[Pap smear for mass screening: Results of an African experiment]

OBJECTIVES

To assess the impact of smear test in the fight against cervix uteri cancer in Senegal.

METHODS

This was a descriptive cross-sectional study of 1836 Pap smears performed in patients over 15 years during several screening campaigns in Senegal conducted between June 2010 and June 2012. We analyzed epidemiological data, pathological smears, and the proposed management.

RESULTS

In 69% of cases, the women were less than 45 years old. They were mostly multiparous and did not use contraceptive methods before. The smears were interpreted in 91.4% (n=1661) and were pathological in 5.2% of cases. They revealed mainly atypical squamous cells of undetermined significance, squamous intraepithelial low-grade lesions, and squamous intraepithelial high-grade lesions, respectively in 2.5% (n=46), 1.7% (n=30) and 1% (n=19) of cases. Multiparity, early marriages were the main risk factors. Patients with pathological smars had colposcopy with cryotherapy (23 cases), and colposcopy and biopsy (13 cases). A hysterectomy was performed in 4 cases.

CONCLUSION

The pathological smear rate found in this study confirms the interest to continue cervical cancer screening with this practice. Strengthening of its geographical and financial access through a national prevention program will effectively help to lower cases of cervical cancer.

Mesenteric myofibroblastic tumor: NSAID therapy after incomplete resection

Myofibroblastic tumors are inflammatory tumors that arise in viscera and soft tissue; their etiopathology is poorly understood. They are capable of infiltration of adjacent organs, local recurrence after surgical resection, and even of distant metastasis. These characteristics result in persistent debate as to the nature of these lesions - whether they are inflammatory or neoplastic, benign or malignant lesions? Diagnosis is almost always made based on histopathological findings. Traditional management is complete surgical excision, but this may be difficult or impossible when the lesion develops in proximity to vital structures. We report the case of a 59-year-old man who was treated in our institution for mesenteric myofibroblastic tumor. Complete resection was not possible due to local infiltration of the mesentery. Recurrence was noted 3 months after surgery; treatment with steroidal and then non-steroidal anti-inflammatory medications (NSAIDs) resulted in clinical and radiologic regression of the tumor.

Extremely different behaviours in high and low body weight lines of chicken are associated with differential expression of genes involved in neuronal plasticity

Long-term selection (> 45 generations) for low or high body weight from the same founder population has generated two extremely divergent lines of chickens, the low (LWS) and high weight (HWS) lines, which at the age of selection (56 days) differs by more than nine-fold in body weight. The HWS line chickens are compulsive feeders, whereas, in the LWS line, some individuals are anorexic and others have very low appetites. The involvement of the central nervous system in these behavioural differences has been experimentally supported. We compared a brain region at 0 and 56 days of age containing the major metabolic regulatory regions, including the hypothalamus and brainstem, using a global cDNA array expression analysis. The results obtained show that the long-term selection has produced minor but multiple expression differences. Genes that regulate neuronal plasticity, such as actin filament polymerisation and brain-derived neurotrophic factor, were identified as being differentially expressed. Genes involved in lipid metabolism were over-represented among differentially expressed genes. The expression data confirm that neural systems regulating feeding behaviours in these lines are different. The results suggest that the lines are set in separate developmental trajectories equipped with slightly different nervous systems. We suggest that the lines adapt behaviourally different to changing situations post hatch, such as the transition from dependence on yolk to feeding, in order to obtain energy. The present study has identified and exemplifies the kind of changes that may underlie the extreme differences in such behaviours.

[Perception of nosocomial risk among healthcare workers at "Hopital Principal" in Dakar, Senegal (survey 2004)]

