Ependymoma

Ependymoma

Ependymoma guddinaan sel-otaa kan uumamuudha, kan inni uumamuunis qaamaa maddaatiifi qaamaa dhiiga keessa jiru keessatti. Sel-otni kun maasii fiigicha jedhamu uuma. Ependymoma sel-ota ependymal keessatti ni jalqaba. Sel-otni kun daandiiwwan kan dhiiga qaamaa maddaatiifi qaamaa dhiiga keessa jiru geessan ni qofa. Dhiigni kun qaamaa maddaatiifi qaamaa dhiiga keessa jiru naannawa ni eega.

Ependymoma umurii kamiyyuu keessa ni uumamuu danda'a, garuu yeroo hedduu daa'immanii keessatti ni uumama. Daa'immanni ependymoma qaban matumaa fi qarqara ni qabaachuu danda'u. Ependymoma kan dargaggoota keessatti uumamu qaamaa dhiiga keessa jiru keessatti uumamuu ni mala. Inni humna qaamaa qaamaa mirga kan miirgoota kan fiigichaan miidhaman to'annoo jala jiru keessatti ni uumamuu danda'a.

Yaalaa inni duraa Ependymomaaf walsimuun yaalaa qalbii ti. Fiigichotni hatattamaan guddatan yookaan fiigichotni yaalaan guutummaan hin baafamneef, yaalota dabalataa ni yaadammachu danda'u. Kunniin yaalaa sa'aatii, radiosurgery, chemotherapy yookaan yaalaa kaayyoo qabu ni dabalatu.

Qorannoo fi tarkaanfiin Ependymoma beekuuf fayyadamani:

• Qorannoo qaamaa mirgaa. Qorannoo qaamaa mirgaa keessatti, ogeessi fayyaa argaa, dhaga'aa, madaalaa, walitti hidhinnaa, humna fi walitti hidhinnaa ni qorata. Rakkoon tokko yookaan kaan keessatti rakkoo argamuun mallattoota qaamaa maddaatiifi qaamaa dhiiga keessa jiru kan fiigichaan miidhamuu danda'u ni argisiisa.
• Qorannoo suuraa. Qorannoo suuraan suuraa qaamaa ni uuma. Inni bakka fi guddina Ependymoma ni agarsiisa. MRI yeroo hedduu fiigicha qaamaa maddaatiif fayyadama. Inni MRI suuraa adda addaa wajjin fayyadama, akka magnetic resonance angiographyatti. Ependymoma qaamaa maddaatiifi qaamaa dhiiga keessa jiru keessatti uumamuu waan danda'uuf, qorannoo suuraa suuraa lachuuwwan lamaan ni uumamuu danda'a.
• Qorannoo dhiiga qaamaa maddaatiifi qaamaa dhiiga keessa jiru. Kan lumbar puncture yookaan spinal tap jedhamu, tarkaanfiin kun injinni lachuuwwan lama keessa jiran qaamaa dhiiga keessa jiru keessatti galchu ni dabalata. Injinni dhiiga qaamaa dhiiga keessa jiru naannawa irraa baasa. Dhiigni kun sel-ota fiigichaa barbaaduuf ni qorata.

Bu'uura qorannoo bu'uura irratti, ogeessi fayyaa kee Ependymoma shakkisiisuun fiigicha baasuuf yaalaa ni yaada. Yeroo baafame, sel-otni fiigichaa qorannoo keessatti mirkaneessuuf ni qorata. Qorannoo adda addaan garee fayyaa sel-ota gosa kan fiigicha keessatti argaman ni himata. Gareen fayyaa kee odeeffannoo kana yaalaa murteessuuf fayyadama.

Filannoon yaalaa Ependymoma:

Ogeessota qaamaa maddaatiifi qaamaa dhiiga keessa jiru, neurosurgeons jedhaman, Ependymoma baay'ina isaa baasuuf ni hojjetu. Kaayyoon fiigicha guutummaa baasuudha. Yeroo tokko tokko Ependymoma qaamaa maddaatiifi qaamaa dhiiga keessa jiru miiraa qabu naannawa jiru waan ta'eef balaa guddaa uuma.

