8 Keyword Epidemiological Pathological forensic medicine Since Milton Halpern, a medical examiner in New York City, recognized an outbreak of fatal malaria in intravenous drug abusers, the forensic pathologists have recognized as an informer of the infectious disease surveillance. In this project, over 3500 autopsy cases during 1999 to 2001 collected from the institute of Forensic Medicine, Ministry of Justice (Taiwan) have been established into a databank and analyzed by using retrospective method. The epidemiological data will include direct and indirect cause of death, mechanism of death, manners of death and social background especially natural cause of death including sudden death. Manner of death of natural, accidental, suicidal, homicidal and unceratinal cause of death are 27.3%, 35.9%, 13.2%, 18.2% and 5.5% of total fatalities, respectively. Mechanism of death of respiratory failure, neurogenic failure, cardiogenic failure and hypovelemic failure are 30.7%, 18.0%, 16.7% and 9.9% of total cases, respectively. 75% of cardiac disease of natural cause of death is identified including atherosclerosis of coronary arteries, hypertrophic cardiomyopathy, cardiac embolic and carditis is recognized. Coronary heart disease (CHD) and carditis are two most frequently identified during autopsy and pathololgical diagnostic procedure of sudden death. Four pancarditis of nine carditis-related deaths and four mutifocal carditis and one focal carditis invade to the nerve bundle are noted. No positive finding of immunohistochemical stain including Coxsackie (A9) and Enterovirus (71) is observed. One meningococcus meningitis of 20 years old female revealed the evidence of cardiac muscle infiltration by acute neutrophils after positive group Y of meningococcus stain in addition 7 108

In this project, over 3500 autopsy cases during 1999 to 2001 collected from the institute of Forensic Medicine, Ministry of Justice (Taiwan) have been established into a databank and analyzed by

9 acute neutrophils after positive group Y of meningococcus stain in addition to the mild meningitis finding. One streptococcal (6 month baby) and one viral (4 years old child) meningoencephalitis and two encephalitis associated with cerebrovascular accident and traumatic head injury are observed. One Taiwan citizen infected with typhus fever during his traveling to the mainland China was proved by immunohistochemical study. Pumonary disease is 8.7% of natural cause of death. 2 interstitial pneumonia, 1 chronic bronchitis, 2 chronic alveolitis of 7 sudden infant death syndrome-related deaths are distinguished. Fatty change associated with cirrhosis of liver is 70% of all hepatic diseases. Combination of hepatic disease with other diseases including respiratory disease, cardiac disease renal disease and sepsis is essential to the cause of death. Lobar pneumonia associated with illicit drug abusers are the major cause of death of illicit drug-related fatalities. These results support the medical examiners and coroners can play an important public health role in conducting surveillance for fatal infectious diseases. Surveillance information of medical examiner system should be promptly disseminated to public health officials and health care providers so that they can take immediate actions such as disease-control efforts and is also useful to describe long-term trends and patterns in disease occurrence and distribution, to portray the natural history of certain conditions, and to evaluate control and prevention measures

One Taiwan citizen infected with typhus fever during his traveling to the mainland China was proved by immunohistochemical study. Pumonary disease is 8.7% of natural cause of death.

10 [1,2,3,4] ( ) 2.6% 3.6% 8.9% 9.4% 29.1% 27.7% 27.2% 9 108

11 (pathogen) hepatotropic viruses hepatic encephalopathy " " flapping tremor (asterixis) portosystemic shunt - -aminobutyric acid

12 [1] meningitis encephalitis (typhus fever)

13 12 108

14 13 108

15 Microsoft Access

16 1725 SPSS Base 8.0 Microsoft Excel

17 16 108

18 1 - Hematoxylin Eosin stain HE 5µm 75ºC % 95% 90% 75% 50% mL HCl/1L 70% ethanol % 80% 90% 100% 100% Histomount 2 Immunohistochemical CDC Zaki

19 Microsoft Excel 72.9% 27.1% % 27.3% 18.2% 13.2% 5.5%

20 % 30.7% 18.0% 16.7% 9.9% 9.8% 2.9% 2.6% 1.9% 1.7% 1.6% 4.0% 37.8% 16.6%

21 42.6% 8.7% 29.4% 26.6% 24.9% 46.9% 25.8% 6.3% 54.7% 11.5% 10.7% 10.4% 9.8% 9.2% 8.1% 6.2% 5.1% 3.4% 3.1%

22 40.4% 10.2% 8.7% 6.4% 4.2% 26.4 % 15.5% 14.6% 9.5% 7.7% 38.4 % 26.6% 13.6% 6.2% 5.1% 25.0% 21.1% 18.0% 12.5% 7.8% / /

23 40.4% 10.2% 8.7% 6.4% 4.2% / / /

24 - Hematoxylin Eosin stain HE ( )

25 Waterhouse-Friderichsen Waterhouse-Friderichsen disseminated intravascular coagulopathy

26 Y 2 Waterhouse-Friderichsen 3 disseminated intravascular coagulopathy CDC Y ( ) Y (group Y) 80/40 mmhg 3000/ul( ) 32000/ul( ) ( ) APTT 82.6/ ( 20-40) Fibrinogen mg/dl (

