Summary : We encountered two cases of abnormal origins of branches arising from the arch of the aorta.That is to say, in the first case, the aortic arch gave directly off the left external carotid artery as its second branch and the left internal carotid artery as its third branch.In the second case, the aortic arch gave directly off the left external carotid artery as its second branch and the left brachiocephalic trunk dividing into the left internal carotid and the left subclavian artery as its last branch.In both cases the right brachiocephalic trunk arose normally as the first branch of the aortic arch. In the first case the left subclavian artery was the last branch of the aortic arch.It is conjectured that those anomalies were caused by the disappearance of the left third aortic arch and the persistence of the left carotid duct during the embryonic period.

During the macroscopic dissecting practice in 1980, two Japanese male cases of bilateral superior caval veins were detected.Such anomalous cases are the 33 rd and 34 th ones in Japanese cadavers and the 2 nd and the 3 rd reported in Nippon Medical School, respectively. According to Adachi, the frequency of the occurrence of bilateral caval veins in adults is estimated at 0.5+0.25%.Case 1 is a 71-year-old male subject. The anomalous left superior caval vein is formed by the union of the left internal jugular, external jugular, subclavian, and vertebral veins. Descending laterally to the aortic arch, it passes through between the left auricle and the left pulmonary veins to enter the coronary sulcus.Then it runs to the right in the coronary sulcus, and opens as the coronary sinus into the right atrium.The right superior caval vein is formed by the union of the right internal jugular, external jugular, subclavian, vertebral, and inferior thyroid veins.This vein runs ordinary course and opens into the right atrium. The left and right superior caval veins measure 10mm and 12mm in caliber respectively.Case 2 is a 78-year-old male. The left and right superior caval veins are formed by the union of the internal jugular, external jugular, and subclavian veins on each side and run identical course with the above-mentioned case 1 to reach the right atrium.The left and right superior caval veins measure 16mm and 18mm in caliber respectively.In both cases, between the left and right superior caval veins, a small communicating branch which is justifiable as the left brachiocephalic vein is present.Thus it is concluded that these two cases may fall into category U which is described by McCotter.The hearts both in case 1 and 2 disclose strikingly dilated coronary sinus and measure 29mm and 31mm in caliber respectively at their orifices into the right atriums.From the embryological point of view, it is postulated that this anomaly is resulted from the complete persistence of the left anterior and common cardinal veins.Moreover, it is of noteworthy, that, in the case 1, completely paired azygos veins are revealed. This is the 3rd case in anatomical literature reported in Japan.

Objectives: The semi-elemental formula EDPAC-01 was administered to tube-fed patients in a clinical setting. Herein, this study aimed to evaluate its tolerability and efficacy. Methods: After a 2-week baseline period, the ongoing nutrition formula of tube-fed patients in long-term care was switched to EDPAC-01, which was administered for 4 weeks following the same energy intake. Tolerability was evaluated in terms of gastrointestinal symptoms, bowel movement, number of days with fever, adverse events, and side effects. Efficacy was evaluated in terms of body weight, serum albumin level, and transthyretin, formerly called prealbumin, level. An exploratory analysis on several laboratory test values was also performed. Results: The study included 13 participants. No serious severe adverse events were reported. The blood glucose level increased in one participant as a side effect, but was mild in severity and did not require treatment. No significant change was observed in any investigated measurement other than the transthyretin level. The transthyretin level was below the reference range in the baseline period (19.32 ± 5.53 mg/dL), but increased on week 2 of the feeding period (21.49 ± 5.88 mg/dL) and eventually reached the reference range by week 4 of the feeding period (22.74 ± 8.75 mg/dL). The exploratory analysis revealed a significant increase in total lymphocyte count and a significant decrease in urea nitrogen, triglyceride, and alkaline phosphatase levels. Conclusions: The semi-elemental formula EDPAC-01 is safe to use and potentially improves the nutritional status in tube-fed patients in long-term care.