Nosocomial Infection (NI) is also observed in healthcare facilities in non-Western countries. The purpose of this report is to describe the findings of a survey undertaken to evaluate hygiene procedures implemented at the "Hopital Principal" in Dakar, Senegal and to assess perception and awareness of nosocomial risk among the hospital staff. A total of 264 healthcare workers were interviewed. Mean age was 39 years (range, 18-60) and the sex ratio was 1.3 (150 men/114 women). Sixty (22.7%) had university degrees, 106 (40.2%) had secondary school diplomas, 50 (18.9%) had attended middle school, and 13 (4.9%) had no schooling. Analysis of interview data showed that 56.1% (157/264) defined NI as infection acquired at the hospital but that only 9.8% (n=26) knew that a minimum 48-hour delay was necessary to distinguish nosocomial from community acquired infection. While understanding about NI was correlated with education level, data showed that 1 out of 3 physicians (13/39) failed to give the exact definition. Hand contact was cited as the second route of transmission. Isolation precautions were understood by 22.7% of personnel (60/264). Systematic handwashing was reported by 363% (96/264) but observation demonstrated that it was not performed properly regardless of the category of personnel. Care protocols were understood by 54.6% of persons interviewed (144/264). A hygiene-training course had been attended by 52.2% (n=138). Two thirds of the staff (69.7%: 54/264) was able to identify the hygiene nurse. Ninety-eight health care providers (37.1%) were familiar with the CLIN (Comités de Lutte contre les Infections Nosocomiales).

[Clinical and laboratory features of typhoid fever in Senegal. A 70-case study]

Clinical and laboratory features, complications and treatment were retrospectively studied in 70 patients with bacteriologically documented typhoid fever, treated between January 1995 and June 2002 at Principal Hospital in Dakar, Senegal. Data analysis was done on a global basis as well as comparatively between the 37 children (under 15 years) and 33 adults. Mean age was 16.7 years (range, 1 to 52). The sex ratio was 1.4. Clinical manifestations included fever (97%), headache (50%), vomiting (71%), abdominal pain (54%), diarrhoea (49%), nnd splenomegaly (10%) without statistically significant difference between children and adults. Lyinphopenia was found in 51% of patients and anaemia in 78%. Coexisting illnesses Included malaria in 25.5% (mainly children) and hepatitis (transminases > 10N) in 24%. Complications included cholecystitis in 3 patients, gastrointestinal haemorrhage in 2, peritonitis in one, endocnrditis in one and osteomyelitis in one. Only one patient (HIV-positive) died. The incidence of antibiotic resistance was low, i.e., ainoxicilline: 2%, nalidixic acid: 1% and cotrimoxazole: 8.2%. No multidrug resistance was observed. This study shows that typhoid fever remains a major health problem in Dakar with slow resolution and potential complications. Amoxicililne and chloramphenicol can still be used for first-line treatment of typhoid fever. Little difference was found between children and adults.

[Hypertrophic obstructive cardiomyopathy in child. About two cases]

The authors report two cases of hypertrophic obstructive cardiomyopathy in young girls, age 3 months and 8 years old. The disease manifested itself as a cardiac heart failure in the infant's case and a syncop in the other case. Cardiac echocardiography showed in he first case asymetric hypertrophic cardiomyopathy with ventricular outflow tract obstruction gradient of 100 mmhg, and concentric hypertrophic with 120 mmhg in the second case. Its evolution was fatal in both cases and led to sudden death at home. This disease is severe as no therapeutic treatment can modify its course.

[Description of the first cases of serotype A, sequence type (ST)-11 meningococcal meningitis in Senegal]

Senegal is located in the African meningitis belt and meningococcal meniningitis outbreaks are yearly events. Occurrence of an epidemic involving serogroup W135 in 2000 and its spread following the Hajj (pilgrimage to Mecca) exposed the strongly Moslem population of Senegal to the risk of early infection. Indeed the first two cases in Dakar occurred simultaneously with the spread of this epidemic strain. The purpose of this article is to describe clinical, laboratory, and therapeutic findings in these two cases and the results of the ensuing epidemiological survey. The relationship with the pilgrimage and consequences on public health in Senegal are discussed.

[Comparison of two cesarean techniques: classic versus Misgav Ladach cesarean]

OBJECTIVE

The aim of the study was to compare two cesarean section techniques Methodology. A prospective study was conducted UB 400 cesareans performed at the Gynecological and Obstetric Clinic of the Dakar Teaching Hospital between March 2000 and August 2000. Two hundred patients underwent the classical procedure (CL group) and the other 200 the Misgav Ladach procedure (ML group). Per- and post-operative data were compared between the two groups with Student's test and the Chi(2) test. A p-value less than 0.05 was considered statistically significant.