Fiigicha guutummaan yaalaan baafame, yaalaa dabalataa hin barbaachisu. Fiigicha tokko yoo hafe, neurosurgeon fiigicha hafe baasuuf yaalaa dabalataa ni yaada. Yaalota dabalataa, akka yaalaa sa'aatii, fiigicha kan kansarii yookaan fiigicha guutummaan baafamuu baatus ni yaadammachu danda'a.

Yaalaa sa'aatii humna guddaa kan sel-ota fiigichaa ajjeesu ni fayyadama. Humni kun X-rays, protons yookaan madda biroo irraa ni dhufuu danda'a. Yaalaa sa'aatii keessatti, miishiniin humna lachuuwwan adda addaatti ni qajeela sel-ota fiigichaa achi ajjeesuuf.

Yaalaa sa'aatii fiigicha kansarii deebi'uu irraa ittisuuf booda yaalaa ni yaadammachu danda'a. Inni neurosurgeons fiigicha guutummaa baafamuu baatus ni yaadammachu danda'a.

Gosa adda addaa yaalaa sa'aatii yaalaa sa'aatii sel-ota fiigichaa irratti xiyyeeffachuuf ni gargaara. Gosa adda addaa yaalaa kana miidhaa sel-ota fayyaa naannawaa irratti balaa hir'isu ni danda'a. Fakkeenyaaf conformal radiation therapy, intensity-modulated radiation therapy fi proton therapy ni dabalata.

Stereotactic radiosurgery yaalaa sa'aatii humna guddaa dha. Inni humna sa'aatii kutaa hedduu irraa fiigicha irratti ni qajeela. Humni tokko tokko baay'ee humna hin qabu. Garuu bakki humni walitti dhufutti humna sa'aatii guddaa kan sel-ota fiigichaa ajjeesu ni argata.

Chemotherapy dawaa sel-ota fiigichaa ajjeesuuf fayyadama. Chemotherapy yeroo hedduu Ependymoma walsimuuf hin fayyadamu. Inni haala tokko tokko keessatti filannoon ta'uu danda'a, akka fiigicha yaalaa fi sa'aatii booda deebi'uutti.

Yaalaa kaayyoo qabu dawaa kan keemikaala adda addaa sel-ota fiigichaa irratti weerara godhu ni fayyadama. Keemikaala kana cufuun, yaalaa kaayyoo qabu sel-ota fiigichaa ajjeesu ni danda'a. Yaalaa kaayyoo qabu Ependymoma yaalaa booda deebi'u walsimuuf filannoon ta'uu danda'a.

Qorannoo klinikaa qorannoo yaalaa haaraa dha. Qorannoo kun filannoon yaalaa dhuunfaa yaaluuf carraa kennu, garuu balaa ga'eesaa beekkamuu hin danda'u. Yoo qorannoo klinikaa fedhte, garee fayyaa kee waliin haasawu.

Suuraan MRI kan miiraa qabate kun, kan mataa namaa agarsiisu, meningiooma ni agarsiisa. Meningiooma kana guddattee gara qaama sammuutti ni cuftee jira.

Suuraa bu'aa sammuu

Yoo ogeessi fayyaa kee yaadee akka bu'aa sammuu qabdu siif yaade, qorannoo fi mala sirriitti beekuuf, yeroo hedduu qorannoo fi mala barbaachisa. Kunniinis ni dabalata:

