Blood transfusion; additional historical aspects. Part 2. The introduction of chemical anticoagulants; trials of 'Phosphate of soda'.

The pioneers of transfusion medicine around the turn of the 19th into the 20th centuries struggled with the awkward propensity of shed blood to clot. This article, a companion to a previous one (Boulton, 2013, Submitted for publication), describes in more detail how they recognised a potential for chemical anticoagulants which led to the introduction for a short period of sodium phosphate to aid blood transfusion: these cases preceded the introduction of citrate (Mollison, 2000, British Journal of Haematology, 108, 13-18).

The history of kidney stone dissolution therapy: 50 years of optimism and frustration with renacidin.

BACKGROUND AND PURPOSE: Over the last 50 years, chemolysis as a primary or adjuvant treatment for urinary stones has fallen in and out of favor. We review the literature for a historical perspective on the origins and chronology of Renacidin therapy, focusing on landmark studies and impracticalities that have seemingly condemned it to history. MATERIALS AND METHODS: A MEDLINE search was performed on the topic of chemolysis of urinary calculi. Historical literature was reviewed with regard to stone composition, treatment modalities, outcomes, and complications. RESULTS: A total of 61 articles were reviewed, 40 of which were case series, representing a total of 817 patients studied. Mulvaney first introduced Renacidin in 1959 as a modification of Suby and Albright's 1943 solution. Because of an overabundance of nonstandardized irrigation protocols, six deaths were reported in the early 1960s resulting in a Food and Drug Administration ban on the practice of upper urinary tract stone dissolution. Over time, Renacidin returned to the urologist's arsenal, appearing first as an adjunct to dissolve catheter and bladder calculi and later (1990) as an approved agent for renal pelvis and ureter use. This feat was almost single-handedly the result of a successful hemiacidrin case series published in 1971 by Nemoy and Stamey. By using daily urine cultures, prophylactic antibiotics, and meticulous intrarenal pressure monitoring, Nemoy and Stamey virtually eliminated all major irrigation complications, paving the way for a flurry of studies. More importantly, they established the link between residual struvite stones, persistent infection, and recurrent staghorn stone formation. CONCLUSIONS: Dissolution of urinary calculi by chemolysis has been shown to be safe and effective if performed with sterile urine cultures, prophylactic antibiotics, and low intrapelvic pressures. The pioneers of this therapy are remembered for their attempts to develop an alternative to open surgery, and, in the process, solidified the "stone-free" concept for infection-based stones.