To the Editor.
—Much appears to have changed during the past 15 to 20 years with regard to reasons for performance of invasive cardiac procedures, if the December Archives article, "Traumatic Pericardiocentesis: Two-Dimensional Echocardiographic Visualization of an Unfortunate Event" (1982;142:2327-2329) indicates today's clinical thinking.The text describes an insulin-dependent diabetic patient with known renal decompensation who was initially seen with the physical findings of pericardial effusion. In the old days, pericardiocentesis was indicated to relieve tamponade or to obtain fluid necessary for diagnosis of tuberculosis, trauma, or carcinoma, for example. In the patient described, there was no evidence reported of tamponade and no historical or physical examination data offered to suggest any cause other than the known diabetic nephropathy. Indeed, the chilling phrase, "a simultaneous two-dimensional echocardiogram was planned to determine the efficacy of using two-dimensional echocardiography for visualizing the pericardiocentesis needle," (my emphasis) appears in the "Report of a