A 51-year-old man with a primary angiosarcoma of the right atrium is reported. The angiosarcoma was not detected by transthoracic echocardiography or computed tomography, but magnetic resonance imaging and transesophageal echocardiography did show the tumor of the right atrial free wall. Weperformed a transvenous endomyocardial biopsy of the tumor under the guidance of transesophageal echocardiography and made the pathological diagnosis.This case demonstrates the advantage of magnetic resonance imaging and transesophageal echocardiography for tumor detection over transthoracic echocardiographyand computedtomography and the usefulness of transesophageal echocardiography for guiding the right atrial endomyocardial biopsy procedure. (Internal Medicine 40: 391-395, 2001)

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Historically pediatric emergency system in our country focused on primary and secondary emergency care, but tertiary pediatric emergency care has been considered since 2009 after the several meetings by the Ministry of Health, Labor and Welfare. The current investigation showed nearly 90% of the critical care emergency centers provide pediatric emergency care, but there were some difference in the annual census of pediatric patient visits and admissions. The average number of pediatric ICU admissions was 19.3 years old (2.4% of adult admissions), pediatric CPA cases was 4.0 years old (2.3% of adult cases), and in-hospital mortality was 2.7 cases/year. These results showed absolutely and relatively small number of critically ill pediatric patients. 20.3% of the institutions had ICU beds for pediatric patients, 7.2% in its critical care emergency center, and 1.6 beds in average. Pediatricians were available during nights or holidays in 72.0% of the institutions, but only 15% of them had full time pediatricians in its critical care emergency centers. Critical care emergency centers provide tertiary pediatric emergency care within its capability, but few institutions manage pediatric admissions due to not only extrinsic causes but intrinsic causes. Therefore, active cooperation between pediatricians and emergency physicians are required for pediatric emergency care. Stabilization by critical care emergency centers and following intensive higher level of care by children's hospitals are indispensable for severely ill pediatric patients. Close cooperation between critical care emergency centers and children's hospitals is essential.