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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.

The Permanente Journal advances knowledge in scientific research, clinical medicine, and innovative health care delivery.

On the Cover

The Permanente Journal


The Breast Cancer Research Stamp—a sampling of stamp images from around the world. The stamp depicts Artemis (Diana in Roman mythology), goddess of the hunt and protector of young girls, bringing and relieving disease in women. She is depicted reaching for an arrow in her quiver to fend off an enemy of women: breast cancer. The position she assumes is also the position for breast self and clinical examination, a subtle reminder for women. The right breast has been removed and replaced with the words “Fund The Fight. Find A Cure.” The rainbow of colors represents the fact that it is a disease of women that affects women of all colors. The rainbow is also thought of as the symbol for hope: in this case, the hope for a cure.


The stamp was originally released in the US in 1998 at a rate of 40 cents (standard first-class letter rate was 32 cents); the balance was allocated to the National Institutes of Health and the Department of Defense to fund breast cancer research. The stamp is now available in 23 countries in various iterations: most based on this design, some completely different. More than $90 million has been raised in the US through the sale of 985 million stamps. There is no way to know how much money has been raised in other countries, but with the funds raised, some countries have set up Cancer Registries and others have purchased mobile mammogram units. Those countries with no research infrastructure use the funds for education, outreach, and treatment. All funds raised in a country stay in that country.


This year’s goal, with fewer than 15 million to sell, is to reach 1 billion stamps sold.

Case Report

Rare Case of Myocardial Infarction in a 19-Year-Old Caused by a Paradoxical Coronary Artery Embolism


Jonathan Kei, MD, MPH; Jennifer Kiss Avilla, MD; Jeffrey J Cavendish, MD


This case focuses on a 19-year-old man who developed an inferior ST-segment elevation myocardial infarction as a result of a previously undetected large atrial septal defect. This cardiac anomaly facilitated the transport of a paradoxical embolism that occluded the right coronary artery.


The Permanente Journal

Clinical Medicine

Image Diagnosis: Arachnoid Cyst


Andrew C Karnazes; Jonathan Kei, MD, MPH; Minh V Le, MD


A 14-year-old boy presented with 3 months of generalized headache that had increased in intensity and frequency with associated lightheadedness. Primary arachnoid cysts result from developmental abnormalities; more rare secondary cysts develop as a result of head injury, meningitis, tumors, or as a complication of brain surgery.


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