Effects of Positive Psychological Capital, Job Crafting and Job Satisfaction on Intention of Retention in Hospital Nurses / 간호행정학회지

Purpose@#This study aimed to identify the factors that affect intention of retention of hospital nurses by examining correlations between positive psychological capital, job crafting, job satisfaction and intention of retention based on the expanded Job Demand-Resources Model. @*Methods@#A total of 198 nurses with more than 6 months of clinical experience were recruited from a university hospital. Data on positive psychological capital, job crafting, job satisfaction and intention of retention were collected from September to October 2021 using self-report questionnaires. @*Results@#Hierarchical regression analysis demonstrated that the factors affecting hospital nurses’ intention to retain were marital status (β=.15, p=.035) in Model 1, positive psychological capital (β=.18, p=.037), and job crafting (β=.29, p=.001) in Model 2, and job satisfaction (β=.55, p<.001) explained by 35% in Model 3. @*Conclusion@#Based on our findings, employer and nursing leaders should provide job satisfaction programs including offering career growth opportunities and building supportive nursing culture for retention among nurses.

National Responsibility Policy for Dementia Care: Current and Future

With the world's fastest-growing aged population, dementia care has become a major public health concern in Korea, prompting the emergence of the policy of national responsibility for dementia care. Over the past one year since the introduction of the new policy, it has shown its strengths and weaknesses. Now is the time for us to put the current status of this policy into perspective in terms of the benefits for patients and caregivers as well as the cost-effectiveness in the management of dementia. In addition, we will suggest the optimal quality control system and education program for dementia care hospitals, highlighting the critical role of neurologists for the success of the national responsibility policy for dementia care.

Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism

BACKGROUND/AIMS: To prevent hypocalcemia after parathyroidectomy (PTX), parenteral calcium is required in addition to oral calcitriol and calcium. After switching to oral calcium, patients can be discharged from the hospital. The aim of this study was to analyze the clinical characteristics and outcomes of PTX performed at a single Korean center and to investigate the associated laboratory factors used to analyze the total amount of postoperative calcium required. METHODS: We enrolled 91 hemodialysis patients undergoing PTX from November 2003 to December 2011. We collected clinical and laboratory data preoperatively, 12 and 48 hours postoperatively, at discharge, and 3 and 6 months postoperatively. RESULTS: In total, 59 patients underwent PTX with autotransplantation (AT), 6 underwent total PTX without AT, 11 underwent subtotal PTX, and 15 underwent limited PTX. Total PTX without AT showed the lowest recurrence rate. At all postoperative time points, the mean levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) decreased significantly, compared with preoperative levels; however, alkaline phosphatase (ALP) increased significantly from 48 hours postoperatively to discharge (p < 0.001). On multiple linear regression analysis, the total amount of injected calcium during hospitalization showed a significant correlation with preoperative ALP (p < 0.001), preoperative iPTH (p = 0.037), and Deltaphosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX. CONCLUSIONS: Preoperative ALP, preoperative iPTH, and Deltaphosphorus at 48 hours may be significant factors in estimating the postoperative calcium requirement. The formula for postoperative calcium requirement after PTX may help to predict the duration of postoperative hospitalization.

Recombinant TAT-CD137 Ligand Cytoplasmic Domain Fusion Protein Induces the Production of IL-6 and TNF-alpha in Peritoneal Macrophages

BACKGROUND: The ligand for CD137 (CD137L; also called 4-1BBL) is mainly expressed on activated APCs such as dendritic cells, B cells and macrophages. Even though CD137L functions as a trigger of the CD137 signaling pathway for T cell activation and expansion, engagement of CD137L can deliver a signal leading to the production of proinflammatory cytokines in macrophages. METHODS: We generated cell-permeable TAT-CD137L cytoplasmic domain fusion protein (TAT-CD137Lct) and examined its ability to initiate the CD137L reverse signaling pathway. RESULTS: Treatment of TAT-CD137Lct induced the production of high levels of IL-6 and TNF-alpha mRNAs and proteins in peritoneal macrophages. TAT-CD137Lct increased phosphorylation of Erk, p38 MAPK and Jnk, and activated transcription factors C/EBP and CREB. However, TAT-CD137Lct did not visibly affect the degradation of the inhibitor of NF-kB (IkBalpha). We further demonstrated that JNK activation was required for TAT-CD137Lct-induced production of TNF-alpha, while activation of Erk and p38 MAPK were involved in IL-6 and TNF-alpha production. CONCLUSION: Our results suggest that TAT-CD137Lct is an effective activator for the CD137L reverse signaling pathway.

