Ka Pakaru Te Whekau

Ko te ngāwhā o te roro he oko toto koretake te āhua, he rite ki te pīpī iti. Ka taea te hanga i roto i te roro, i te tūpū rākau rānei, ā, ka puta mai pea he maha o ngā tohu neurological.

Ko ngā ngāwhā o te roro (CCMs) he rōpū o ngā oko toto iti, koretake, kōtiti, he angiangi ngā pakitara. Ka taea pea te kite i roto i te roro, i te tūpū rākau rānei. Kei roto i ngā oko te toto e neke haere ana, e pakaru ana te nuinga. He rite ngā CCM ki ngā pīpī iti. I ētahi tāngata, ka taea e ngā CCM te tuku toto ki te roro, ki te tūpū rākau rānei.

He rerekē te rāhi o ngā CCM. I te nuinga o te wā, ka iti iho i te haurua inihi (1 henimita). Ko te nuinga o ngā CCM he sporadic. Ko te tikanga o tēnei, ka puta te CCM hei ngāwhā kōeke kotahi ana kahore he hītori whānau. Engari, tata ki te 20% o ngā CCM ka pā ki ngā tāngata o te whānau kotahi. E mohiotia ana enei ko ngā CCM whānau. E hono ana ngā CCM whānau ki te huringa o te ira e tukuna ana i roto i ngā whānau. Ko te nuinga o ngā tāngata he CCM whānau, he maha ngā ngāwhā kōeke.

Ko te CCM tētahi o ngā momo ngāwhā oko toto o te roro e wātea ana ngā oko toto koretake. Ko ētahi atu momo ngāwhā oko toto:

• Ngāwhā arteriovenous (AVM).
• Fistula arteriovenous dural.
• Ngāwhā venous whanaketanga (DVA).
• Telangiectasia capillary.

Mō ngā tāngata he momo sporadic, he mea noa kia rua ngā DVA me te CCM.

Ka taea e ngā CCM te tukunga toto, ā, ka arahi ki te toto i roto i te roro, i te tūpū rākau rānei, e mohiotia ana ko te toto. Ka taea e ngā toto o te roro te tuku i ngā tohu maha, pēnei i ngā hopu.

I runga i te wāhi, ka taea hoki e ngā CCM te tuku i ngā tohu rite ki te pēhanga, pēnei i te raruraru ki te nekehanga, ki te āhua rānei o ngā waewae, ā, i ētahi wā, ngā ringa. Ka taea hoki e ngā CCM te tuku i ngā tohu o te kopu me te putea.

Kaore pea ngā āhuatanga o te raru o ngā whekau o te roro (CCMs) e puta. I etahi wā, ki te puta te CCM ki te mata o waho o te roro, ka taea e ia te whakaeke i ngā āwangawanga. Ā, ko ngā CCM e kitea ana i ētahi atu wāhi ka puta mai he maha o ngā tohu. Kei roto i ēnei ngā CCM kei roto i te tuaiwi o te tuara, te pūtake o te roro e hono ana i te tuaiwi o te tuara me te roro, me ngā ganglia whanaunga kei roto i te roro. Hei tauira, ko te toto i roto i te tuaiwi o te tuara ka pāngia ai ngā tohu o te kopu me te putea, te raruraru rānei ki te nekehanga, ki te āhua rānei o ngā waewae, o ngā ringa rānei. Ko te nuinga, ko ngā tohu o ngā CCM ka uru atu ki: Ngā āwangawanga. Ngā mamae o te upoko kino. Te ngoikore o ngā ringa, o ngā waewae rānei. Te ngenge. Te raruraru ki te kōrero. Te mahara me te aroha kino. Te raruraru ki te taurite me te hikoi. Ngā huringa o te tirohanga, pēnei i te tirohanga takirua. Ka taea e ngā tohu te kino ake i te wā me te toto maha. Ka taea te puta mai anō te toto i muri i te toto tuatahi, i muri mai rānei. Ki ētahi tāngata, kaore pea e puta mai te toto anō. Rapua te awhina hauora tonu mena ka pāngia koe e tetahi tohu o te āwangawanga. Tikina hoki te awhina hauora tonu mena kei a koe ngā tohu e whakaatu ana i te raru o ngā whekau o te roro, te toto rānei o te roro.

