Celebrating 20 years


This Winter 2017 issue of The Permanente Journal marks the first issue of our 20th anniversary year. We've grown a lot in the past 20 years, currently reaching an online readership of more than one million worldwide. We've expanded to publish books and a literary and visual arts e-journal, leaflet. We are indexed in MEDLINE and continue to grow our digital footprint. We look forward to continuing to bring you more high-quality content during the next 20 years.

Amys CME Advert


The Permanente Press, in conjunction with The Permanente Journal presents this medical literary and arts e-journal, leaflet -- to open greater opportunity to share the creative visual and written works of physicians and nurses.




Health care professionals and employees are encouraged to submit original poetry, prose, and artwork for future issues.

On The Cover

Kaiser Permanente, The Permanente Medical Group, The Permanente Federation 


Irish Fence
By Samuel H Glassner, MD


The fence pictured here runs along the outermost boundary of the grounds of the Rock of Cashel, in Cashel, County Tipperary, Ireland. This site contains a spectacular group of medieval buildings set on a limestone outcrop above the Golden Vale, and is reputed to be where St Patrick converted the King of Munster in the 5th century.


Dr Glassner is a retired Emergency Physician from the Walnut Creek Medical Center in CA.


Endobronchial Tuberculosis

Image Diagnosis: Endobronchial Tuberculosis Masquerading as an Endobronchial Tumor with Presentation as Middle Lobe Syndrome
Kamal Gera, MD; Nevin Kishore, MRCP(UK)


A 70-year-old woman, a never-smoker, presented to our hospital with a dry cough, breathlessness, temperature increase in the evening, and 2 months of loss of appetite and weight loss. Her physical examination was unremarkable. Her chest radiograph posterior-anterior view showed an ill-defined patchy opacity in the right lower zone with loss of cardiac silhouette (Figure 1A).



Adult Epiglottitis

Adult Epiglottitis: A Case Series
Benjamin Lindquist, MD; Sybil Zachariah, MD; Anita Kulkarni, MD

With the advent of immunizations against Haemophilus influenzae serotype b, epiglottitis in the pediatric population has declined rapidly in the past several decades.1,2 As a result, most cases of epiglottitis now occur in adults.2 The differential diagnosis for epiglottitis includes benign conditions such as pharyngitis, laryngitis, viral syndrome, and influenza as well as severe conditions causing airway obstruction, including angioedema, anaphylaxis, foreign body aspiration, and caustic ingestion.



Intracranial Hemorrhage

ECG Diagnosis: Deep T Wave Inversions Associated with Intracranial Hemorrhage
Joel T Levis, MD, PhD, FACEP, FAAEM


The 12-lead electrocardiogram (ECG) in patients with acute intracranial hemorrhage (ICH) can demonstrate several findings associated with ICH and increased intracranial pressure, including deep, inverted “cerebral” T waves, prolonged QT interval, Osborn (J) waves, and U waves.1-3 In addition to the ECG changes described above, cardiac dysrhythmias have been reported in patients with ICH (particularly with subarachnoid hemorrhage), including: sinus bradycardia; sinus tachycardia; atrial pacemaker and atrial fibrillation; premature atrial, junctional, and ventricular complexes; ventricular tachycardia; and atrioventricular blocks.4





25,000 print readers per quarter, 7,628 eTOC readers, and in 2016, 1.4 million page views on TPJ articles in PubMed from a broad international readership.


The Permanente Journal (ISSN 1552-5767) is published quarterly by The Permanente Press. The Permanente Journal is available online (ISSN 1552-5775) at www.thepermanentejournal.org.


Articles, editorials, letters to the editor, and other material represent the opinion of the authors. Send your comments to permanente.journal@kp.org.

Copyright 2017 The Permanente Journal - Kaiser Permanente. All Rights Reserved.