• Qorannoo neurolojii. Qorannoo neurolojii kutaa garaagaraa sammuu kee qora, akkamitti akka hojjetuuf ilaaluuf. Qorannoo kana keessatti, argaa, dhaga'aa, madaala, walitti hidhinna, humna fi walitti hidhinna qorachuu ni dabalata. Yoo naannoo tokko ykn kaan keessatti rakkina qabaatte, kun mallattoo ogeessi fayyaa keetif. Qorannoo neurolojii bu'aa sammuu hin argisiisu. Garuu, ogeessi fayyaa kee kutaa sammuu keetiif rakkina qabu hubachuuf si gargaara.
• Suuraa CT mataa. Suuraa kompiitara tomografii, kan jedhamu CT suuraa, suuraa uumaa X-reyii fayyadama. Baay'ee argamu, fi bu'aan saffisaan ni dhufta. Kanaafuu, yoo mataa dhibbaa ykn mallattoolee kaaniin qabaatte, sababa hedduu qabaachuu danda'u, CT qorannoo suuraa duraa ta'uu danda'a. Suuraa CT rakkoo sammuu kee keessa fi naannoo sammuu kee keessa jiru ni argeessa. Bu'aan ogeessi fayyaa kee qorannoo itti aanu murteessuuf mallattoolee ni kenna. Yoo ogeessi fayyaa kee yaadee suuraa CT kee bu'aa sammuu agarsiisa, MRI sammuu barbaachisa ta'uu danda'a.
• Suuraa PET sammuu. Suuraa posiitroon emishiin tomografii, kan jedhamu PET suuraa, bu'aa sammuu tokko ni argeessa. Suuraa PET, qoricha raadiyoo-aktiiv kan sirreeffama keessa galfamu fayyadama. Qoricha sun dhiiga keessa darbee gara sellii bu'aa sammuutti ni maxxanta. Qoricha sun sellii bu'aa sammuu suuraa maashini PET ittiin fudhatamu irratti ni mul'isa. Selliin daqiiqaa fi baay'inaan babal'atu qoricha hedduu ni fudhata.

Suuraa PET, bu'aa sammuu daqiiqaa guddatu argeessuuf fayyadama guddaa qaba. Fakkeenyaaf, glioblastoma fi oligodendroglioomaa tokko tokko dabalata. Bu'aa sammuu gadi aanaa guddatu suuraa PET irratti hin mul'atu. Bu'aa sammuu kan hin dhukkubsine gadi aanaa guddata, kanaafuu, suuraa PET bu'aa sammuu gaarii irratti fayyadama hin qabu. Namni bu'aa sammuu qabu hundinuu suuraa PET hin barbaachisu. Ogeessi fayyaa kee suuraa PET barbaachisa ta'uu yookaa hin ta'iin gaafadhu.

• Fakkeenya qaamaa walitti qabu. Bioopsii sammuu, mala qaama bu'aa sammuu qorannoo laaboraatoorii keessatti qorachuuf baasuudha. Yeroo baay'ee, dookterri suurguun bu'aa sammuu baasu keessatti fakkeenya ni argata.

Yoo suurguun hin danda'amne, fakkeenyi meetiraan baasuu danda'a. Fakkeenya qaama bu'aa sammuu meetiraan baasuun, mala stereotaktiik niidil bioopsii jedhama.

Mala kana keessatti, qullaa xinnoo mataa keessatti ni qotama. Meetira xinnoo qullaa sana keessa ni galfata. Meetiran sun fakkeenya qaama fudhachuu keessatti fayyadama. Qorannoo suuraa kan akka CT fi MRI, daandii meetiraa karoorsuuf fayyadama. Bioopsiin keessatti wanta tokko hin mirkanneef, qoricha naannoo sana dhiphisuuf fayyadama. Yeroo baay'ee qoricha halkan akka rafu siif kenna.

Yoo gareen fayyaa kee hojii hojjechuun kutaa sammuu keetiif barbaachisaa miidhu sodaate, bioopsii meetiraa suurguutti fayyadamuu danda'a. Yoo bu'aan sammuu bakka suurguun ga'uu rakkisaa jiru, meetiraan qaama bu'aa sammuu baasuuf barbaachisa ta'uu danda'a.

Bioopsii sammuu balaa walitti qabuu qaba. Balaaleen dhiiga sammuu keessa ba'uu fi miidhaa qaama sammuutti dabalata.