RESULTS

The two groups were similar for socio-demographic and clinical data. The delay between the skin incision and infant delivery was significantly shorter in the ML group (5 minutes 26 seconds versus 6 minutes 20 seconds). The same trend was found for the length of operation (36 minutes 36 seconds versus 54 minutes 38 seconds). Fewer sutures were used in the ML group (2.92 versus 4.14). There is no significant difference for dose of analgesia, post-operative complications and hospital discharge. Cost analysis demonstrated that the Misgav Ladach procedure was 10000 FCFA (15 euros) less costly.

CONCLUSION

Misgav Ladach method is simple, rapid, cost-effective cesarean procedure which appears to be an attractive alternative to traditional cesarean section.

[Infectious etiology of dysenteric syndromes at the Principal Hospital of Dakar in 1999 and 2000]

Dysenteric syndromes are relatively frequent in tropical areas, due essentially to infectious etiologies, constituted by flimsy pathogenic agents outside and possibilities of laboratory investigations little available. The authors evaluated during two years (1990-2000) the results of 399 parasitological examinations and 419 bacteriological examinations concerning dysenteric syndromes admitted to the laboratory of "Hopital Principal de Dakar". The objective of these examination is to contribute to the management of cases. The patients are divided into two groups: the first group is constituted by children less than two years old hospitalised in the pediatric services, and the second group includes all the other patients. The parasitological studies schow that parasitic etiologies are almost non existent in the first group while in the second group, they are essentially represented by Entamoeba histolytic with 19.5% of prevalence. The bacteriological studies show 42.7% of positivity rate in the first group and 19.5% in the second group with a predominance of E. coli and Shigella dysenteriae. The prevalence or pathogenic agents associations is not neglectable: they represent 8% or positive results with a predominance of amoeba-Shigella association. These results confirm the necessity of a best case management during the preanalytic phase in order to improve the scores of positivity and the particularities of hospitalised children les than two years old, to when the frequency of observed cases is high with bacteriological etiologies essentially (E. coli EPEC+, Nosocomial bacteria).

[A comparative study on the clinical utility of cefozopran and cefpirome against complicated urinary tract infections]

Aiming at evaluating the utility of cefozopran (CZOP) against complicated urinary tract infections with the velocity of eradication of causal bacteria in early treatment and clinical efficacy by new criteria of UTIs, a comparative study was conducted using cefpirome (CPR) as the control drug. CZOP and CPR were administered by intravenous drip infusion at a dose of 1 g twice daily. The duration of treatment was for 5 days. The study method involved randomized assignment of the subjects to either group CZOP or group CPR. The results were as follows: 1. Of a total of 80 cases treated, 65 (CZOP group--32 cases, CPR group--33 cases) were evaluated for efficacy. 2. The overall clinical efficacy evaluation according to the criteria proposed by Japanese UTI Committee rated the CZOP group as 90.6% (29/32), and the CPR group as 90.9% (30/33), with no significant difference between the 2 groups. Clinical efficacy evaluated by attending physicians rated the CZOP group as 93.8% (30/32) and the CPR group as 90.9% (30/33). There was no significant difference between the 2 groups. 3. The efficacy rates to pyuria on day 2 were 26.7% and 0% for the CZOP group and the CPR group, respectively, indicating a higher efficacy rate for the former (p < 0.05). Those on after treatment were 59.4% and 54.5% for the CZOP group and the CPR group, respectively, with no significant difference between the 2 groups. 4. Regarding the bacteriological effect, the eradication rates of both groups were over 90% on day 1 and after treatment. There was no significant difference between the 2 groups. 5. Side effects occurred in 1 case (2.6%) out of 39 in the CZOP group and in 1 case (2.4%) out of 41 in the CPR group. Laboratory test value fluctuation was noted in 8 (20.5%) of 39 cases in the CZOP group and 11 (26.8%) of 41 cases in the CPR group. There was no significant difference between the 2 groups. The results indicate that CZOP achieves an early efficacy to pyuria, and is as useful as CPR against complicated urinary tract infections.

[Repair of collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger]

OBJECTIVE

To introduce the surgical procedure and clinical result of microsurgical repair on collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger.

METHODS

From 1987, 23 cases with collateral ligament rupture in the interphalangeal joint were repaired by part of superficial flexor tendon of finger. The initial point of collateral ligament was drilled two holes, 2 to 3 mm in distance, and crossed by steel wire. Then the superficial flexor tendon of finger was crossed under the steel wire and sutured to the terminal point of superficial flexor tendon of finger by 5/0 to 7/0 nontraumatic suture thread to maintain suitable tension, and sutured to collateral ligament by 8/0 nontraumatic suture thread. Extension splint fixation was performed 4 to 6 weeks postoperatively.

