Occurence of microplastics in the hyporheic zone of rivers.

Although recent studies indicate that fluvial systems can be accumulation areas for microplastics (MPs), the common perception still treats rivers and streams primarily as pure transport vectors for MPs. In this study we investigate the occurrence of MPs in a yet unnoticed but essential compartment of fluvial ecosystems - the hyporheic zone (HZ). Larger MP particles (500-5,000 µm) were detected using attenuated total reflectance (ATR) - Fourier-transform infrared (FTIR) spectroscopy. Our analysis of MPs (500-5,000 µm) in five freeze cores extracted for the Roter Main River sediments (Germany) showed that MPs were detectable down to a depth of 0.6 m below the streambed in low abundances (≪1 particle per kg dry weight). Additionally, one core was analyzed as an example for smaller MPs (20-500 µm) with focal plane array (FPA)- based µFTIR spectroscopy. Highest MP abundances (~30,000 particles per kg dry weight) were measured for pore scale particles (20-50 µm). The detected high abundances indicate that the HZ can be a significant accumulation area for pore scale MPs (20-50 µm), a size fraction that yet is not considered in literature. As the HZ is known as an important habitat for invertebrates representing the base of riverine food webs, aquatic food webs can potentially be threatened by the presence of MPs in the HZ. Hyporheic exchange is discussed as a potential mechanism leading to a transfer of pore scale MPs from surface flow into streambed sediments and as a potential vector for small MPs to enter the local aquifer. MPs in the HZ therefore may be a potential risk for drinking water supplies, particularly during drinking water production via river bank filtration.

Alcohol-dose-dependent DNA methylation and expression in the nucleus accumbens identifies coordinated regulation of synaptic genes.

Alterations in DNA methylation have been associated with alcohol exposure and proposed to contribute to continued alcohol use; however, the molecular mechanisms involved remain obscure. We investigated the escalating effects of alcohol use on DNA methylation, gene expression and predicted neural effects in the nucleus accumbens of rhesus macaques that self-administered 4% alcohol for over 12 months. Using an exploratory approach to identify CpG-rich regions, followed by bisulfite sequencing, the methylation levels of 2.7 million CpGs were compared between seven low-binge drinkers and nine heavy-very heavy drinking subjects. We identified 17 significant differential methylation regions (DMRs), including 14 with methylation levels that were correlated with average daily alcohol consumption. The size of the DMRs ranged from 29 to 158 bp (mean=63.7), included 4-19 CpGs per DMR (mean=8.06) and spanned a range of average methylation values from 5 to 34%. Eight of the DMRs mapped to genes implicated in modulating synaptic plasticity. Six of the synaptic genes have not previously been linked to alcohol use. Validation studies of these eight DMRs using bisulfite amplicon sequencing and an expanded set of 30 subjects confirmed the significant alcohol-dose-associated methylation of the DMRs. Expression analysis of three of the DMR-associated genes, LRP5, GPR39 and JAKMIP1, revealed significant correlations between DMR methylation and whole-gene or alternative transcript expression, supporting a functional role in regulating gene expression. Together, these studies suggest that alcohol-associated synaptic remodeling may be regulated and coordinated at the level of DNA methylation.

Prenatal indices for mandibular retrognathia/micrognathia.

OBJECTIVE: Micro- and retrognathia of mandibular origin may lead to life-threatening respiratory problems in connection with glossoptosis immediately after birth. Prenatal screening for this malformation is therefore increasingly important. Today this is accomplished by predominantly subjective standards. Objective criteria have been proposed but have not become established. We therefore made an effort to develop indices that would identify major skeletal discrepancies or micrognathia in as straightforward a fashion as possible during routine prenatal sonography. MATERIALS AND METHODS: Series of fetal jaw sonograms (Toshiba Aplio MX®) were obtained in 313 women with normal pregnancies from weeks 19-29 of gestation. Upper- and lower-jaw landmarks were interactively located on screen and evaluated for reproducibility. Linear parameters representative of maxillary and mandibular length (SpA'-SpP' and Rami-SymMe) were measured and related to femur length and gestational age. Based on these data, indices for maxillary, and mandibular length were derived and analyzed. RESULTS: High correlations were identified for mandibular length both with gestational age (R = 0.845; R(2) = 0.713) and with femur length (correlation coefficients (R) = 0.839; coefficients of determination (R(2)) = 0.704). For maxillary length, the respective correlation coefficients were 0.691 (R(2) = 0.477) and 0.656 (R(2) = 0.430). Estimates of mandibular and maxillary length based on gestational age and femur length were obtained by regression analysis. The mean bimaxillary length ratio was 0.628 ± 0.043. CONCLUSION: Maxillary and mandibular growth can be objectively evaluated via indices. It is conceivable to develop this approach into a sensitive and reliable method of prenatal jaw screening for major skeletal anomalies and congenital malformations.

