Celebrating 20 years


The Winter 2017 issue of The Permanente Journal marked 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.



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.


Numb Chin Syndrome

Image Diagnosis: Numb Chin Syndrome
Rabih Geha, MD; Trevor Jensen, MD


A 58-year-old woman with a history of stage III lung adenocarcinoma presented with good dentition, no oral lesions, and reduced sensation to light touch over the right side of her chin. A scan showed diffuse dural thickening concerning for leptomeningeal carcinomatosis.



Gastrointestinal Bleeding

Image Diagnosis: Unusual Cause of Gastrointestinal Bleeding in a Young Man: Isolated Gastric Angiodysplasias
Sandeep Lamoria, MD; Arka De, MD; Vishal Sharma, MD, DM


Gastric angiodysplasias are an uncommon cause of upper gastrointestinal bleeding and may be associated with underlying predisposing factors like hereditary hemorrhagic telangiectasia syndrome or under-going hemodialysis. They may present with hematemesis, melena, or chronic gastrointestinal blood loss resulting in anemia.



Myocardial Infarction

ECG Diagnosis: Right Ventricular Myocardial Infarction
Manvi R Nagam, MBBS; David R Vinson, MD; Joel T Levis, MD, PhD, FACEP, FAAEM


Approximately 25% to 50% of cases of inferior wall myocardial infarction are associated with a right ventricular myocardial infarction (RVMI).1 In a large meta-analysis, the presence of RVMI was associated with a 2.6-fold increased risk of mortality as well as an increase in ventricular arrhythmias, high-grade atrioventricular block, and mechanical complications.2 The hemodynamic syndrome associated with RVMI includes hypotension, elevated venous pressures, and shock without evidence of congestive heart failure.3




The Permanente Journal (ISSN 1552-5767) is published quarterly by The Permanente Press. Journal subscriptions are entered for the calendar year. Advance payment in US dollars is required.


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.


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

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