• Fakkeenya qaamaa laaboraatoorii keessatti qorachuu. Fakkeenyi bioopsii qorannoo laaboraatoorii keessatti ni ergata. Qorannoowwan selliin kan dhukkubsatan yookiin kan hin dhukkubsatin ni argeessa. Akka selliin maikirooskoopin jalatti mul'atu, gareen fayyaa kee selliin akkamitti akka guddatan ni himu. Kun, darajji bu'aa sammuu jedhama. Qorannoowwan kaaniin jijjiirama DNA sellii keessa jiru ni argeessa. Kun, gareen fayyaa kee tarii walitti qabuu kee uumuu keessatti si gargaara.

MRI sammuu. Suuraa maagneetik riizonaansiin, kan jedhamu MRI, suuraa keessa qaamaa uumaa maagneetii cimaa fayyadama. MRI, bu'aa sammuu argeessuuf baay'ee fayyadama, sababiin isaas sammuu suuraa qorannoo suuraa kaaniirratti ifa ta'een ni agarsiisa.

Yeroo baay'ee, MRI dura, dhidhiin sirreeffama keessa galfatama. Dhidhiin sun suuraa ifa ta'een ni uuma. Kun, bu'aa sammuu xinnoo argeessuuf ni gargaara. Gareen fayyaa kee bu'aa sammuu fi qaama sammuu fayyaa adda baasuuf ni gargaara.

Yeroo tokko tokko, suuraa daqiiqaa uumuuf, gosa MRI adda barbaachisa. Fakkeenya tokko MRI hojii. MRI adda kana, kutaa sammuu haasaa, sochii fi hojii barbaachisaa kaaniin to'achuu agarsiisa. Kun, ogeessi fayyaa kee suurguu fi tarii walitti qabu karoorsuuf ni gargaara.

Qorannoo MRI adda biraa, spektarooskoopii maagneetik riizonaansiidha. Qorannoo kun, MRI fayyadamuun, sadarkaa keemikaala tokko tokko sellii bu'aa sammuu keessa jiru ni qora. Keemikaala hedduu yookiin gadi aanaa qabaachuun, gareen fayyaa kee gosa bu'aa sammuu qabdu ni himu.

Perfushiin maagneetik riizonaansii, gosa MRI adda biraadha. Qorannoo kun, MRI fayyadamuun, baay'ina dhiiga kutaa garaagaraa bu'aa sammuu keessa jiru ni qora. Kutaa bu'aa sammuu dhiiga hedduu qabu, kutaa bu'aa sammuu hojii cimaa qabu ta'uu danda'a. Gareen fayyaa kee odeeffannoo kana tarii walitti qabuu kee karoorsuuf fayyadama.

Suuraa PET sammuu. Suuraa posiitroon emishiin tomografii, kan jedhamu PET suuraa, bu'aa sammuu tokko ni argeessa. Suuraa PET, qoricha raadiyoo-aktiiv kan sirreeffama keessa galfamu fayyadama. Qoricha sun dhiiga keessa darbee gara sellii bu'aa sammuutti ni maxxanta. Qoricha sun sellii bu'aa sammuu suuraa maashini PET ittiin fudhatamu irratti ni mul'isa. Selliin daqiiqaa fi baay'inaan babal'atu qoricha hedduu ni fudhata.

Suuraa PET, bu'aa sammuu daqiiqaa guddatu argeessuuf fayyadama guddaa qaba. Fakkeenyaaf, glioblastoma fi oligodendroglioomaa tokko tokko dabalata. Bu'aa sammuu gadi aanaa guddatu suuraa PET irratti hin mul'atu. Bu'aa sammuu kan hin dhukkubsine gadi aanaa guddata, kanaafuu, suuraa PET bu'aa sammuu gaarii irratti fayyadama hin qabu. Namni bu'aa sammuu qabu hundinuu suuraa PET hin barbaachisu. Ogeessi fayyaa kee suuraa PET barbaachisa ta'uu yookaa hin ta'iin gaafadhu.

