To the Editor:— An unusual syndrome has been described recently in association with malignant carcinoid of the small intestine and hepatic metastases (Isler, P., and Hedinger, C.: Metastasierendes Dünndarmcarcinoid mit scheren, vorwiegend das rechte Herz betreffenden Klappenfehlern und Pulmonalstenose—ein eigenartiger Symptomenkomplex?Schweiz. med. Wchnschr.83:4-7 [Jan.] 1953). This syndrome is principally manifested by peculiar cutaneous flushes, chronic diarrhea, respiratory distress, and valvular disease of the heart. Personal experience with five cases of this syndrome within the past few months and the knowledge of several other such cases makes it likely that there are many more such cases as yet undiagnosed. Because of protean clinical manifestations, the "carcinoid syndrome" may mimic a variety of diseases. The cutaneous flushes are characterized by episodic erythema, patchy cyanosis, and blanching and may be confused with other types of vasomotor instability. They were erroneously ascribed to the menopause in one of our patients. A