[Sonographic evaluation of fetal clefts of the lip, alveolus and palate]. / Sonografische Diagnostik fetaler Spaltbildungen von Lippe, Kiefer und Gaumen.

Clefts of the lip, alveolus and palate are among the most common congenital malformations. Due to their frequent combination with other structural anomalies, chromosomal defects and genetic syndromes, the prenatal diagnosis of clefts plays an important role. Furthermore, the prenatal detection of clefts enhances the parents' psychological preparation and enables the planning of postnatal management. This article reviews the occurrence, appearance and pathophysiology of these malformations as well as the different sonographic techniques used to diagnose clefts and their extent. Previously reported 2D- and 3D-techniques as well as our own recent diagnostic approach focussing on the diagnosis of isolated cleft palate are described.

Solid state NMR strategies for the structural characterization of new hybrid materials based on the intercalation of nitroxide radicals into CdPS3.

The radical cations 2-(3-N-butylpyridinium)-4,4,5,5-tetramethyl-4,5-dihydro-1H-imidazol-1-oxyl-3-N-oxide (m-BuPYNN) and 4-(ethylammonium)-2,2,6,6-tetramethylpiperidin-1-oxide (EATEP) are successfully intercalated into the layered host structure of CdPS(3) via ion exchange. The reaction proceeds either directly from ethanolic solutions of the radical iodide salt or via a two-stage process involving first the formation of an intermediate tetramethylammonium intercalate. The resulting materials, which are described by the compositional formula Cd(1-x)PS(3){Rad}(2x), are characterized by chemical analysis, X-ray powder diffraction, bulk susceptibility measurements and EPR spectroscopy. Modern single and double resonance solid state NMR techniques are introduced successfully to study the structural modifications of the host lattice and the details of the intermolecular guest/host interactions. (1)H MAS-NMR spectra reveal substantial differences in the unpaired electron spin density distributions within the radical ions intercalated into the host lattice compared to those obtained for the pure radical ion salts, leading to different bulk magnetic properties. The results of (1)H/(31)P double resonance experiments indicate that the orientation of the guest molecules is dominated by Columbic interactions between the radical cations and the negatively charged cadmium vacancies in the host lattice.

Quantitative immunohistochemical examination of the local cellular reactions following implantation of biomaterials.

Examining the biocompatibility of implant materials includes the in vivo investigation of the local tissue response following implantation in experimental animals. By contrast to qualitative and semi-quantitative approaches often used in this field, a quantitative technique would facilitate a more accurate determination and better comparability of different studies. Therefore, this study aimed at evaluating the applicability of the free image analysis software ImageJ for fast, easy and reproducible quantification of the tissue response following implantation of titanium samples in rats with subsequent immunohistochemical examination of peri-implant tissue samples for monocytes and macrophages (ED1) and MHC class II positive antigen presenting cells (OX6). The quantification of positively stained cells in the vicinity of the implant pockets was based on a grid-supported manual count carried out using two ImageJ plugins (CellCounter, Grid) and resulted in a mean coefficient of variation of 13.8% (ED1) and 19.6% (OX6) between different investigators and 10.0% (ED1) and 13.8% (OX6) for repeated counting by the same investigator. In conclusion, ImageJ was found to be suitable for morphometric evaluation of the tissue response following implantation, particularly the analysis of discrete cellular events at the tissue-biomaterial interface. The procedure which was used is described in detail, and its advantages and disadvantages are discussed.

The 'equals sign': a novel marker in the diagnosis of fetal isolated cleft palate.