Pigmented Mammary Paget Disease with Reticulated Features: A Rare Variant of Mammary Paget Disease

Pigmented mammary Paget disease (PMPD) is a rare subtype of mammary Paget disease that presents as a hyperpigmented patch or plaque over the areola and nipple. We herein report on an unusual case of PMPD with reticulated features in a 98-year-old female. The histology showed intraepidermal pagetoid cells containing melanin pigments without any underlying intraductal carcinoma.

Analysis of the Effect of Oral Antihistamines in Patients with Chronic Urticaria in Terms of the Disease Outcome and Quality of Life / 대한피부과학회지

BACKGROUND: Chronic urticaria (CU) has a considerable influence on the well-being of patients and it has a negative impact on the quality of life (QOL). Oral antihistamines are commonly used as the first-line treatment for CU. Although the efficacy and safety of antihistamines are well established for treating CU, a responder-based analysis to identify the improvement of symptoms and QOL has not yet been performed for Korean patients. OBJECTIVE: The purpose of this study was to compare the baseline urticaria severity score and the QOL with those after antihistamines treatment, and to assess the clinical outcome of CU after long-term antihistamine treatment. METHODS: A total of 103 CU patients were asked to complete a questionnaire about the effect of CU on their QOL at their first visit. Both the urticaria severity score and QOL were determined before and after a 6-month period, during which time the patients were administered a regular antihistamine prescription. QOL was assessed using a modified version of the Dermatology Life Quality Index (DLQI). The clinical efficacy was measured at baseline and at all visits. RESULTS: Oral antihistamines significantly improved the total QOL scores after 6-months treatment (p or =75% reduction of symptoms from baseline. CONCLUSION: Our data highlights the importance of continuous antihistamine treatment for the management of CU. Oral antihistamines, when taken regularly, can improve the QOL and urticaria severity of CU patients.

A Case of Squamous Cell Carcinoma of the Liver in a Patient with Arsenic Keratosis Associated with Multiple Bowen's Disease / 대한피부과학회지

Arsenic keratosis can be a precursor of both Bowen's disease and squamous cell carcinoma. In fact, there is a direct dose-response relationship between the amount of arsenic exposure and the development of skin cancer. Therefore, meticulous dermatologic surveillance and follow-up are advised to detect malignancy at an early and curable stage. We herein report on a case of a 62-year-old man who presented with multiple Bowen's disease and arsenic keratosis. His past history revealed chronic exposure to arsenic through consumption of Chinese traditional herbal medicine. After a follow-up loss of 2 years, he returned with multiple extracutaneous metastases of squamous cell carcinoma, including the liver. Our case emphasizes the importance of regular follow-up and survey for skin cancer and other internal malignancies in patients with history of chronic arsenic exposure.

A Case of Focal Acral Hyperkeratosis

Focal acral hyperkeratosis (FAH) is a rare genodermatosis with an autosomal dominant pattern of inheritance; however, it may also be sporadic. FAH is characterized by late-onset crateriform keratotic papules, some coalescing into plaques, along the borders of the hands and feet. We herein report a case of FAH in a 47-year-old male with a family history of similar lesions in three generations. The histological findings revealed focal areas of orthohyperkeratosis over an area of depressed but otherwise normal epidermis. The dermis showed no specific changes, which distinguished this case from acrokeratoelastoidosis, which shows elastorrhexis of clinically similar lesions.

