQWHQVD LUUHJXODU HQ SHG~QFXOR FHUHEUDO
GHUHFKR 3RGHPRV FRPSUREDU TXH KD GHVDSDUHFLGR OD
KHUQLDFLyQ XQFDO \ HO GHVSOD]DPLHQWR GHO PHVHQFpIDOR
DSUHFLiQGRVH ORV UHVWRV GHO KHPDWRPD H[WUDGXUDO LQWHU
YHQLGR

Documento descargado de http://www.revistaneurocirugia.com el 12/03/2015. Copia para uso personal, se prohbe la transmisin de este documento por cualquier medio o formato.

1HXURFLUXJtD
*LPpQH]3DQGR\FRO  

FRQWUD HO ERUGH OLEUH GHO WHQWRULR SURYRFDGD SRU XQD GLUHFWDVREUHHOWHQWRULR
KHUQLDFLyQ XQFDO WUDQVWHQWRULDO GHO ODGR FRQWUDULR (VWD  (QHOGLDJQyVWLFRGLIHUHQFLDOSRGUtDPRVLQFOXLUODOHVLyQ
OHVLyQ GHQRPLQDGD +HQGLGXUD GH .HUQRKDQ .HUQRKDQV D[RQDO GLIXVD GDGR TXH HQ OD 50 VH DSUHFLDQ SHTXHxDV
1RWFKKDEtDVLGRGHVFULWDHQHVWXGLRVDQDWRPRSDWROyJLFRV OHVLRQHV FyUWLFRVXEFRUWLFDOHV YLVWDV ~QLFDPHQWH HQ OD
SHURHOGLDJQyVWLFRSRULPDJHQQRKDSRGLGRUHDOL]DUVHKDVWD VHFXHQFLD)/$,5)LJXUDSHURODDXVHQFLDGHOHVLRQHV
TXHKDVLGRSRVLEOHHOXVRGHODUHVRQDQFLDPDJQpWLFD50
GHPDQHUDJHQHUDOL]DGD
 (OGLDJQyVWLFRQHXUROyJLFR\QHXURTXLU~UJLFRVHEDVDHQ
OD ORFDOL]DFLyQ WRSRJUiFD GHO GDxR GHO VLVWHPD QHUYLRVR
\DVHDHQVLVWHPDQHUYLRVRSHULIpULFRRFHQWUDO\GHQWURGH
pVWH HQ OHVLyQ FRUWLFDO GH XQR X RWUR KHPLVIHULR WURQFXODU
RPHGXODU3DUDHOORHVIXQGDPHQWDOODH[SORUDFLyQFOtQLFD
XWLOL]DQGRORVGHQRPLQDGRVVLJQRVORFDOL]DGRUHVTXHQRV
D\XGDQDVLWXDUWDQWRHOQLYHOFRPRODODWHUDOLGDGGHODOHVLyQ
(QXQQ~PHURPX\UHGXFLGRGHSDFLHQWHVGLFKRVVLJQRVORFD
OL]DGRUHV SRGUtDQ OOHYDUQRV D XQ HUURU SRU LQGLFDUQRV XQ
RULJHQWHyULFRGHODOHVLyQHQXQD]RQDVDQDHQPDVFDUDQGR
HQFXHUSRFDOORVR\UHJLyQGRUVRODWHUDOGHOPHVHQFpIDORDVt
FRPRODHYROXFLyQFOtQLFDKDFLDODPHMRUtDHQSRFRVGtDV
QRVGHVFDUWDQGLFKRGLDJQyVWLFR*UDFLDVDOD50WDPELpQ
GHVFDUWDPRVRWURSRVLEOHRULJHQGHOIDOVRVLJQRORFDOL]DGRU
FRPROHVLRQHVVXSUDWHQWRULDOHVRWURQFXODUHVSULPDULDVHQ
HOODGRGHUHFKR
 (QFXDQWRDOPHFDQLVPRGHSURGXFFLyQVHWUDWDGHXQD
OHVLyQ WUDXPiWLFD VHFXQGDULD (Q QXHVWUR FDVR WHQHPRV
HYLGHQFLDTXHKDH[LVWLGRXQDKHUQLDFLyQWUDQVWHQWRULDOGHO
XQFXVGHELGRDODOHVLyQGHO,,,SDUTXHSURYRFDPLGULDVLV
LSVLODWHUDO DO KHPDWRPD H[WUDGXUDO 'LFKD KHUQLDFLyQ KD
SURGXFLGRXQGHVSOD]DPLHQWRGHOWURQFRFHUHEUDOKDFLDHO
OD OHVLyQ UHDO VLHQGR HQ UHDOLGDG XQ IDOVR VLJQR ORFDOL]D ODGR GHUHFKR )LJXUD  SURYRFDQGR OD FRPSUHVLyQ GHO
GRU/DIUHFXHQFLDGHORVVLJQRVORFDOL]DGRUHVIDOVRVHVPX\ PHVHQFpIDOR FRQWUD HO ERUGH OLEUH GHO WHQWRULR (Q OD 7&
EDMD\ODFDXVDVXHOHVHURWUDOHVLyQRGDxRGHOVLVWHPD FHUHEUDOWDPELpQVHDSUHFLDDXVHQFLDGHOHVLyQKHPRUUiJLFD
QHUYLRVR TXH SDVD GHVDSHUFLELGR \ TXH SXHGH H[SOLFDU HO SULPDULDHQHOPHVHQFpIDOR)LJXUD(QHOFRUWHFRURQDO
KDOOD]JRFOtQLFRHQDSDULHQFLDLQFRQJUXHQWH
 &HQWUiQGRQRVHQQXHVWURFDVRFOtQLFRDQWHXQSDFLHQWH
WUDXPiWLFRTXHSUHVHQWDXQDOHVLyQH[SDQVLYDVXSUDWHQWRULDO