Rapua te awhina hauora i tenei wa tonu ki te pāngia koe e tetahi tohu o te hopu. Whiwhi ano hoki i te awhina hauora tonu mena he tohu kei a koe e whakaatu ana i te ngoikoretanga o te whekau roro, te toto roro ranei.

Ko te nuinga o ngā raruraru kei roto i te kōpū o te roro (CCMs) e mohiotia ana ko te "ahua ohorere". Ka puta mai rātou hei tetahi raruraru anake, kāhore hoki he pūkenga whānau. Ko te ahua ohorere te nuinga o te wā he raru venous whanaketanga (DVA) e hono atu ana, arā, he uaua koretake me te ahua o te rakau makutu.

Heoi, tata ki te 20% o te hunga he CCM kei a rātou tetahi ahua ira. Ka tukuna atu tenei ahua ki roto i ngā whānau, e mohiotia ana ko te mate pūngao o te kōpū. Ko te hunga he ahua penei pea he mema whānau kei a rātou ngā CCMs, te nuinga o te wā he nui atu i te kotahi te raruraru. Ka taea te whakau i te tautuhi mā te whakamātau ira e hiahia ana ki te tauira toto, ki te tauira waha rānei. Ka tūtohutia te whakamātau ira mo te hunga he:

• Tohutoro MRI o ngā CCM maha kāhore he DVA.
• He pūkenga whānau o ngā CCMs.

Ka taea hoki e te radiation ki te roro, ki te tuaiwi o te tuara rānei te hua i ngā CCM i roto i ngā tau e rua ki te rua tekau i muri mai. Ka taea e ētahi atu mate pūngao onge te hono atu ki te CCM.

Ko te nuinga o ngā raruraru o te whekau roro (CCMs) kāhore he take mārama. Engari ko te ahua e tukuna ana i roto i ngā whānau ka taea te whakaoho i ngā CCM maha, ā, i te tīmatanga, ā, i te roanga o te wā.

Tae noa ki tēnei wā, kua kitea e ngā rangahau e toru ngā huringa ira e whakahaere ana i ngā raruraru o te whekau e tukuna ana i roto i ngā whānau. Tata ki ngā take whānau katoa o ngā raruraru o te whekau kua tohua i roto i aua huringa ira.

Ka tukuna ngā CCM whānau i roto i ngā whānau mā te huringa o tētahi o ēnei ira:

• KRIT1, e kiia ana hoki ko CCM1.
• CCM2.
• PDCD10, e kiia ana hoki ko CCM3.

Ko ēnei ira te take o te pānga ki te rere o ngā oko toto me ngā pūmua e pupuri ana i ngā pūtau oko toto tahi.

Ko ngā raruraru tino nui o ngā ngoikoretanga kiore o te roro (CCMs) e puta mai ana i te toto maha, e kiia ana ko te toto. Ko ngā CCM e toto ana anō, anō pea ka pā te pēhanga toto, ā, ka arahi ki te pakaru o te pūnaha io.

E tino piki ake te tūpono o te toto anō ki te hunga kua pā te toto i mua. E tino piki ake hoki te tūpono o te toto anō ki ngā CCM kei roto i te pūtake o te roro.

Kaore he uauatanga

Ko te nuinga o te hunga e pangia ana e ngā āhuatanga kōhao o te roro (CCMs) kāore he tohu. Ka kitea pea te CCM hei hua o te whakaahua roro mō tētahi atu āhuatanga. I etahi wā, ka āhei ngā tohu motuhake ki te whakahau i tō kaimahi hauora kia mahi atu i ngā whakamātautau.