Aneurysm of the inferobasal wall and ventricular septal rupture complicated with inferior myocardial infarction / 대한내과학회지

The incidence of left ventricular aneurysm following acute myocardial infarction is 5 to 10 percent. Eighty % of aneurysms involve the anteroapical wall of the left ventricle: They are four times more frequent in this wall than in the inferior or posterior wall. Anterior myocardial infarction causes aneurysm in the anteroapical wall of the left ventricle, while inferior myocardial infarction causes aneurysm in the posterobasal wall of the left ventricle. Yet the aneurysmal complications in the interventricular septum after myocardial infarction are very rare. A 74-year-old woman with inferior myocardial infarction presented with both an aneurysm of the inferobasal wall and a ventricular septal rupture, and these were detected by two-dimensional and Doppler echocardiography. The aneurysm originated from the inferobasal portion of the left ventricular wall. The short-axis view of the two-dimensional echocardiography revealed an abrupt discontinuity of the junctional area of the inferoseptum and the inferior segment, and a large aneurysm at the inferior portion of the left ventricular cavity. The communication orifice was 4 cm wide. Color Doppler echocardiography showed a left-to-right shunt flow from the aneurysm to the right ventricle. We report here on a case of an aneurysm of the inferobasal wall and a ventricular septal rupture, and these lesions were detected by two-dimensional and Doppler echocardiography.

The Change of Cognitive Function and Prognostic Factor in Alzheimer's Disease: 1-Year Follow-up Study

BACKGROUND: The rate of cognitive change and prognostic factor in Alzheimer's disease are important for clinical management, but little is known in Korea. We report a one year follow-up study of comprehensive evaluation including cognitive functions, behavioral and psychological symptoms of dementia (BPSD) and activity of daily living (ADL). METHODS: 43 patients with Alzheimer's disease were enrolled. All subjects received the Korean version of Mini-Mental State Examination (K-MMSE), the Severe Dementia Scale (SDS), the extended version of Korean Clinical Dementia Rating Scale (CDR) and Sum of Box (CDR-SB), the Barthel index of Activity of Daily Living (B-ADL), the Korean Instrumental Activity of Daily Living (K-IADL) and the Korean version of the Neuropsychiatric Inventory (K-NPI). We retested each scale after 1 year and evaluated the changes. RESULTS: The mean change rates of K-MMSE, SDS, CDR, CDR-SB and B-ADL scores were 2.0 +/- 3.2 (-7~8) mean +/- SD (range), 3.5 +/- 4.9 (-7~14), -0.4 +/- 0.7 (-2~1), -0.8 +/- 4.4 (-10~9) and 1.5 +/- 3.7 (-7~9). The change of K-MMSE and B-ADLscore according to CDR were significantly different. The annual rates of changes of scores on K-MMSE, B-ADL and CDR were largest in CDR 1 group (K-MMSE: 4.0 +/- 2.7, B-ADL: 3.4 +/- 2.8, CDR: -1 +/- 0.7). The change rate of SDS was largest in CDR 4 (7.2 +/- 4.3). There were not any significant factors that affected the change of K-MMSE, SDS, B-ADL or CDR. CONCLUSIONS: These results suggest that K-MMSE is sensitive to the early stage and SDS is sensitive to the later stage. The deterioration rate of cognitive function in Alzheimer's disease is large at middle stage.

Care Grading System and the Professional Role of Long-term Care Insurance

The preliminary Long Term Care Insurance(LTCI) of Korea now entered on its rehearsal phase. The economic condition of Korea and the demand for health strengthening through proper medical service of elderly were not fairly reflected in the LTCI. The complex procedure of application for LTC service and unskilled decision system were revealed from the exhibition trial of LTCI. Many requests were suggested to establish operating system. The elderly wanted to take a combined medical and care service than simple care service. Therefore, the professional role of LTCI for a high degree of efficiency should be readjusted and LTCI have to be changed to fit in with the reality of Korea.