RESULTS

Followed up 3 to 6 months, 15 cases were excellent, 6 cases were better, 2 cases were moderate, and the excellent rate was 91.34% according to Saetta standard.

CONCLUSION

Microsurgical repair on collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger is a convenient and effective surgical method.

[Development and characterization of a monoclonal antibody which recognizes a new prostate-organ specific antigen]

PURPOSE

Development and characterization of monoclonal antibodies which recognizes a new prostate-organ specific antigen.

METHOD

For development of monoclonal antibodies, hybrid cells were prepared by fusion of spleen cells of BALB/c mice immunized with the homogenates of surgically resected prostatic tissue and P 3 x Ag 8 U 1 (P 3 U 1) murine myeloma cells. Supernatants of hybrid clones were primarily screened using an ELISA on human prostatic cancer cell line PC-3 and human bladder cancer cell line T-24. In the secondary screening, they were tested on normal tissues by immunohistochemical staining. To characterize the antigens, biochemical analyses were performed using seminal plasma as an antigen by western blotting and gel filtration, and the reactivity of antibodies were compared with that of antibodies against prostatic acid phosphatase (PAP), prostate-specific antigen (PSA) and gamma-seminoprotein (gamma-Sm).

RESULTS

A monoclonal antibody termed KP-9 was obtained and it only reacted with PC-3 and prostate tissues, but did not react with other cell lines and normal tissues. Immunohistochemical staining of prostate tissue revealed that KP-9 stained grandular epithelium and grandular exudate of normal and malignant prostatic tissues, and especially, strongly stained the apical site of grandular epithelium. Western blotting and gel filtration of seminal plasma suggested that the molecular weight of the KP-9 antigen was more than 300,000 and was different from PAP, PSA and gamma-Sm.

CONCLUSION

We have developed a monoclonal antibody, KP-9 which specifically reacts with prostatic cancer as well as benign prostatic tissues. The antigen recognized by KP-9 appeared to be a new prostate-organ specific antigen and may be a useful marker for prostatic cancer such as PAP, PSA and gamma-Sm.

[Severe malaria in children from the seasonal low-transmission zone of Senegal: effect of age on the clinical manifestations]

The influence of age on the clinical presentation of severe malaria and especially on its two most commonly encountered manifestations, cerebral malaria and severe anaemia, has been retrospectively examined in 161 children (< 16 years old) admitted in the paediatric department of Hospital Principal de Dakar from January 1st 1990 to February, 29th 1996. They lived in Dakar and its suburbs, a region of Senegal were the malaria transmission rate is very low. Cases were defined by at least one of the World Health Organization criteria of severe malaria and the presence of Plasmodium falciparum in blood smears. Severe anaemia was present in 73.1%, 52.1% and 26.2% cases of severe malaria among children aged 0-3 years, 4-7 years and 8-15 years, respectively, (p < 0.0001). The frequency of cerebral malaria was 11.3%, 28.2% and 60.6% in the same age groups, respectively, (p < 0.0001). Severe anaemia and cerebral malaria were associated in 8.7% of the cases of severe malaria. The fatality rate was significantly lower in cases of severe anaemia without cerebral malaria (3%) than in cases of cerebral malaria without severe anaemia (17.5%; p < 0.02). Among young children, severe anaemia was associated with brief hyperparasitaemia or with prolonged lower parasitaemia. Other things being equal, older patients had a lower risk of severe anaemia. The results suggest that the high prevalence of severe anaemia in young children, even in an area of very low endemicity, depends more on age and parasitaemia than on the transmission level.

