Non-thrombotic pulmonary embolism (NTPE) is a rare but potentially fatal complication of filler injections. It can result not only from direct intravascular injection but also from the migration of fillers into veins due to local pressure. Here, we report the autopsy findings of two deaths resulting from NTPE following vaginal filler injections. The first case involved a 38-year-old woman who lost consciousness 20-40 minutes after receiving an injection of 15 mL of hyaluronic acid (HA) filler. A large amount of filler was observed in the vagina with gross embolization of the paravaginal vessels. Microscopic examination revealed HA embolism in the lungs. Despite treatment, the patient died 10 days after the procedure. The second case involved a 35-year-old woman who experienced desaturation and cardiac arrest 4 minutes after receiving a collagen filler and a hybrid filler consisting of HA and polylactic acid. An autopsy revealed NTPE and systemic embolism of the collagen filler. She died 1 month after treatment in the intensive care unit. The vagina poses a significant risk for filler injections owing to its rich venous plexus. Doctors should be fully aware of this risk, and a complete autopsy should be performed in such cases.

Non-thrombotic pulmonary embolism (NTPE) is a rare but potentially fatal complication of filler injections. It can result not only from direct intravascular injection but also from the migration of fillers into veins due to local pressure. Here, we report the autopsy findings of two deaths resulting from NTPE following vaginal filler injections. The first case involved a 38-year-old woman who lost consciousness 20-40 minutes after receiving an injection of 15 mL of hyaluronic acid (HA) filler. A large amount of filler was observed in the vagina with gross embolization of the paravaginal vessels. Microscopic examination revealed HA embolism in the lungs. Despite treatment, the patient died 10 days after the procedure. The second case involved a 35-year-old woman who experienced desaturation and cardiac arrest 4 minutes after receiving a collagen filler and a hybrid filler consisting of HA and polylactic acid. An autopsy revealed NTPE and systemic embolism of the collagen filler. She died 1 month after treatment in the intensive care unit. The vagina poses a significant risk for filler injections owing to its rich venous plexus. Doctors should be fully aware of this risk, and a complete autopsy should be performed in such cases.

Non-thrombotic pulmonary embolism (NTPE) is a rare but potentially fatal complication of filler injections. It can result not only from direct intravascular injection but also from the migration of fillers into veins due to local pressure. Here, we report the autopsy findings of two deaths resulting from NTPE following vaginal filler injections. The first case involved a 38-year-old woman who lost consciousness 20-40 minutes after receiving an injection of 15 mL of hyaluronic acid (HA) filler. A large amount of filler was observed in the vagina with gross embolization of the paravaginal vessels. Microscopic examination revealed HA embolism in the lungs. Despite treatment, the patient died 10 days after the procedure. The second case involved a 35-year-old woman who experienced desaturation and cardiac arrest 4 minutes after receiving a collagen filler and a hybrid filler consisting of HA and polylactic acid. An autopsy revealed NTPE and systemic embolism of the collagen filler. She died 1 month after treatment in the intensive care unit. The vagina poses a significant risk for filler injections owing to its rich venous plexus. Doctors should be fully aware of this risk, and a complete autopsy should be performed in such cases.

Non-thrombotic pulmonary embolism (NTPE) is a rare but potentially fatal complication of filler injections. It can result not only from direct intravascular injection but also from the migration of fillers into veins due to local pressure. Here, we report the autopsy findings of two deaths resulting from NTPE following vaginal filler injections. The first case involved a 38-year-old woman who lost consciousness 20-40 minutes after receiving an injection of 15 mL of hyaluronic acid (HA) filler. A large amount of filler was observed in the vagina with gross embolization of the paravaginal vessels. Microscopic examination revealed HA embolism in the lungs. Despite treatment, the patient died 10 days after the procedure. The second case involved a 35-year-old woman who experienced desaturation and cardiac arrest 4 minutes after receiving a collagen filler and a hybrid filler consisting of HA and polylactic acid. An autopsy revealed NTPE and systemic embolism of the collagen filler. She died 1 month after treatment in the intensive care unit. The vagina poses a significant risk for filler injections owing to its rich venous plexus. Doctors should be fully aware of this risk, and a complete autopsy should be performed in such cases.