Efficacy and Safety of Entacapone in the Patients with Parkinson's Disease Experiencing Wearing-off Phenomenon: Multicenter Randomized Placebo-controlled Double Blind Study

BACKGROUND: The purpose of this study was to assess the efficacy and safety of entacapone, a catechol-O-methyltransferase (COMT) inhibitor in Parkinson's disease (PD) patients with wearing-off phenomenon. METHODS: A total of 197 PD patients were included in this 2-month multi-center, randomized, placebo-controlled, double blind, parallel-group study. After a 2-week screening period, each patient was randomly allocated to receive either entacapone (n=98) or placebo (n=99) as an adjunct to levodopa. The efficacy was evaluated with the changes of "on" and "off" time percentage while awake, the reduction of the levodopa dose, Unified Parkinson's Disease Rating Scale (UPDRS), and the clinical global impression (CGI) by the examiner. RESULTS: The percentage of "on" time increased by 9.4 +/- 18.0% in the entacapone group, 7.4 +/- 15.6% in the placebo group. The percentage of "off" time was reduced by 8.6 +/- 16.9% in the entacapone group, 6.6 +/- 18.2% in the placebo group. These parameters did not show a statistical significance between the two groups. However, the levodopa dose was significantly reduced in the entacapone group (51.6 +/- 154.5 mg/day) compared with the placebo group (0.7 +/- 130.0 mg/day) (p=0.009). The total and motor scores of the UPDRS were significantly decreased in the entacapone group (p=0.039, p=0.017, respectively). The most common adverse drug reactions in the entacapone group were urine discoloration (22%), dyskinesia (13%), dizziness (7%). CONCLUSIONS: Entacapone was a safe and well-tolerated drug. Although the changes of "on" and "off" time were not significant, entacapone showed an overall significant beneficial effect in the PD patients with wearing-off phenomenon.

Obturation efficiency of non-standardized gutta-percha cone in curved root canals prepared with 0.06 taper nickel-titanium instruments / 대한치과보존학회지

The purpose of this study was to evaluate the obturation efficiency of a non-standardized gutta-percha cone in curved root canals prepared with 0.06 taper nickel-titanium instruments. Sixty simulated curved root canals in clear resin blocks were prepared with crown-down technique using 0.06 taper rotary ProTaper(TM) and ProFile (Dentsply-Maillefer) until apical canal was size 30. Root canals were randomly divided into 4 groups of 15 blocks and obturated with cold-laterally compacted gutta-percha technique by using either a non-standardized size medium gutta-percha cone or an ISO-standardized size 30 one as a master cone. Gutta-percha area ratio were calculated at apical levels of 1, 3, and 5 mm using AutoCAD 2000 after cross-sectioning, and the data were analyzed with one-way and two-way ANOVAs and Duncan's multiple range test. Non-standardized size medium cone groups showed significantly higher gutta-percha area ratio than standardized cone groups at all apical levels (p < 0.01). Non-standardized cone groups used significantly less accessory cones than standardized cone groups (p < 0.01).

The Neurops ychologic Features of Alcohol-Related Dementia

BACKGROUND: Recent studies indicate that heavy alcohol drinking is a significant factor for dementia. There are little studies for the neupsychology of alcohol-related persistent dementia patients in Korea. The main purpose of our study is investigate the results of neuropsychological test and neuroimaging of alcoholic dementia. METHODS: Eleven inpatients meeting DSM-IVcriteria for alcohol-related persistent dementia were examined with careful history taking, Seoul neuropsychological screening battery and brain CT. RESULTS: The mean K-MMSE, CDR scores were 18.4+/-3.8, 1.4+/-0.5, respectively. Language functions including spontaneous speech, comprehension, repetition, reading, writing were almost normal, except K-BNT. Attention, visuospatial function, calculation, orientation, memory, frontal executive function were severely impaired. Diffuse brain atrophy was the main finding on the brain CT. Personality changes including impulsivity, apathy, lack of motivation were observed most of the patients. CONCLUSION: Alcohol-induced persistent dementia subjects were impaired on the test of attention, visuospatial function, calculation, orientation, memory, frontal related function, but language function was relatively preserved.