Severe malaria among children in a low seasonal transmission area, Dakar, Senegal: influence of age on clinical presentation

The influence of age on the clinical presentation of severe malaria and especially on its 2 most commonly encountered manifestations, cerebral malaria and severe anaemia, has been retrospectively examined in 161 children (< 16 years old) admitted to the paediatric department of Hôpital Principal de Dakar from 1 January 1990 to 29 February 1996. They lived in Dakar and its suburbs, a region of Senegal where the malaria transmission rate is very low. Cases were defined by at least one of the World Health Organization criteria of severe malaria and the presence of Plasmodium falciparum in blood smears. Severe anaemia was present in 73.1%, 52.1% and 26.2% cases of severe malaria among children aged 0-3 years, 4-7 years and 8-15 years, respectively (P < 0.0001). The frequency of cerebral malaria was 11.3%, 28.2% and 60.6%, respectively, in the same age groups (P < 0.0001). Severe anaemia and cerebral malaria were associated in 8.7% of the cases of severe malaria. The fatality rate was significantly lower in cases of severe anaemia without cerebral malaria (3%) than in cases of cerebral malaria without severe anaemia (17.5%; P < 0.02). Among young children, severe anaemia was associated with brief hyperparasitaemia or with prolonged lower parasitaemia. Other things being equal, older children had a lower risk of severe anaemia. The results suggest that the high prevalence of severe anaemia in young children, even in an area of very low endemicity, depends more on age and parasitaemia than on the transmission level.

[Clinical study of extracorporeal shock wave lithotripsy for 1000 patients with renal and ureteral stones]

Using a Dornier HM3 lithotripter, we treated 1,000 patients with renal and ureteral stones from April, 1986 to July, 1989. They consisted of 612 solitary stones (pelvic stones, 152; calyceal stones, 167; ureteral stones, 293), 265 multiple stones and 123 staghorn calculi (complete, 48; partial, 75). The overall rate of the auxiliary procedure was 59.3% (pre-operative, 47.9%; post-operative, 11.4%). Pre-operative procedure included 430 catheterizations, 26 percutaneous nephrostomies (PNSs) and 23 pyelograms . Post-operative procedure included 69 transurethral lithotripsy , 21 PNSs, 26 percutaneous nephrolithotripsy (PNLs), 6 meatotomy , 5 chemolysis and 1 open surgery. 484 (68.3%) in 709 good follow-up cases were stone-free at the time of 3 months since the first extracorporeal shock-wave lithotripsy (ESWL). Complications were pain (34.8%), fever (4.3%), pain & fever (8.5%), subcapsular hematoma (0.1%) and ureteral obstruction (0.1%). Thus, ESWL is considered to be a useful means for renal and ureteral stones and in the case of large stone the combination therapy with PNL is more effective than ESWL-monotherapy.

[Clinical study of norfloxacin in the treatment of acute epididymitis]

The efficacy and safety of Norfloxacin were studied in the treatment of 20 patients with acute epididymitis. Norfloxacin was orally administered at a dose of 200 mg 3 times a day for 14 days. Clinical efficacy rate on the 7th day was 95% (19/20), excellent in 9 cases, moderate in 10 cases and poor in 1 case, and on the 14th day was 95% (18/19), excellent in 12 cases, moderate in 9 cases and poor in 1 case. On the 14th day, fever, pain and swelling had disappeared in 8 cases (in 2 cases on the 7th day). The efficacy on the 14th day was further investigated compared to that on the 7th day. Before treatment with Norfloxacin, in 13 of the 20 patients, pyuria was observed. Cultivating the bacteria was isolated in 4 of the 13 patients. Norfloxacin remarkably affected the treatment of these patients with pyuria and bacteriuria. In the treatment with Norfloxacin, the count of leukocytes, erythrocyte sedimentation rate and CRP were obviously improved. Side effects and abnormal clinical laboratory findings were not observed. From these results, Norfloxacin 600 mg/day, t.i.d was considered useful and safe in the treatment of acute epididymitis.

[Studies on recent clinically isolated Staphylococcus aureus--drug susceptibility and incidence of MRSA in clinical isolates]

Susceptibility of various antimicrobial agents against clinically isolated Staphylococcus aureus was evaluated by Kirby Bauer methods. The incidence of MRSA (Methicillin cephem resistant Staphylococcus aureus) was also investigated. When S. aureus was isolated from urine, the clinical background of the case was further studied. The results are listed below; 1) M1N0 showed the highest susceptibility rate (83.1%) against 537 strains of S. aureus tested, followed by CMZ (63.7%) and CET (63.5%). The susceptibility rate of DMPPC was 41.9%. The incidence of MRSA was 31.3%. 2) In effusion, MRSA was most highly isolated (72.2%). 3) S. aureus isolated from blood and sputa was relatively more resistant to beta-lactams. 4) Strains from urine showed relatively high susceptibility rates. No MRSA was isolated from urine. 5) Thirteen out of twenty-four cases, whose urines were proven to be S. aureus positive, were polymicrobial infection patients.

