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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

Roman Stonemason

Roman Stonemason
Tom Janisse, MD, MBA


A Roman stonemason works to repair the vulnerable corner of a 1000-year-old structure. He stands sturdy in his fashionably buckled black boots, blue jeans with plaster-clouded knees, and traditional blue work coat with lapels. Kneepads wait to support his delicate work close to the ground, hammering additional bits of marble, variously sized, to fit all filling defects. He restores a historic work of masonry 30 generations after its construction and reconstruction, done just like this in just this way, in a process first learned during the transition from wood to stone.


Pott Puffy Tumor

Image Diagnosis: Pott Puffy Tumor
Diane Apostolakos, MD, MS; Ian Tang, MD


A 20-year-old man was admitted to our hospital with complaints of frontal headache, sinusitis, and fever for one week. Sir Percivall Pott (1714- 1788), a surgeon at St. Bartholomew’s Hospital in London, first described it as Pott Puffy tumor, referring to one of the four historic manifestations of inflammation noted by Aulus Cornelius Celsus (c 25 BC-c 50 AD): rubor (redness), tumor (swelling), calor (warmth), and dolor (pain).



Tubo-ovarian Abscess

Image Diagnosis: Tubo-ovarian Abscess with Hydrosalpinx
Kiersten L Carter, MD; Gus M Garmel, MD, FACEP, FAAEM

Risk factors of tubo-ovarian Abscess include younger age, multiple sexual partners, nonuse of barrier contraception, and a history of pelvic inflammatory disease. Compared with ultrasonography, computed tomography has increased sensitivity to detect thick-walled, rim-enhancing adnexal masses. The aim of therapeutic management is to be as noninvasive as possible. However, if this approach fails to yield clinical improvement within 3 days, reassessment of the antibiotic regimen, with consideration for laparoscopy, laparotomy, adnexectomy, hysterectomy, or image-guided abscess drainage is necessary.




Image Diagnosis: Gastric Migration of Hookworms in a Patient with Anemia
Chalapathi Rao Achanta, MD


A 65-year-old man presented to our hospital with 4 months of fatigue and weakness. He denied any bleeding manifestations and had pallor on examination. The patients’ esophagus was normal, but there were motile hookworms in the gastric antrum and heavy loads of hookworms in the duodenum.





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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.


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