Background: Suicide remains a significant global public health challenge, with hanging as the most prevalent suicide method in South Korea. This study aimed to determine diagnostic markers confirming suicidal hanging-associated deaths. Methods: In this prospective study, hemorrhages at the periosteal-clavicular origin of the sternocleidomastoid (SCM) muscles were compared among suicidal hanging, manual strangulation, and ligature strangulation cases. This study included 211 cases of suicide by hanging, and a control group of 50 individuals who underwent cardiopulmonary resuscitation but died of other causes. Additionally, nine cases of ligature strangulation and six cases of manual strangulation were analyzed. Postmortem examinations were conducted, and clavicular hemorrhages were histologically evaluated. Statistical analyses were performed using the χ2 test. Results: Hemorrhages at the periosteal-clavicular origin of the SCM were observed in 178 of the 211 hanging cases (84.4%). The highest frequency of clavicular hemorrhage was found in typical hanging cases with complete suspension. Among the 50 control cases, only three showed hemorrhages in the clavicular region, but these were extravasations in the adjoining soft tissue, not in the periosteum. In cases of manual and ligature strangulation, SCM hemorrhages were found within the muscle tissue and were not of periosteal-clavicular origin. Conclusion Hemorrhage at the periosteal-clavicular origin of the SCM is a significant finding in suicidal hanging and serves as a potential pathognomonic marker for confirming cases of suicidal hanging. The study revealed a statistically significant association between the type of hanging, completeness of body suspension, and the occurrence of these hemorrhages.Cardiopulmonary resuscitation does not cause a hemorrhage at this location.

Background: Suicide remains a significant global public health challenge, with hanging as the most prevalent suicide method in South Korea. This study aimed to determine diagnostic markers confirming suicidal hanging-associated deaths. Methods: In this prospective study, hemorrhages at the periosteal-clavicular origin of the sternocleidomastoid (SCM) muscles were compared among suicidal hanging, manual strangulation, and ligature strangulation cases. This study included 211 cases of suicide by hanging, and a control group of 50 individuals who underwent cardiopulmonary resuscitation but died of other causes. Additionally, nine cases of ligature strangulation and six cases of manual strangulation were analyzed. Postmortem examinations were conducted, and clavicular hemorrhages were histologically evaluated. Statistical analyses were performed using the χ2 test. Results: Hemorrhages at the periosteal-clavicular origin of the SCM were observed in 178 of the 211 hanging cases (84.4%). The highest frequency of clavicular hemorrhage was found in typical hanging cases with complete suspension. Among the 50 control cases, only three showed hemorrhages in the clavicular region, but these were extravasations in the adjoining soft tissue, not in the periosteum. In cases of manual and ligature strangulation, SCM hemorrhages were found within the muscle tissue and were not of periosteal-clavicular origin. Conclusion Hemorrhage at the periosteal-clavicular origin of the SCM is a significant finding in suicidal hanging and serves as a potential pathognomonic marker for confirming cases of suicidal hanging. The study revealed a statistically significant association between the type of hanging, completeness of body suspension, and the occurrence of these hemorrhages.Cardiopulmonary resuscitation does not cause a hemorrhage at this location.