OBJECTIVES: To determine the feasibility of visualization of the uvula and the soft palate during routine two-dimensional (2D) ultrasound examination and to develop a sonographic procedure that facilitates prenatal detection of isolated fetal cleft palate. METHODS: We examined 667 consecutive patients with a singleton pregnancy between 20 and 25 weeks of gestation who were referred to our practice for a detailed fetal anomaly scan. The uvula was visualized either in a frontal section through the neck and pharynx or via a transverse section with subsequent slight tilting of the transducer. The soft palate was visualized in a median sagittal section through the head. To test whether the techniques described are suitable for inclusion in routine examinations, the time allowed for a normal ultrasound scan was not changed from 30 min. RESULTS: A normal uvula could be visualized with a typical echo pattern (the 'equals sign') in 90.7% of the cases and the soft palate could be completely visualized in a median sagittal section in 85.3% of the cases. Visualization of at least one of the two structures (either the uvula or the soft palate) was successful in 98.4% of the cases. In one case an isolated cleft palate (in an otherwise normal fetus) was diagnosed; in one case with a cleft lip and palate, the cleft palate and the completely split uvula were detected. In 1.2% of the cases the examination did not provide sufficient information on either the uvula or the soft palate. CONCLUSIONS: In a high percentage of cases, relevant soft palate structures can be visualized successfully with 2D ultrasound, permitting cleft palate to be ruled out in routine examinations. Visualization of the equals sign proves an intact palate. Absence of the equals sign indicates cleft palate and should prompt further examination of the soft palate in a median sagittal section. Cleft palate can be confirmed when the soft palate cannot be visualized. This technique also facilitates evaluation of the soft palate in the event of a cleft lip and palate.

Intercalation of stable organic radicals into layered saponite clay.

2-(3- and 4-N-methylpyridinium)-4,4,5,5-tetramethyl-4,5-dihydro-1H-imidazol-1-oxyl 3-N-oxide (abbreviated as m- and p-MPYNN), the butyl derivative (m- and p-BuPYNN), 4-(N-ethylammonium)-2,2,5,5-tetramethylpiperidin-1-oxyl (ETEP) and N,N,N',N'-Tetramethyl-1,4-phenylenediamine radical cation (TMPD(+)) have been successfully intercalated into saponite clay. The amount of intercalated material has been determined via UV/VIS spectroscopy, elemental analysis and EPR spectroscopy, and the expansion of the layer distance from approximately 12.0 to ca. 15 A has been measured by X-ray powder diffraction. The magnetic properties of these materials, which result from the interplay of the modified intermolecular interactions between the guest species, and the additional interaction with the host lattice, have been characterized by magnetic susceptibility, EPR and solid state NMR measurements. While the (29)Si and (27)Al NMR spectra show little influence of the radical species on the local structural environments of the nuclei in the host lattice, the guest-host interaction manifests itself in significant line-broadening and (in some cases) resonance displacements of the (1)H NMR signals belonging to the molecular radical cations. In the case of TMPD(+) intercalates, the NMR and EPR data indicate predominant radical dimerization within the interlayer space.

Antibody response to collagen after functional implantation of different polyester vascular prostheses in pigs.

Besides inflammation, specific immune responses are seen also after implantation of biomaterials. The aim was to investigate the humoral response to bovine collagen type I following implantation of various polyester (Dacron) prostheses into pigs. In 24 randomized pigs, the infrarenal aorta was replaced with a segment of collagen-impregnated, woven polyester prosthesis of low, medium, or high porosity. IgG antibodies were detected by immunoassay using native and denatured collagen type I as a target for blood samples taken on day 1 (implantation), 10, 17, 24, 62, and 116. As generally observed, antibodies to native and denatured collagen are of low titer and were significantly correlated with enhanced binding to the denatured form (p < 0.001). The highest overall antibody prevalence to native and denatured collagen was obtained on day 116 with 68% and on day 62 with 59%, respectively. Prostheses with high porosity induced an early immune response on day 10; those with low and medium porosity induced the highest antibody levels later after 2 months. Collagen antibodies neither correlated with serum IgG contents nor with antibodies to the prosthesis polyester matrix. Thus, humoral immune response against implant components may provide a further parameter in describing biocompatibility but also a potential marker that may facilitate monitoring of individual perigraft reaction.

[Vaccination for stab and bite injuries in the facial region]. / Impfschutz bei Stich- und Bissverletzungen im Gesichtsbereich.

