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Carcinoid tumours are often indolent asymptomatic tumours. However, a small but significant proportion are malignant and difficult to manage. Multiple endocrine neoplasia type 1 (MEN-1) may be associated with carcinoid tumours and should therefore be considered in the investigation of these patients. This review puts into context the use of newer imaging modalities, including octreotide scintigraphy. The therapeutic treatment options are discussed, including the use of octreotide, the role of receptor-targeted therapy, hepatic-artery embolisation, and the arguments against chemotherapy. We review the need for careful patient selection when considering curative and palliative surgery, including liver transplantation. We conclude that there are now better diagnostic tools and therapeutic options available for those patients with malignant carcinoid tumours, and that these patients are best managed by a multidisciplinary approach. Earlier detection and treatment of these tumours should lead to improved quality of life and survival, which, ideally, should be assessed in formal trials.

50 normotensive subjects (22 controls with no cardiac disease, 24 patients with coronary heart-disease, and 4 with early cardiomyopathy) were investigated with gated cardiac blood-pool scintigraphy before and during cold pressor stimulation. The controls had no change or a significant rise (p less than 0.005) in left ventricular ejection fraction and preserved normal myocardial-wall motion, whereas patients with coronary-artery disease or cardiomyopathy had a significant fall (p less than 0.001) in left ventricular ejection fraction and many developed abnormal regional wall motion despite the absence of angina pectoris. Cold pressor gated cardiac blood-pool studies were more sensitive than single-lead exercise electrocardiography (p = 0.03) in the detection of patients with severe coronary-artery disease without previous myocardial infarction.