Background: Suicide remains a significant global public health challenge, with hanging as the most prevalent suicide method in South Korea. This study aimed to determine diagnostic markers confirming suicidal hanging-associated deaths. Methods: In this prospective study, hemorrhages at the periosteal-clavicular origin of the sternocleidomastoid (SCM) muscles were compared among suicidal hanging, manual strangulation, and ligature strangulation cases. This study included 211 cases of suicide by hanging, and a control group of 50 individuals who underwent cardiopulmonary resuscitation but died of other causes. Additionally, nine cases of ligature strangulation and six cases of manual strangulation were analyzed. Postmortem examinations were conducted, and clavicular hemorrhages were histologically evaluated. Statistical analyses were performed using the χ2 test. Results: Hemorrhages at the periosteal-clavicular origin of the SCM were observed in 178 of the 211 hanging cases (84.4%). The highest frequency of clavicular hemorrhage was found in typical hanging cases with complete suspension. Among the 50 control cases, only three showed hemorrhages in the clavicular region, but these were extravasations in the adjoining soft tissue, not in the periosteum. In cases of manual and ligature strangulation, SCM hemorrhages were found within the muscle tissue and were not of periosteal-clavicular origin. Conclusion Hemorrhage at the periosteal-clavicular origin of the SCM is a significant finding in suicidal hanging and serves as a potential pathognomonic marker for confirming cases of suicidal hanging. The study revealed a statistically significant association between the type of hanging, completeness of body suspension, and the occurrence of these hemorrhages.Cardiopulmonary resuscitation does not cause a hemorrhage at this location.

Background: Suicide remains a significant global public health challenge, with hanging as the most prevalent suicide method in South Korea. This study aimed to determine diagnostic markers confirming suicidal hanging-associated deaths. Methods: In this prospective study, hemorrhages at the periosteal-clavicular origin of the sternocleidomastoid (SCM) muscles were compared among suicidal hanging, manual strangulation, and ligature strangulation cases. This study included 211 cases of suicide by hanging, and a control group of 50 individuals who underwent cardiopulmonary resuscitation but died of other causes. Additionally, nine cases of ligature strangulation and six cases of manual strangulation were analyzed. Postmortem examinations were conducted, and clavicular hemorrhages were histologically evaluated. Statistical analyses were performed using the χ2 test. Results: Hemorrhages at the periosteal-clavicular origin of the SCM were observed in 178 of the 211 hanging cases (84.4%). The highest frequency of clavicular hemorrhage was found in typical hanging cases with complete suspension. Among the 50 control cases, only three showed hemorrhages in the clavicular region, but these were extravasations in the adjoining soft tissue, not in the periosteum. In cases of manual and ligature strangulation, SCM hemorrhages were found within the muscle tissue and were not of periosteal-clavicular origin. Conclusion Hemorrhage at the periosteal-clavicular origin of the SCM is a significant finding in suicidal hanging and serves as a potential pathognomonic marker for confirming cases of suicidal hanging. The study revealed a statistically significant association between the type of hanging, completeness of body suspension, and the occurrence of these hemorrhages.Cardiopulmonary resuscitation does not cause a hemorrhage at this location.

Background/Aims: Sorafenib is the standard of care in the management of advanced hepatocellular carcinoma (HCC). The purpose of this study was to investigate the characteristics, treatment patterns and outcomes of sorafenib among HCC patients in South Korea. Methods: This population-based retrospective, single-arm, observational study used the Korean National Health Insurance database to identify patients with HCC who received sorafenib between July 1, 2008, and December 31, 2014. A total of 9,923 patients were recruited in this study. Results: Among 9,923 patients, 6,669 patients (68.2%) received loco-regional therapy prior to sorafenib, and 1,565 patients (15.8%) received combination therapy with concomitant sorafenib;2,591 patients (26.1%) received rescue therapy after sorafenib, and transarterial chemoembolization was the most common modality applied in 1,498 patients (15.1%). A total of 3,591 patients underwent rescue therapy after sorafenib, and the median overall survival was 14.5 months compared to 4.6 months in 7,332 patients who received supportive care after sorafenib. The mean duration of sorafenib administration in all patients was 105.7 days; 7,023 patients (70.8%) received an initial dose of 600 to 800 mg. The longest survival was shown in patients who received the recommended dose of 800 mg, subsequently reduced to 400 mg (15.0 months). The second longest survival was demonstrated in patients with a starting dose of 800 mg, followed by a dose reduction to 400–600 mg (9.6 months). Conclusions Real-life data show that the efficacy of sorafenib seems similar to that observed in clinical trials, suggesting that appropriate subsequent therapy after sorafenib might prolong patient survival.