\XQDKHPLSDUHVLDLSVLODWHUDOORPiVIUHFXHQWHHVTXHVHD
GHELGR D RWUD OHVLyQ FRUWLFDO HQ HO KHPLVIHULR FRQWUDULR D
XQDOHVLyQSULPDULDHQHOWURQFRHQFHIiOLFRFRQWUDODWHUDODO
GpFLW R ELHQ D XQD OHVLyQ LSVLODWHUDO GH OD YtD SLUDPLGDO
SRU GHEDMR GH VX GHFXVDFLyQ EXOEDU HV GHFLU XQD OHVLyQ
PHGXODU LQFRPSOHWD /D KHQGLGXUD GH .HUQRKDQ SXHGH
H[SOLFDUODKHPLSDUHVLDLSVLODWHUDOGHVFULWD\HVSUHFLVRVRV
SHFKDUODWUDVGHVFDUWDUOHVLRQHVFRUWLFDOHVFRQWUDODWHUDOHVR
OHVLRQHV PHGXODUHV TXH KD\DQ SRGLGR SDVDU LQDGYHUWLGDV
(QHOFDVRFOtQLFRSUHVHQWDGRQRKDH[LVWLGRXQHUURUGLDJ
QyVWLFRQLWHUDSpXWLFRGHELGRDOIDOVRVLJQRORFDOL]DGRU\D
TXHpVWHVHKDSURGXFLGRXQDYH]UHDOL]DGRHOWUDWDPLHQWR
H[LJLGR SRU OD SDWRORJtD H[LVWHQWH HYDFXDFLyQ TXLU~UJLFD
GHOD50)LJXUDYHPRVODOHVLyQGHOSHG~QFXORFHUHEUDO
GHUHFKRMXVWRDG\DFHQWHDOERUGHGHOWHQWRULR3RUWDQWRHO
PHFDQLVPR GH SURGXFFLyQ HV VLPLODU DO SRVWXODGR SDUD OD
KHQGLGXUDGH.HUQRKDQ'HELGRDTXHHOGDxRVHSURGXFH
SRUFRPSUHVLyQGLUHFWDVREUHODYtDSLUDPLGDOHOSURQyVWLFR
IXQFLRQDO VH FRQVLGHUD SREUH VL ELHQ HQ QXHVWUR FDVR HO
SDFLHQWHVHKDUHFXSHUDGRFDVLSRUFRPSOHWR
&RQFOXVLyQ
 $XQTXH HO FXDGUR FOtQLFR TXH GHVFULELPRV QR HV
IUHFXHQWH DQWH XQ SDFLHQWH FRQ IRFDOLGDG QHXUROyJLFD
LSVLODWHUDODXQDOHVLyQH[SDQVLYDVXSUDWHQWRULDOHQHOFXDO
OD 7& QR H[SOLTXH OD FOtQLFD XQD 50 SRGUtD GHPRVWUDU
OHVLyQGHOSHG~QFXORFHUHEUDOFRQWUDODWHUDO
GHO KHPDWRPD H[WUDGXUDO D GLIHUHQFLD GHO FDVR GHVFULWR
SRU:ROI GRQGH XQ HUURU DO LQWHUSUHWDU OD ODWHUDOLGDG GH
XQD7&FHUHEUDOHQXQSDFLHQWHFRQXQIDOVRVLJQRORFDOL]D
GRUVLPLODUDQXHVWURFDVROOHYyDLQWHUYHQLUDXQSDFLHQWH
GH XQ KHPDWRPD VXEGXUDO HQ HO ODGR VDQR 8QD VLWXDFLyQ
FRPRHVDHVH[WUDRUGLQDULDPHQWHUDUDGHELGRVREUHWRGRD
%LEOLRJUDItD
 &KHQ56DKMSDXO5'HO0DHVWUR5)HWDO,QLFLDO
HQODUJHPHQWRIWKHRSSRVLWHSXSLODVDIDOVHORFDOLVLQJVLJQLQ
LQWUDSDUHQFKLPDO IURQWDO KDHPRUUKDJH - 1HXURO 1HXURVXUJ
3V\FKLDWU\
TXHWRGRVORVHVWXGLRVGHLPDJHQ7&\50LQGLFDQFODUD
PHQWHODODWHUDOLGDGGHOHVWXGLRDXQTXHVHDSRVLEOH
 3DUD OOHJDU DO GLDJQyVWLFR GHO IDOVR VLJQR ORFDOL]DGRU
XQDYH]GHVFDUWDGDSDWRORJtDPHGXODUWDQWRFOtQLFDFRPR
SRU SUXHEDV GH LPDJHQ OD 50 FHUHEUDO IXH IXQGDPHQWDO
(QHOODDSUHFLDPRVFODUDPHQWHXQDOHVLyQHQHOSHG~QFXOR
FHUHEUDO TXH VHJ~Q VX FRPSRUWDPLHQWR HQ ODV GLVWLQWDV
 &RKHQ$5:LOVRQ-0DJQHWLFUHVRQDQFHLPDJLQJRI
.HUQRKDQVQRWFK1HXURVXUJHU\
  'DYLH & .HQQHG\ 3 .DWL +$ 6HYHQWK QHUYH
SDOV\DVDIDOVHORFDOLVLQJVLJQ-1HXURO1HXURVXUJ3V\FKLD
WU\
 +DPDGD+.XZD\DPD1(QGR6HWDO'HWHFWLRQ
RI .HUQRKDQV QRWFK RQ PDJQHWLF UHVRQDQFH LPDJLQJ LQ D
VHFXHQFLDV )LJXUDV  \  KLSHULQWHQVD HQ 7 \ )/$,5 SDWLHQWZLWKDFXWHVXEGXUDOKDHPDWRPD%U-1HXURVXUJ
HLVRLQWHQVDHQ7VHFDWDORJDGHOHVLyQQRKHPRUUiJLFD 
WUDGXFLHQGRODOHVLyQD[RQDOSURGXFLGDSRUODFRPSUHVLyQ  -DPLHVRQ'57HDVGDOH(:LOOLVRQ+-)DOVHORFD