Incidence and Risk Factors of Rehospitalization with Respiratory Syncytial Virus Infection in Premature Infants / 소아과

PURPOSE: We performed this study to evaluate the risk of rehospitalization for respiratory syncytial virus(RSV) infection among premature infants discharged from a neonatal intensive care unit(NICU). METHODS: We performed a retrospective study for rehospitalization for RSV infection and risk factors among premature infants who were admitted to NICU and discharged between May 2001 and April 2003 in Wonkwang University Hospital. RSV detection was utilized by direct fluorescent antibody tests in nasopharyngeal aspirates. We also reviewed various risk factors including gestational age, birth weight, sex, ventilatory care, surfactant administration, chronic lung disease(CLD), siblings in school or kindergarten age, and month of discharge. RESULTS: The rehospitalization rate for RSV infection was 6.6%(26/381) in premature infants and 22.2%(4/18) in premature infants with CLD. The most common season of rehospitalization for RSV infection was between November to January, this was 69.2%(18/26) in premature infants, the same as children: 61.2%(93/152). The risk factors for RSV rehospitalization among premature infants were CLD, siblings in school or kindergarten age and discharge between October to December from NICU. CONCLUSION: The risk for RSV rehospitalization among premature infants from NICU was low. Preterm infants subject to risk factors of CLD, siblings in school or kindergarten age, and discharge between October to December from NICU, were most likely to require hospitalization for RSV disease. In CONCLUSION: Prophylaxis for RSV infection should be considered one month before discharge from NICU in the RSV season between October and December.

Clinical Studies of Sinus Headache in Children / 소아과

PURPOSE: Headache is a common reason for children to seek medical care. There are many causes of headaches in children, such as migraine and its variants, tension, intracranial masses, and sinusitis. A high frequency of diagnosis of sinus headache, which specialists consider to be relatively rare, raises the possibility that migraine and other headache types are sometimes mistaken for sinus headache. This report studied the clinical characteristics of sinus headache in the pediatric population. METHODS: We analyzed the clinical manifestations of 25 patients who had sinusitis in 97 children whose chief complain was headache. The clinical manifestation involved location, type, frequency and associated symptoms of headache, frequency of upper respiratory tract infection(URI), and family history of migraine. RESULTS: There were eight cases of organic headaches, which were two cases of brain tumor, two cases of arachnoid cyst, one case of Moyamoya disease, one case of brain abscess and two cases of eye problems. The mean age of patients who had sinus headaches was 8.2 years. The most common age group was between 6 and 11 years(76%). The most common location of sinus headache was the frontal area in 10 cases(40%). And the most common pattern of headache was dull and steady pain in 16 cases(64%). The most common associate symptom of headache were gastrointestinal symptoms such as nausea, vomiting and abdominal pain in 13 cases(52%). There were 13(52%) of patients who had no history of frequent URI. There were also seven(28%) patients who had a family history of migraines. CONCLUSION: Considered in aggregate, the data show that the occurrence of sinus inflammation associated with a headache should neither trigger a diagnosis of sinus disease nor exclude a diagnosis of migraine. It should prompt diagnostic consideration of both conditions.

The Effect of Declining Small Solute Clearance on Protein Intake and Nutritional Status in Progressive Renal Failure / 대한신장학회잡지