Fakkeenya qaamaa walitti qabu. Bioopsii sammuu, mala qaama bu'aa sammuu qorannoo laaboraatoorii keessatti qorachuuf baasuudha. Yeroo baay'ee, dookterri suurguun bu'aa sammuu baasu keessatti fakkeenya ni argata.

Yoo suurguun hin danda'amne, fakkeenyi meetiraan baasuu danda'a. Fakkeenya qaama bu'aa sammuu meetiraan baasuun, mala stereotaktiik niidil bioopsii jedhama.

Mala kana keessatti, qullaa xinnoo mataa keessatti ni qotama. Meetira xinnoo qullaa sana keessa ni galfata. Meetiran sun fakkeenya qaama fudhachuu keessatti fayyadama. Qorannoo suuraa kan akka CT fi MRI, daandii meetiraa karoorsuuf fayyadama. Bioopsiin keessatti wanta tokko hin mirkanneef, qoricha naannoo sana dhiphisuuf fayyadama. Yeroo baay'ee qoricha halkan akka rafu siif kenna.

Yoo gareen fayyaa kee hojii hojjechuun kutaa sammuu keetiif barbaachisaa miidhu sodaate, bioopsii meetiraa suurguutti fayyadamuu danda'a. Yoo bu'aan sammuu bakka suurguun ga'uu rakkisaa jiru, meetiraan qaama bu'aa sammuu baasuuf barbaachisa ta'uu danda'a.

Bioopsii sammuu balaa walitti qabuu qaba. Balaaleen dhiiga sammuu keessa ba'uu fi miidhaa qaama sammuutti dabalata.

Darajji bu'aa sammuu, selliin bu'aa sammuu laaboraatoorii keessatti qoratamanii ni kenname. Darajjiin sun, gareen fayyaa kee selliin akkamitti akka guddatanii fi babal'atan ni himu. Darajjiin sun, selliin maikirooskoopin jalatti akkamitti akka mul'atan irratti hundaa'a. Darajjiin 1 hanga 4 gidduutti jira.

Bu'aa sammuu darajji 1 gadi aanaa guddata. Selliin sun, sellii fayyaa naannoo isaa irraa baay'ee adda miti. Darajjiin guddatu, selliin jijjiirama darbu, akkasumas baay'ee adda ta'u jalqabu. Bu'aa sammuu darajji 4 baay'ee daqiiqaa guddata. Selliin sun, sellii fayyaa naannoo isaa irraa wal hin fakkaatu.

Bu'aa sammuu darajji hin qabu. Dhukkuba kaansarii kaaniin darajji qabu. Dhukkuba kaansarii kaaniif, darajjiin kun dhukkuba kaansarii akkamitti akka guddatee fi faca'e ni ibsa. Bu'aa sammuu fi kaansarii sammuu faca'uu hin dandeessu, kanaafuu darajji hin qabu.

Gareen fayyaa kee odeeffannoo hundumaa qorannoo diyaagnoosikee irraa argatte, hubannoo prognoosikee uumuuf fayyadama. Prognoosin kun, bu'aa sammuu fayyadamuun fayyadamuu danda'uu akkamitti akka ta'e ni ibsa. Wantoonni prognoosii namoota bu'aa sammuu qaban irratti dhiibbaa uumu ni dabalata:

• Gosa bu'aa sammuu.
• Bu'aa sammuu akkamitti akka daqiiqaa guddatu.
• Bu'aa sammuu sammuu keessatti eessa akka jiru.
• Jijjiirama DNA sellii bu'aa sammuu keessa jiru.
• Bu'aa sammuu suurguun guutummaatti baasuun danda'uu yookaa danda'uu.
• Fayyaa fi badhaadhinaa guutummaa kee.