[A case report of septicemia caused by methicillin cephem resistant Staphylococcus aureus (MRSA)]

The frequency of MRSA (Methicillin cephem resistant Staphylococcus aureus) infection has increased recently. A case of septicemia caused by MRSA is reported with discussion on its prophylaxis.

[Clinical studies on sultamicillin fine granules in the urological field]

Clinical studies of sultamicillin (SBTPC) fine granules, an oral antibiotic with ester linked ampicillin and beta-lactamase inhibitor, sulbactam, were performed in acute uncomplicated cystitis and complicated urinary tract infections. 1. SBTPC fine granules were administrated at a dose of 187.5 mg 2-3 times daily for 5-7 days to 6 patients with acute uncomplicated cystitis. Clinical efficacies as judged according to the criteria of the UTI Committee were excellent in 5 cases and moderate in 1 case with an effectiveness rate of 100%. All of 7 identified bacteria were eradicated by the treatment. 2. SBTPC fine granules were administrated at a dose of 187.5 mg or 375 mg 3 times daily for 5-7 days to 17 patients with complicated urinary tract infections. Clinical efficacies as judged according to the criteria of the UTI Committee were excellent in 8 cases, moderate in 4 cases and poor in 5 cases with an effectiveness rate of 70.6%. Out of 17 identified bacteria, 14 (82.4%) were eradicated by the treatment. 3. As adverse reactions, glossitis, diarrhea and pharyngeal redness were observed in 1 case out of 31 cases treated with the drug. These symptoms, however, were mild and transient. No abnormal laboratory test values were observed. From the above results, it appears that SBTPC fine granules are useful in the treatment of urinary tract infections.

[Pharmacokinetics and urinary excretion of aspoxicillin after consecutive administration at a dose of 4 grams]

Aspoxicillin (ASPC), a new injectable penicillin, was administered to 5 healthy male adult volunteers once a day at a daily dose of 4 g for 5 consecutive days to study its absorption and excretion. The results of this study are summarized as follows: 1. In consecutive administration of ASPC for 5 successive days, no remarkable changes were observed in serum concentrations and urinary excretion after each administration of ASPC. Therefore, no tendency of accumulation of the drug was recognized. 2. The serum ASPC concentration showed its peak values ranged from 212.3 to 224.8 micrograms/ml at completion of the intravenous drip infusion of ASPC. 3. Urinary recovery rates of ASPC ranged from 70 to 80%. 4. There were neither abnormal findings in subjective and objective symptoms nor abnormal values in physical and clinical laboratory test due to the administration of ASPC.

[Two cases of heterotopic bone formation in the kidney and clinico-pathological study of 36 cases reported in Japan]

We report two cases of heterotopic bone formation in the kidney. One patient was a 54-year-old man who consulted his family physician with the complaint of fever-up and nocturia. X-ray examination revealed a calcification in the left kidney and location of the pelvis for outside. Therefore, abdominal CT scan and selective renal angiography were performed. As a malignant renal tumor with hypovascularity could not be neglected, left nephrectomy was performed on August 18, 1980. Grossly, the resected kidney was 230 g in weight and had a 8 X 3 cm mass with a white cut surface and bone-like tendency. Histopathologically, a well-developed bone with erythropoietic bone marrow was found outside of the renal capsule. The other patient was a 52-year-old man with the complaint of painful swelling of left scrotum and lumbago. X-ray examination revealed bilateral renal stones and left ureteral stone. Bilateral nephrolithotomy and left ureterolithotomy were performed, and some stones and a part of bilateral renal pelvis which was bony hard and white in color were resected. Histopathologically, there were well-developed bone formation and infiltration of inflammatory cells in renal pelvic membrane. Among 36 reported cases in Japan, 16 cases were in male and 20 cases in female patients. Our second case was the first cases of bilateral renal heterotopic bone formation complicated with bilateral renal stones in 5 reported cases with renal stones. Including our first case, 5 cases which had heterotopic bone formation in renal capsule have been reported.