The use of drugs does not play as important a role in the practice of diagnostic roentgenology as in many of the other medical specialties and, accordingly, the roentgenologist's activities in the field of pharmacology are understandably limited. His interests quite naturally are centered chiefly upon those drugs which he can put to practical use in his daily work—agents such as amyl nitrite for the temporary relief of cardiospasm, prostigmin to rid the intestinal tract of gas, and morphine to produce sphincteric contraction at the ampulla of Vater. In general, these drugs have been adopted for use in roentgenology only after their physiologic action has been adequately studied by various laboratory methods. On the other hand, it has become increasingly apparent that the roentgenologist can be of considerable assistance to the physiologist in the evaluation of unknown or questionable properties of certain drugs, particularly in regard to their actions on the digestive tract. It was largely for this reason that roentgenologic assistance was sought in a study of some interesting properties of tetraethylammonium. Superficially, at least, this agent appeared to have potentialities of being useful both practically and from the standpoint of explaining certain poorly understood aspects of gastro-intestinal physiology. Pharmacologic Background Tetraethylammonium is a quaternary ammonium compound structurally similar to acetylcholine. In 1945, Acheson and Moe (1), working on heart-lung preparations of dogs, noted some interesting effects of the tetraethylammonium ion which had not been previously reported. Subsequent animal experiments (2, 3), in which reactions of the blood pressure, heart rate, and nictitating membrane were used as test responses, indicated that intravenous or intramuscular injections of the drug produced a rather specific blockade of the transmission of nerve impulses through sympathetic and parasympathetic ganglia. Clinical Aspects Clinical experimentation (4, 5) showed that parenteral administration of tetraethylammonium produced widespread autonomic nervous system effects consisting of postural hypotension, increase in skin temperature and blood flow in the extremities, elevation of the cardiac rate, cessation of sweating, dry mouth, fixation of the pupils in mid-dilatation, loss of ocular accommodation, and inability to void. Certain hypertensive subjects showed a significant drop in both systolic and diastolic blood pressure, and in the case of one such patient who also had a duodenal ulcer, the ulcer pain stopped completely during the period of activity of the drug. Additional investigation of this patient showed that gastric secretion was markedly decreased by the drug, but that the pain disappeared long before the stomach emptied itself of secretions already present.
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