Walitti qaamaa sammuu irratti hojjetamaa kan hundaa'u, qaama sammuu kanseera ta'uu ykn kanseera hin taane (kan nama hin miidhu, qaama sammuu gaarii jedhamee waamamu) irratti kan hundaa'adha. Filannoon walitti qabamaa kanneen, gosa, guddaan, sadarkaa fi bakka qaama sammuu irratti kan hundaa'adha. Filannoon kun, qal'ina, wal'aansa raadiyeeshinii, wal'aansa raadiyeeshinii sirrii, keemotaaraapii fi wal'aansa qajeelchaa dabalata. Filannoon walitti qabamaa yaaduu keessatti, gareen fayyaa kee fayyaan kee guutuu fi fedhii kee ilaala. \nWalitti qabamni yeroo sanaa hin barbaachisu. Qaama sammuu kee xiqqaa yoo ta'e, kanseera hin taane fi mallattoo hin uumne yoo ta'e, walitti qabamni yeroo sanaa hin barbaachisu. Qaama sammuu xiqqaa, gaarii, guddatu ykn baayyee gadi aanaa guddatu dhibbaa hin uumne. Qaama sammuu guddatuuf yeroo muraasa waggaa keessatti MRI sammuu gootanii ilaaluu dandeessu. Qaama sammuu yeroo itti yaadamu caalaa yoo guddate ykn mallattoo yoo uumte, walitti qabamni barbaachisa ta'a.\nYaala endoskoopii transnaasal transsfenooidaaliin, meeshaan qal'inaa qolaa keessa fi balbala naasaa gidduu gara qaama sammuu pitiwiitarrii seenuun fayyadama.\nKaayyoo qal'ina qaama sammuu irratti hojjetamaa, selli qaama sammuu hundumaa baasuudha. Qaama sammuu hundumaa baasuu hin danda'amu. Yoo danda'ame, qal'ichaan qaama sammuu baayyee nagaa ta'een baasuuf hojjeta.\nQaama sammuu baasuun kanseera sammuu fi qaama sammuu gaarii walitti qabuu keessatti fayyadama.\nQaama sammuu tokko tokko xiqqaa fi qaama sammuu naannoo irraa adda baasuuf salphaa dha. Kunis qaama sammuu hundumaa baasuuf carraa guddaa argisiisa. Qaama sammuu kaan qaama naannoo irraa adda baasuun hin danda'amu. Yeroo tokko tokko qaama sammuu kutaa sammuu barbaachisaa bira jiraata. Haala kana keessatti qal'iin balaa ta'a. Qal'ichaan qaama sammuu baayyee nagaa ta'een baasuun ni danda'ama. Qaama sammuu kutaa baasuun yeroo tokko tokko baasuu kutaa jedhama.\nQaama sammuu kee kutaa baasuun mallattoota kee hir'isuuf ni dandeessa.\nQaama sammuu baasuuf mala adda addaa jira. Filannoon siif gaarii ta'e haala kee irratti kan hundaa'adha. Fakkeenya gosa qal'ina qaama sammuu keessaa:\n- Kutaa mataa baasuun gara qaama sammuu seenuun. Qal'ina sammuu kutaa mataa baasuun kan walitti qabamu, kraaniyootoomii jedhama. Karaan hojii qaama sammuu baasu caalaatti hojjetamuudha. Kraaniyootoomii kanseera sammuu fi qaama sammuu gaarii walitti qabuu keessatti fayyadama.\nQal'ichaan gara ilkaan kee irratti qallaa godha. Ilkaan fi firiin karaa irraa jijjiirama. Sana booda qal'ichaan meeshaan qallaa kutaa lafaa mataa qallaasa. Lafiin qaama sammuu seenuuf baasa. Yoo qaama sammuu sammuu keessa gadi ta'e, meeshaan qaama sammuu fayyaa karaa irraa qabuuf fayyadama. Qaama sammuu meeshaalee adda addaatiin qallaasa. Yeroo tokko tokko leezarii qaama sammuu balleessuuf fayyadama.