In cases of stab and bite injuries to the face there is a risk of general infection and the necessity for an active and/or passive immunization must be considered by the first treating physician. In Central Europe tetanus, rabies, hepatitis B and C as well as HIV must be taken into account as possible consequences of such injuries. With regard to a tetanus immunization the indication for the post-exposition prophylaxis (PEP) should generally be as wide as possible. For other protective vaccinations a differentiated decision in co-operation with other fields of activity and public health authorities should be realized. The current recommendations for the systemic infections relevant in Central Europe are described.

[Intraoperative laparoscopic cholangiography -- when is it useful?]. / Die intraoperative laparoskopische Cholangiografie -- Wann ist sie sinnvoll?

Since the introduction of laparoscopic cholecystectomy (LC), a decrease in the practice of intraoperative cholangiography (IOC) has been reported. Are there actually reasons for carrying on IOC during LC? Depending on the management of common bile duct (CBD) stones treatment a different IOC regime is recommended. If the single-stage laparoscopic extraction of ductal calculi during LC is preferred, routine IOC is generally necessary to detect all CBD stones for desobstruction via ductus cysticus or choledochotomy. When therapeutic splitting is favoured, including two-stage management with endoscopic desobstruction and later LC, routine IOC can be foregone. However, selective practice of IOC can help to reduce the rates of unnecessary preoperative investigations from 40-60 % to 20 % when postoperative endoscopic desobstruction demonstrates similar success rates of about 95 %. Regarding the preventive character of laparoscopic IOC to CBD injuries, a routine investigation should be adopted by institutions with injury rates > 0.4 % and in the learning phase of young surgeons. For all other institutions a selective practice should be recommended when difficult intraoperative conditions render recognition of the anatomical situation more difficult or for identification of dissected non-bleeding ducts near the triangle of Calot.

The influence of antimicrobial treatments on the cytocompatibility of polyurethane biosensor membranes.

The cytocompatibility of polyurethane membranes was tested following ultraviolet or gamma irradiation as well as treatment with hydrogen peroxide or glutaraldehyde containing solutions. Despite the fact that all of the methods had been recommended for antimicrobial treatment of glucose biosensors, the treatments investigated significantly influenced cytocompatibility characteristics. Cytotoxicity of membrane eluates was not observed following irradiation treatments. This was also the case when the membranes were repeatedly washed following chemical treatment. Cell growth upon the membranes was stimulated to a different extent after gamma and UV irradiation as well as following hydrogen peroxide treatments. Residues of an urea-based hydrogen peroxide inclusion compound caused a restriction in cell growth upon the membranes as was similarly observed with 2 and 4% glutaraldehyde solutions acting over 2 and 4 h, respectively. It is concluded that cytocompatibility in vitro reflecting the host response against a biomaterial in vivo does not only depend upon the material itself but also upon antimicrobial treatments which could have consequences for its bioperformance characteristics.

[Minimally invasive options for gastric tumors]. / Minimalinvasive Optionen bei Magentumoren.

INTRODUCTION: Depending on the origin of the tumor tissue, gastric tumors may be more or less accessible for biopsy diagnostics. However, especially submucous tumors present a diagnostic problem. Entity and dignity may remain unclear particularly in larger tumors and may not be clarified before operative excision via gastrotomy and frozen section diagnostics. Similar problems may occur in the diagnostics of epithelial tumors, if a reliable appraisal of the dignity based on forceps biopsy is impossible. To clarify their entity and dignity, tumors can be completely extirpated with minimally invasive techniques. PATIENTS AND METHODS: Apart from the endoscopic mucosa resection (EMR), laparoscopic intragastric tumor resection and laparoscopic wedge resection were performed, especially in larger tumors. In the period from December 1999 to December 2001, we saw an indication for minimally invasive procedures in 22 patients. There were 5 cases of submucous tumors of unclear entity and 17 epithelial lesions. The epithelial lesions included 12 patients with tumors of unclear dignity and five cases with early gastric carcinomas. RESULTS: The EMR was performed without complications in all 14 cases. One of the three cases with wedge resection was followed by a gastrectomy for oncological reasons. One early postoperative bleeding occurred, which was controlled laparoscopically. Conversion to open surgery due to technical problems was necessary in two cases of laparoscopic intragastric resection, and in one case a gastrectomy was required for oncological intention. CONCLUSION: Beside the diagnostic aspect, the mentioned techniques also enable a minimally invasive therapy of locally excisable gastric tumors. In addition to benign and low grade malignant lesions, early gastric carcinomas of the intestinal type present an indication.