27 ) D-dimer ng/ml ( 250) (DIC) (septicemia) Enterobacter sakazakii CDC Y Y Y

28 27 108

29 1 2 bacterial aortitis

30 29 108

31 1 2 (1)

32 (2) (3) / /

34 2 hepatorenal failure hepatoencephalopathy 1 lipase trypsin

35 34 108

36 35 108

37 Status thymicolymphaticus Sudden unexplained death syndrome sudden infant death syndrome

38 Sudden Infant Death Syndrome 39.3 E4 V1 M5 Ceftriaxone

39 Zaki ( ) (typhus fever) Cefazolin Erythro mycin Minocycline Vanco mycin Streptomycin Rifapin CDC Adenovirus pneumonia

40 Zaki Typhus fever PCR DNA

41 Y (group Y) Typhus fever

42 1. Cotran RS, Kumar V and Collins Tucker. Robbins Pathologic Basis of Disease. Chapter 7,8,13,19,30, W. B. Saunders. 6 th edition, Laupland KB et al: Invasive Group A Streptococcal Disease in Children and Association with Varicella-Zoster Virus. Infectious Pediatrics 105(5) : Shaw, KP. and Fong JM Atypical Victims Related To Meth-amphetamine Abuse. J. Forensic Pathology Association, Shaw, KP. Chen. Li., Dong Liang Lin, Jiang-Chunn Liu, and Fong, JM JM. 1993d. Human Methamphetamine-Related Fatalities: Epidemiological, Pathological and Toxicological Studies. International Forensic Science. P Shaw, KP, Pu CE, Lin DL, Liu JC, Fong JM. A Comparative Study of Inhalation and Self-Administration Methamphetamine-Induced Toxicities in Rats. Advances in Forensic Sciences. 1995;5: Serotec. Antigen retrieval techniques for use with formalin-fixed paraffin-embedded section. Serotec UK. P68-72, Spitz, WU. Medicolegal investigation of death. 3 rd edition. Charles. C. Thomas Wetli. CV, Mittleman RE and Rao VJ. Partical Forensic Pathology Igakushion Co. New York NY. USA

43 ~ p75~ (5):291~300, ( ) 3(2) p (1):198~208, p291~ Waterhouse-Friderichsen (01-022)

44 ( A) 10x2 ( B) 10x10 ( C) 10x10 ( D) 10x40 ( A) H&E 20X ( B) ( C) ( D) ( A)

45 ( B) Waterhouse-Friderichsen (01-022) ( A) 10x2 ( B) 10x10 ( C) 10x20 ( D) 10x40 ( A) H&E 20X

46 ( B) ( C) H&E 200X ( D) ( A) ( B) Waterhouse-Friderichsen (01-022) ( A) 10x2 ( A) 10x2 ( B) 10x

47 ( C) 10x40 ( D) 10x40 ( A) H&E 20X ( B) ( A) H&E 20X ( B) ( C) ( D) Waterhouse-Friderichsen (01-022) ( A) 10x2 ( B) 10x

48 ( C) 10x10 ( D) 10x40 ( A) 10x2 ( A) Waterhouse-Friderichsen H&E 20X ( B) Waterhouse-Friderichsen H&E 20X ( C) Waterhouse-Friderichsen ( D) Waterhouse-Friderichsen ( A) H&E 20X ( B) Waterhouse-Friderichsen (01-022)

49 ( A) 10x10 ( A) ( B) ( A) disseminated intravascular coagulopathy ( B)

50 ( ) ( B) 10x20 ( A) 10x2 ( A) ( B) 10x

51 ( B) H&E 200X ( A) H&E 20X ( B) ( A) ( B) H&E 200X ( ) ( A) ( B)

52 ( ) Nisseria Meningococcus, group Y Nisseria Meningococcus, group Y

53 ( ) ( A) 10x20 ( A)

54 ( B) ( A) H&E 200X ( B) ( A) ( B) ( )

55 ( A) 10x10 ( A) ( B) ( A) ( B) ( A) ( B) ( )

56 Nisseria Meningococcus, group Y Nisseria Meningococcus, group Y

57 ( ) ( A)

58 ( B) ( A~ B), 400X ( A) ( B) ( )

59 ( A) 10x10 ( A) ( B) ( A~ B), 400X ( A) ( B) ( )

60 ( A) 10x10 ( C) 10x10 ( D) 10x40 ( A) ( B) ( A ~ D), 400X ( )

61 ( A) 10x10 ( C) 10x10 ( D) 10x40 ( A ~ D), 400X ( A)

62 ( B) bacterial aortitis ( ) ( A) 10x2 ( A) 10x2 ( B) 10x10 ( B) 10x

63 ( C) 10x40 ( C) 10x40 ( A) H&E 20X ( B) ( C) ( A) H&E 20X ( B) ( C) ( )

64 ( A) 10x10 ( A) ( B) ( A) ( B) ( A) ( B) ( )