\nYaala keessatti, naannoo sana hin dandeessineef dawaa argattu. Yaala keessatti dawaa itti raafamu argattu. Yeroo tokko tokko yaala sammuu keessatti nama sana kaasa. Kun yaala sammuu nama sana kaasu jedhama. Yoo nama sana kaase, qal'ichaan gaaffii gaafata fi hojii sammuu kee deebitee ilaala. Kun balaa kutaa sammuu barbaachisaa miidhu hir'isuuf gargaara.\nHojii qaama sammuu baasu xumuramee booda, kutaa lafaa mataa bakka isaatti deebi'a.\n- Tuuba dheeraa, xixiqqaa fayyadamuun gara qaama sammuu seenuun. Qal'ina sammuu endoskoopii sammuu keessa tuuba dheeraa, xixiqqaa seenuun kan walitti qabamuudha. Tuubichi endoskoopii jedhama. Tuubichi sirri lensootaa ykn kaamera xixiqqaa qaba, suuraa gara qal'ichaatti erga.\nQal'ina sammuu endoskoopii pitiwiitarrii walitti qabuu keessatti baayyee fayyadama. Qaama sammuu kun balbala naasaa duuba guddata. Tuubaa dheeraa, xixiqqaa qolaa fi sinusii keessa gara sammuutti seenuun fayyadama.\nYeroo tokko tokko qal'ina sammuu endoskoopii qaama sammuu sammuu kutaa biraa baasuuf fayyadama. Qal'ichaan meeshaan qallaa godhee lafaa mataa qallaasa. Tuubaa dheeraa, xixiqqaa qaama sammuu keessa gadiseen fayyadama. Tuubichi qaama sammuu gadi seenuun itti fufu.\nKutaa mataa baasuun gara qaama sammuu seenuun. Qal'ina sammuu kutaa mataa baasuun kan walitti qabamu, kraaniyootoomii jedhama. Karaan hojii qaama sammuu baasu caalaatti hojjetamuudha. Kraaniyootoomii kanseera sammuu fi qaama sammuu gaarii walitti qabuu keessatti fayyadama.\nQal'ichaan gara ilkaan kee irratti qallaa godha. Ilkaan fi firiin karaa irraa jijjiirama. Sana booda qal'ichaan meeshaan qallaa kutaa lafaa mataa qallaasa. Lafiin qaama sammuu seenuuf baasa. Yoo qaama sammuu sammuu keessa gadi ta'e, meeshaan qaama sammuu fayyaa karaa irraa qabuuf fayyadama. Qaama sammuu meeshaalee adda addaatiin qallaasa. Yeroo tokko tokko leezarii qaama sammuu balleessuuf fayyadama.\nYaala keessatti, naannoo sana hin dandeessineef dawaa argattu. Yaala keessatti dawaa itti raafamu argattu. Yeroo tokko tokko yaala sammuu keessatti nama sana kaasa. Kun yaala sammuu nama sana kaasu jedhama. Yoo nama sana kaase, qal'ichaan gaaffii gaafata fi hojii sammuu kee deebitee ilaala. Kun balaa kutaa sammuu barbaachisaa miidhu hir'isuuf gargaara.\nHojii qaama sammuu baasu xumuramee booda, kutaa lafaa mataa bakka isaatti deebi'a.\nTuuba dheeraa, xixiqqaa fayyadamuun gara qaama sammuu seenuun. Qal'ina sammuu endoskoopii sammuu keessa tuuba dheeraa, xixiqqaa seenuun kan walitti qabamuudha. Tuubichi endoskoopii jedhama. Tuubichi sirri lensootaa ykn kaamera xixiqqaa qaba, suuraa gara qal'ichaatti erga.\nQal'ina sammuu endoskoopii pitiwiitarrii walitti qabuu keessatti baayyee fayyadama. Qaama sammuu kun balbala naasaa duuba guddata. Tuubaa dheeraa, xixiqqaa qolaa fi sinusii keessa gara sammuutti seenuun fayyadama.