Documento descargado de http://www.revistaneurocirugia.com el 12/03/2015. Copia para uso personal, se prohbe la transmisin de este documento por cualquier medio o formato.

1HXURFLUXJtD
/HVLyQPHVHQFHIiOLFDFRQWUDODWHUDOSRUKHUQLDFHUHEUDO,PDJHQHQ5HVRQDQFLD0DJQpWLFDGHOD+HQGLGXUDGH.HUQRKDQ  

OLVLQJVLQJVLQWKHVSLQDOFRUG%-0 WXPRXU D IDOVH ORFDOLVLQJ VLJQ FDXVHG E\ YDVFXODU FRPSUHV

  .HUQRKDQ -: :ROWPDQ +: ,QFLVXUD RI WKH FUXV
GXHWRFRQWUDODWHUDOEULDQWXPRU$UFK1HXURO3V\FKLDWU\

 .ROH0.+\VHOO6(05,FRUUHODWHRI.HUQRKDQV
QRWFK1HXURORJ\
 ,WR\DPD<)XMLRND68VKLR<.HUQRKDQVQRWFKLQ
FKURQLFVXEGXUDOKHPDWRPDQGLQJVRQPDJQHWLFUHVRQDQFH
LPDJLQJ-1HXURVXUJ
  OZDPD 7 .XURGD 7 6XJLPRWR 6 HW DO 05,
GHPRQVWUDWLRQRI.HUQRKDQVQRWFKFDVHUHSRUW1HXURUDGLR
ORJ\
  0DVWURQDUGL / 3X]]LOOL )P 5XJJHUL $ HW DO
0DJQHWLFUHVRQDQFHLPDJLQJQGLQJVRI.HUQRKDQ:ROWPDQ
VLRQ" 5HSRUW RI WZR FDVHV - 1HXURO 1HXURVXUJ 3V\FKLDWU\

 :ROI5)WHU:HHPH&$.ULNNH$3.HUQRKDQV
QRWFKDQGPLVGLDJQRVLV/DQFHW
  =DIRQWH 5' /HH &< .HUQRKDQ:ROWPDQ QRWFK
SKHQRPHQRQ DQ XQXVXDO FDXVH RI LSVLODWHUDO PRWRU GpFLW
$UFK3K\V0HG5HKDELO
*LPpQH]3DQGR - &DEH]XGR$UWHUR -0 )HUQiQGH]
3RUWDOHV , 5RGUtJXH]6iQFKH] -$ *yPH]3HUDOV
/ /RUHQ]DQD / 8JDUUL]D ) /HVLyQ PHVHQFHIiOLFD
FRQWUDODWHUDO SRU KHUQLD FHUHEUDO ,PDJHQ HQ 5HVRQDQFLD
0DJQpWLFD GH OD +HQGLGXUD GH .HUQRKDQ .HUQRKDQV
QRWFK LQ DFXWH VXGEXUDO KHPDWRPD &OLQ 1HXURO 1HXURVXUJ 1RWFK1HXURFLUXJtD

  0LFKHOXFFL 5 7DVVLQDUL &$ 3ODVPDWL 5 HW DO &RUUHVSRQGHQFLDSRVWDO-RUJH*LPpQH]3DQGR&-XOLR&LHQIXH
7ULJHPLQDOQHXUDOJLDDVVRFLDWHGZLWKFRQWUDODWHUDOLQWUDFUDQLDO JRV/LQDUHVQ%%DGDMR]