Caustic acid burn of the upper gastrointestinal tract: first use of endosonography to evaluate the severity of the injury.

Judging the severity of an injury after erosions of the upper gastrointestinal tract has been exclusively based on endoscopic inspection. For the first time, we used minimal probe endosonography during initial endoscopy and endoscopical progress observations to improve assessment of injury depth determining the therapy. Nine hours after admitting a patient after acid ingestion, the initial endoscopy and simultaneous endosonography with a 12-MHz minimal endosonographical probe took place. The affected wall sections with macroscopical coagulation necrosis regularly showed a richer echo, broadened first layer, and a low-echo wall edema that had developed under the necrosis. Differences existed between the breadth of the first echo-rich layer and the breadth of the edema below it. The indiscriminability of single wall layers correlated with the intensity of the edema. The initial injury depth was defined based on the depth extension of the wall edema and the discriminability of the layers. In the control examinations, a complete wall edema with limited assessability developed independently of the injury's initial severity. The assessment of injury depth was only possible during a short time span. Differences existed in the regression time of the wall edema. The initial endosonography and diagnostic findings over time showed differences between superficial and deep wall injuries after erosion. In this way, the injury depth could be correctly estimated, thus directly influencing therapy planning.

Immunogenicity of polymeric implants: long-term antibody response against polyester (Dacron) following the implantation of vascular prostheses into LEW.1A rats.

Implanted biomaterials trigger acute and chronic inflammatory responses directly correlated to the central role of phagocytic cells at the host-implant interface. This study was designed to evaluate specific humoral immune responses following repeated intraperitoneal implantations of collagen-impregnated polyester (Dacron) prosthetic segments into LEWIS rats. Serum antibody detection was performed by enzyme immunoassay with the prosthetic segments as a target. Cutoff values for antibody positivity were greater than or equal to the 99th percentile for control rats. Polymer immunoglobiulin G (IgG) antibodies were significantly increased (p < 0.05) by repeated implantation and were subsequently followed until experimental day 293. Antibody formation was significantly enhanced through the application of complete Freund's adjuvant in combination with the first implantation. All rats within this group were antibody-positive on day 53, but only 6 of 10 animals that received the prosthesis without the adjuvant were. After preincubation of sera with bovine collagen type I (solid phase adsorbed or in solution), polymer antibody binding was discovered not to be diminished, indicating that the IgG antibodies detected were not directed against the prosthesis impregnation. Furthermore, a significant correlation was obtained between polymer antibody binding to collagen-impregnated and nonimpregnated prostheses (r(s) = 0.797, p < 0.001). There was no substantiated correlation between antibody binding to polyester and to an irrelevant polymer (Tecoflex EG 80). We conclude that specific polymer antibodies may indeed provide an additional parameter for biocompatibility testing as well as a possible serological marker of an inflammatory response to implants.

Laparoscopic-endoscopic rendezvous resection of gastric tumors.

BACKGROUND: Submucosal and mucosal tumors of the stomach display a wide spectrum of histopathologic and prognostic characteristics. Biopsies obtained using endoscopic techniques often do not provide the representative histologic sample needed for further therapeutic decisions. METHODS: From 1999 to 2002, 18 patients with gastric tumors underwent a combined endoscopic-laparoscopic local resection of the tumors using two different procedures and were prospectively analyzed. Tumors of the posterior wall were resected using laparoscopic intragastral resection (LIR). Tumors located in the anterior wall were resected using lesion-lifting or the laparoscopic wedge resection (LWR) approach. RESULTS: Laparoscopic resections were performed in 18 patients. The mean age of the patients was 64.4 years (range, 38-81 years). Preoperative preparation included endoscopy with biopsies and histologic examination, ultrasound examination, computed tomography scan, and endoscopic ultrasonography. We performed the LWR on 10 patients and the LIR on 8 patients. After resection, the final immunohistologic examination of the specimens showed gastrointestinal stroma cell tumors in nine cases, neurinomas or benign neurofibrotic tumors in four cases, and one leiomyoma. Four additional patients with mucosal early gastric cancer and high comorbidity risks also underwent a limited full-thickness wedge resection. In all the patients, the surgical margins were tumor free, and no lymphatic or venous invasion was encountered in pathologic specimens. Method-specific complications occurred in one case (perforation of the stomach wall). No fatal outcome had to be registered. CONCLUSIONS: When selected properly, the laparoscopic-endoscopic approach is considered to be curative and minimally invasive for resection of localized gastric tumors. In cases of histopathologically unknown tumors preoperatively, definitive examination of the complete specimen provides the basis for further therapeutic decisions.