65 ( A) 10x10 ( A) ( B) ( A) ( B) ( A) ( B) ( )

66 ( A) 10x10 ( A) ( B) ( A) ( B)

67 ( A) ( B) ( ) ( A) ( B)

68 ( ) ( A)

69 ( B) ( A) ( B) ( A) ( B) ( )

70 ( A) 10x10 ( A) ( B) ( A) ( B) ( A) ( B) ( ) ( A) ( B)

71 ( ) ( A) 10x1.25 ( B) 10x10 ( A) 10x2 ( A) H&E 12.5X

72 ( B) ( A) H&E 20X ( B) ( A) ( B) ( )

73 ( A) 10x10 ( A~ A) ( ) ( ) ( ) ( B~ B) ( ) ( A) ( B)

74 ( ) ( A) 10x2 ( A) 10x2 ( B) 10x10 ( B) 10x10 ( C) 10x40 ( C) 10x40 ( A) H&E 20X

75 ( B) ( C) ( A) H&E 20X ( B) ( C) ( )

76 ( A) 10x10 ( A) ( B) ( A) ( B) ( A) ( B) ( ) ( A) 10x

77 ( A) 10x10 ( A~ B) H&E 40X, 400X ( A) 100X ( A) 400X

78 ( ) ( A) 10x2 ( B) 10x10 ( C) 10x40 ( A ~ C) H&E 20X, 100X, 400X

79 ( ) ( B) 10x10 ( C) 10x40 ( C) 10x40 ( A)

80 ( B) ( C) ( A) ( B) ( C) ( ) ( B) 40x

81 ( A) 10x10 ( A) ( B) ( A) ( B) ( A) ( B) ( ) ( A) 10x1.25 ( B) 10x

82 ( C) 10x10 ( D) 10x20 ( A~ D) H&E 12.5X, 40X, 100X, 200X

83 ( ) ( A) 10x2 ( B) 10x10 ( A)

84 ( B) ( A) H&E 20X ( B) ( A) ( B) ( ) ( A) 10x2 ( A) 10x2 ( B) 10x

85 ( A) 10x2 ( B) 10x10 ( A) H&E 20X ( B) ( A) H&E 20X ( B) ( A) H&E 20X ( A) ( ) ( C) 10x40 ( C)

86 ( ) ( A) 10x2 ( B) 10x10 ( A) H&E 20X

87 ( B) ( A) ( B) ( A) ( B) ( ) ( A) 10x2 ( B) 10x

88 ( A) 10x10 ( A) H&E 20X ( B) ( A) ( B) ( A) ( B) ( ) ( A) 10x2 ( B) 10x

89 ( A) 10x10 ( A) 10x2 ( B) 10x10 ( A) H&E 20X ( B) ( A) ( B) ( A) H&E 20X ( B) ( )

90 ( A) 10x10 ( A) ( B)

91 ( ) ( A)

92 ( B) ( A) ( B) ( A) ( B) ( ) ( A) ( B) ( A) ( A)

93 (02-CDC-01) ( A) ( B)

94 ( A) ( B) ( A) ( B) (02-CDC-01) ( C) 10x10 ( D) 10x

95 ( A) 10x10 ( A) ( B) ( C) ( D) ( A) ( B) (02-CDC-01)

96 ( A) 10x10 ( A) ( B) ( A) ( B) ( A) ( B) (02-CDC-01) ( A) ( B)

97 ( ) ( A) 10x2 ( B) 10x10 ( A~ B)

98 , 400X ( A~ B) H&E 20X, 100X ( A~ B), 400X ( ) ( A) 10x2 ( B) 10x

99 ( C) 10x10 ( D) 10x40 ( A~ B), 400X ( A) H&E 20X ( B) ( C) ( D) ( ) ( A) 10x2 ( B) 10x

100 ( A) 10x2 ( B) 10x10 ( A) H&E 20X ( B) ( A~ B) Status thymicolymphaticus Sudden unexplained death syndrome H&E 20X, 100X ( A~ B), 400X sudden infant death syndrome ( )

101 ( A) 10x2 ( B) 10x10 ( C) 10x40 ( A) 10x40 ( A~ A) Sudden Infant Death Syndrome H&E 20X, 100X, 400X

102 ( ) ( A~ B) Sudden Infant Death Syndrome, 400X

103 ( ) ( A) (glial nodule) typhus fever ( A B ) leptospirosis

104 ( ) ( B) (glial nodule) typhus fever ( A B ) leptospirosis

105 ( ) ( A) 10x2 ( A~ B) DIC H&E 20X, 400X

106 ( ) Adenovirus pneumonia

107

計畫編號：DOH92-DC-1009

計畫編號：DOH92-DC-1009 DOH94-DC 1034 1 1 94 9412 31 ... 1-3 4-7 8-10 11-12 13-27 2 8 29-30 3 1 3 2 3 3 3 4 ( ) 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 4 5 2 4 6 2-14 4 7 15-24 4 8 25-44 4 9 45-64 5 0 65 5 1 5 2 5 3 5 4 55-57

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