\nYeroo tokko tokko qal'ina sammuu endoskoopii qaama sammuu sammuu kutaa biraa baasuuf fayyadama. Qal'ichaan meeshaan qallaa godhee lafaa mataa qallaasa. Tuubaa dheeraa, xixiqqaa qaama sammuu keessa gadiseen fayyadama. Tuubichi qaama sammuu gadi seenuun itti fufu.\nQal'ina qaama sammuu baasuun balaa fi rakkoo qaba. Kunis dhibee, dhiiga ba'uu, dhiiga walitti qabamuu fi qaama sammuu miidhu dabalata. Balaan biraa qaama sammuu qaama sammuu irratti argamu irratti kan hundaa'adha. Fakkeenyaaf, qal'ina qaama sammuu gara uffata ijaatti walitti qabamu balaa ija dhabuu qaba. Qal'ina qaama sammuu gara uffata dhaga'uu walitti qabamu dhaga'uu dhabuu danda'a.\nWal'aansa raadiyeeshinii qaama sammuu irratti, humna guddaa selli qaama sammuu ajjeesuuf fayyadama. Humni kun X-rey, prootoonii fi kan biraa irraa dhufuu danda'a. Wal'aansa raadiyeeshinii qaama sammuu irratti, yeroo baayyee maashinii qaama keessa alaa irraa dhufuu danda'a. Kun wal'aansa raadiyeeshinii alaa jedhama. Baayyee hin taane, raadiyeeshinii qaama keessa galchuun ni danda'ama. Kun braakiiteeraapii jedhama.\nWal'aansa raadiyeeshinii kanseera sammuu fi qaama sammuu gaarii walitti qabuu keessatti fayyadama.\nWal'aansa raadiyeeshinii alaa, yeroo baayyee walitti qabamni guyyaa gabaabaa keessatti hojjetama. Karoorri walitti qabamni tokko tokko, torban 2-6 keessatti guyyaa shan walitti qabamni hojjetama.\nWal'aansa raadiyeeshinii alaa, qaama sammuu kee keessa qaama sammuu argamu irratti xiyyeeffachuu danda'a, ykn sammuu kee guutuu irratti hojjechuun ni danda'ama. Namoonni qaama sammuu qaban hedduun, qaama sammuu naannoo irratti raadiyeeshinii argatu. Yoo qaama sammuu hedduu yoo ta'e, sammuu guutuu walitti qabamni barbaachisa ta'a. Sammuu guutuu yoo walitti qabame, wal'aansa raadiyeeshinii sammuu guutuu jedhama. Wal'aansa raadiyeeshinii sammuu guutuu, baayyee kanseera qaama sammuu irraa gara qaama biraatti babal'atee qaama sammuu keessatti qaama sammuu hedduu uumee walitti qabuuf fayyadama.\nDuubatti, wal'aansa raadiyeeshinii X-rey fayyadama, garuu haala haaraa walitti qabamni kun prootoonii humna fayyadama. Prootoonii humna, selli qaama sammuu miidhuuf xiyyeeffachuu danda'a. Qaama fayyaa naannoo miidhuu hin dandeessu. Walitti qabamni prootoonii, daa'imman qaama sammuu walitti qabuuf gargaara. Akkasumas qaama sammuu kutaa sammuu barbaachisaa baayyee walitti qabuuf gargaara. Walitti qabamni prootoonii, walitti qabamni raadiyeeshinii X-rey duubatti caalaa hin argamu.\nBalaan wal'aansa raadiyeeshinii qaama sammuu irratti, gosa fi humna raadiyeeshinii argattu irratti kan hundaa'adha. Balaan hedduun walitti qabamni ykn sana booda mudatu, dadhabbii, mataa dhukkubbii, yaadachuu dhabuu, ilkaan miidhaa fi rifeensa dhabuudha. Yeroo tokko tokko balaan wal'aansa raadiyeeshinii waggaa hedduu booda mul'ata. Balaan sana booda, yaadachuu fi yaaduu rakkisaa dabalata.\nTeeknooloojii wal'aansa raadiyeeshinii stereeyootaaktikkii, raadiyeeshinii humna sirrii kaa'uuf gama gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa gamaa