[Prospective study on patients outcome following laparoscopic vs. open cholecystectomy]. / Prospektive Analyse zur Outcomebewertung nach laparoskopischer versus konventioneller Cholecystektomie.

AIMS OF THE STUDY: Differences in outcome between patients undergoing laparoscopic (LC) vs. open cholecystectomy (OC) should be examined under objective and subjective aspects. METHODS: We prospectively evaluated the postoperative course of 135 patients who underwent LC or OC in 1999. In the first step we examined the recover period with the help of the modified McPeek-Index. In the second phase during a 35 postoperative days-spanned analysis all patients noted there physical, emotional and social well-being in a circulating standard questionnaire, based on the modified Gastrointestinal Quality Life Index (GIQLI). RESULTS: Responses were obtained from 103 patients (76.3 %) undergoing 29 OC and 74 LC. 21.4 % of the patients aged 70 and older or had perioperative risks > II in ASA-Classification (LC 19.8 vs. OC 30.1 %). The (objective) McPeek-Outcome was similar in both groups, with no statistical advantage for LC (best score: 69 % LC vs. 62 % OC). The subjective assessment of the patients showed that patients having LC felt fully fit 10.2 days earlier than patients after OC (23.9 vs. 34.1 days). Patients in the LC-group returned to work after an average of 24.7 days, compared with 42.2 days following OC. The main finding of the postal questionnaire was a significantly earlier recruitment in physical, emotional and social status following LC in the group of aged > 70 and > ASA II-Score-patients, in contrast to control-OC-group. CONCLUSION: The study suggests an additional advantage in surgical outcome after LC, in comparison to OC. The laparoscopic approach is the preferable procedure to treat especially older and comorbide patients, when local or anesthesiological contraindications are absent.

Conservative treatment of ectopic pregnancy in a cesarean section scar with methotrexate: a case report.

Ectopic pregnancies sited in dehiscent cesarean section scars have a high risk of rupture and bleeding. Attempts at operative therapy frequently end in loss of the uterus. A connection with the cavum uteri justifies an attempt at dilatation and curettage. We describes a patient with combined systemic and local intra-amniotic methotrexate (MTX). The uterus was preserved.

Antigenicity of polyester (Dacron) vascular prostheses in an animal model.

Objectives to investigate the specific humoral immune response to three different polyester (Dacron) prostheses in pigs. Design, materials and methods twenty-four growing pigs were randomly divided into three groups. The infrarenal aorta was replaced by a segment of collagen-impregnated woven polyester prosthesis (low, medium and high porosity). Serum antibodies were detected by modified enzyme immunoassay using non-impregnated prosthesis as the target for the blood samples taken on experimental days 1, 10, 17, 24, 62 and 116 of the 22 pigs followed over the whole observation period. Results significantly enhanced (p <0.05) mean IgG antibody binding against polyester was detected on experimental days 10, 17, 24 and 62 with antibody prevalences of 41%, 41%, 32% and 37%, respectively. Antibody positive pigs were divided into early responders (n =9) and late responders ( n =5) with antibody detection on day 10 and/or 17 vs day 62 and/or 116. No significant differences between the three different prostheses were found. The formation of specific IgG antibodies against polyester in the animals investigated demonstrates a broad individual variability. Conclusions polyester is an antigenic polymer. Specific antibodies, reflecting the inflammatory response, might be not only a parameter for testing biomaterials but also for determining individual bio(in)compatibility for long-term biomaterial function.

Naumoff short-rib polydactyly syndrome compounded with Mohr oral-facial-digital syndrome.

A stillborn baby boy had findings of severe constitutional dwarfism with short limbs, short ribs, and polydactyly that were consistent with Naumoff (type III) short-rib polydactyly syndrome. He also had additional congenital anomalies, including cleft palate, notching of the upper lip, small tongue with accessory sublingual tissue. These oral and pharyngeal anomalies were consistent with Mohr (type II) oral-facial-digital syndrome. We suggest the stillborn infant represented a compound of Naumoff short-rib polydactyly syndrome (SRPS-III) and Mohr oral-facial-digital syndrome (OFDS-II).