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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

Horsetail Fall
by Sapna Reddy, MD


Horsetail Fall cascades down the surface of El Capitan, in Yosemite National Park in CA, when there is an adequate snow accumulation combined with warmer temperatures. For only two weeks in February the angle of the setting sun on clear days illuminates the waterfall, transforming its color to that of flaming lava. The phenomenon attracts tens of thousands of visitors every year. Yosemite National Park is a national treasure and must be protected as such for future generations.



Image Diagnosis: Hemorrhagic Bullae in a Primary Varicella Zoster Virus Infection
Cátia Canelas, MD; João M Carvas, MD; Cristiana Sevivas, MD;Dina Carvalho, MD


A 47-year-old man, 20 pack-per-year smoker, and heavy alcohol drinker, with an episode of pulmonary tuberculosis 10 years previously, presented to the Emergency Department with 7 days of cough, mucous sputum, and abdominal pain. Additionally, he presented with 5 days of a pruriginous skin rash that started on the thorax but rapidly disseminated to the entire body, and with 3 days of fever.



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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