I runga i te take i whakapaehia ai te āhuatanga, ka taea e tō kaimahi hauora te tono i ngā whakamātautau hei whakau i ngā CCM, te kimi rānei i ētahi atu āhuatanga e pā ana, te whakakore rānei i aua āhuatanga. Ka taea e koe te whakamātautau whakaahua hei titiro ki ngā huringa i roto i ngā oko toto. Ka taea hoki e tō kaimahi hauora te tono i ngā whakamātautau ki te kua oti te whakatau i a koe me te CCM, ā, kei a koe ngā tohu hou. Ka taea e ngā whakamātautau te whakaatu mena kei te toto ranei kei reira ngā CCM hou.

• Whakaahua ā-pūtau (MRI). I roto i tēnei whakamātautau, ka hangaia he pikitia taipitopito o tō roro, o tō tuaiwi rānei. I etahi wā, ka ringihia he tae whakakāhua ki roto i te uaua i te ringa.
• **Whakamātautau ira. **Mēnā he hītori whānau tōu mō te āhuatanga, ka taea e te tohutohu ira me ngā whakamātautau toto, ngā whakamātautau wāhi waha rānei te kimi i ngā huringa ira e pā ana ki ngā CCM.

Ka tukuna he MRI ki te tangata.

Ko ngā āhuatanga o te roro (CCMs) ka tukuna e ngā tohunga. Ā, e āhei ana: \n\n- Ngā tākua i whakangungua ki ngā āhuatanga o te roro me te pūnaha io, e kiia ana ko ngā neurologists me ngā neurologists cerebrovascular.\n- Ngā tākua i whakangungua ki te pokanga o te roro me te pūnaha io, e kiia ana ko ngā neurosurgeons.\n- Ngā tākua i whakangungua ki te whakaahua i te roro, e kiia ana ko ngā neuroradiologists.\n\nKa uru pea ngā tākua i whakangungua ki ētahi atu ngā mahi ki tō maimoatanga.\n\nKa arotake tō rōpū hauora ki ō tohu me ngā whakamātau whakaahua hei whakatau i tētahi mahere maimoatanga. Ka tūtohu pea te rōpū tiaki kia matakitaki tata ki te āhuatanga o te rua. Ā, ka tūtohu pea tō rōpū tiaki kia tangohia, kia maimoatia rānei te āhuatanga o te rua. He maha ngā kōwhiringa kei reira mō te maimoatanga o te āhuatanga o te rua mā te pokanga. Ā, kei te rapu ngā rangahau i ngā rongoā e taea ai te whakaiti i te tūponotanga o te toto.\n\nKi te pēhea koe e mau ana i ngā āwangawanga e pā ana ki te āhuatanga o te rua, ka tukuna pea ki a koe ngā rongoā hei mutu i ngā āwangawanga.\n\nKi te whai tō mahere maimoatanga i te pokanga, ka whai hua pea ngā hangarau whakaahua matatau ake. Ka taea pea e koe te whai i te MRI mahi, e ine ana i te rere o te toto i ngā wāhanga mahi o te roro. Ko tētahi atu kōwhiringa ko te tractography, e hanga ana i tētahi mahere o te roro hei whakarite i te pokanga kia haumaru rawa.\n\nKo te tirohanga o ngā āhuatanga o te roro o te rua e whakawhirinaki ana ki ngā mea maha, tae atu ki tō rātou rāhi, te tipu me te whakaohooho rānei i ngā tohu. Kāore etahi CCM e whakaohooho i ngā tohu, engari ko ētahi atu ka whakaohooho i te toto nui ki te roro.\n\nKei te titiro ngā tohunga ki te whakamahi i te hangarau whakaahua hei whakapai ake i ngā kī taurangi o te huarahi o te mate i ētahi tāngata. Kei te titiro hoki rātou ki te whakamahi i te whakaahua hei tiki i ētahi atu mōhiohio mō te āhua o te mate o tētahi tangata. Ko ēnei hangarau ko te whakaahua mā te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o te whakamahi i te whakaahua o

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