fudge Sep 5
Replying to @Atul_Gawande @C4AHC
Employers bore most of the cost of rising healthcare , keeping wages stable as they bore most of the rising insurance cost

Female breast developmental stages

Stage 1

Preteen. Only the tip of the nipple is raised.

Stage 2

Buds appear, and breast and nipple are raised. The dark area of skin around the nipple (the areola) gets larger.

Stage 3

Breasts are slightly larger, with glandular breast tissue present.

Stage 4

The areola and nipple become raised and form a second mound above the rest of the breast.

Stage 5

Mature adult breast. The breast becomes rounded and only the nipple is raised.

Personalised-Angel-Baby-Cherub-Plaque-Boys-Grave-Memorial-Ornament-Blue-Tribute
Image not available

External otitis: Fungal

History:
This is a 60 year old gentleman who presents with itching in his ear and decreased hearing. He has problems with cerumen and frequently has his ear irrigated. After the last irrigation, one month ago, he noticed weeping and drainage from his ear. Now the plugging and severe pruritis are his chief complaints.

Examination:
The canal is completely filled with a whitish debris. This can be wet or sometimes dry and airy. It has the appearance of mold.

^ Click on the arrow to view the video


History:
The above set of pictures are from a patient that had chronic ear drainage for many years. She has a candida infection with chronic itching.

Information: Fungus is frequently the cause of inflammatory external otitis.Fungal infection: An infection in which fungi grow in the canal causing superficial redness of the bony canal wall skin with musty smelling exudate and powdery appearing debris (fungal mycelia). Moisture and immunosuppresion increase the incidence of this otitis.
Commonly due to the Aspergillus species, a saprophytic fungus that forms a grayish (Aspergillus fumigatus) blotting paper membrane covered with black spores (Aspergillus niger). May also appear white (Candida albicans) or yellow (Aspergillus flavus). Upon suction removal the underlying tympanic membrane appears injected, edematous, and denuded of epithelium. Adequate suctioning of the ear canal is necessary for therapy and prevention. Topical antifungal drops, acidifying drops, or antifungal powders are frequently used. This condition becomes chronic if not completely treated.

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