BACKGROUNDS: Malnutrition is common in patients with chronic renal failure(CRF) and various signs of malnutrition are strong predictors of increased morbidity and mortality. Monitoring of protein intake and nutritional status is therefore important in the clinical management of CRF patients. Few studies have demonstrated direct correlations among renal function, protein intake, and nutritional status in a prospective study although clinical experiences suggest such relationship. The aim of this study was to prospectively evaluate correlations between renal function, protein intake, and nutritional status during progressive renal failure. METHODS: A total of 431 studies on renal function, protein intake, and nutritional status was carried out in 282 patients with normal renal function and varying degrees of renal failure before beginning dialysis. Renal functional indices included weekly Kt/Vurea, total weekly creatinine clearance(Ccr, L/week/1.73m2), creatinine clearance(Ccr, mL/min/1.73m2), urea clearance(Curea, mL/min) and residual renal function(RRF, mL/min). Protein intake was assessed from the protein equivalent of total nitrogen appearance normalized by standard weight(nPNA, g/kg/day) by DOQI formula[nPNA(D)], Bergstr m formula 1[nPNA(B1)] and Bergstr m formula 2[nPNA(B2)]. Nutritional indices were fat free edema free body mass(FFEFBM, kg) by creatinine kinetics, %lean body mass(LBM, %) and serum albumin(g/dL). We evaluated correlations between renal function, protein intake and nutritional status by linear regression analysis. In a separate analysis, 237 studies from 94 patients with follow-up studies were analyzed for correlations among renal function, protein intake, and nutritional status. RESULTS: There was a highly significant correlation among weekly Kt/Vurea, weekly creatinine clearance, and residual renal function, among nPNA(D), nPNA (B1), nPNA(B2), and between FFEFBM and %LBM. Significant correlation was also observed between weekly Kt/Vurea and nPNA, between weekly Kt/ Vurea and FFEFBM, between weekly Kt/Vurea and %LBM, between nPNA and FFEFBM, and between nPNA and %LBM. The results were the same in patients with follow-up studies. CONCLUSION: These results clearly demonstrate that renal urea and creatinine clearance is closely correlated with protein intake and nutritional status in predialysis patients. With declining small solute clearances, protein intake decreased and nutritional status became worse. Starting dialysis before malnutrition becomes apparent may improve patient morbidity and mortality after dialysis.

Fluid Overload in Dialysis Patients / 대한신장학회잡지

End-stage renal disease(ESRD) is the fatal retention of non-volatile, metabolic waste products, salt, and water due to extensive loss of functioning nephrons. Renal replacement therapy is primarily aimed to remove retained waste products and fluid. Adequacy of dialysis is the dose of dialysis below which one observes a significant worsening of morbidity and mortality. Urea kinetic modeling, Kt/Vurea, etc. is regarded as a quantitative guideline of dialysis adequacy in both hemodialysis(HD) and peritoneal dialysis(PD). Water is one of the most important uremic toxin retained in ESRD patients. The importance of fluid overload on morbidity and/or mortality in dialysis patients is yet to be evaluated. Recent technology of HD provides adequate Kt/ Vurea for relatively short dialysis time and higher patient survival. Blood pressure control and extracellular fluid(ECF) volume are closely related with dialysis time in HD patients. Short dialysis time, 3-4 hours per session may not enough to control blood pressure. Hypertension is an important risk factor of survival in dialysis patients. Fluid overload is the most important factor of hypertension in dialysis patients. Patients with uncontrolled hypertension have higher mortality rate despite similar Kt/Vurea compared with patients with good blood pressure control. A longer dialysis time improves ECF volume and blood pressure control and decreases cardiovascular mortality. Continuous ambulatory peritoneal dialysis(CAPD) is a slow continuous therapy and is believed to maintain better control of ECF volume and blood pressure compared with hemodialysis. ECF volume and blood pressure controls are improved after initiation of CAPD, however, return to pre-CAPD levels after a few years of CAPD when residual renal function disappears. Patients transferred to hernodialysis from CAPD lose around 4kg of body weight for a few months on HD. Approximately 25% of CAPD patients are clinically fluid overloaded. Increased peritoneal permeability is an independent risk factor for patient and technique survivals in CAPD patients. Fluid overload in CAPD patients with increased peritoneal pernability is believed to be an important underlying mechanism of increased mortality and technique failure in this group. In conclusion, fluid overload is an important risk factor of mortality in dialysis patients. Sufficient dialysis time resulting good controls of ECF volume and blood pressure in hemodialysis patients and individualized dialysis prescription according to the peritoneal permeability in CAPD patients are vital to provide adequate dialysis and to decrease cardiovas-cular mortality.

A Case of Painful Legs and Moving ToesSyndrome Responsive to Gabapentin

The syndrome of painful legs and moving toes (PLMT) is a rare movement disorder characterized by severe burning pain in legs associated with peculiar involuntary movements of toes and is difficult to treat. A 70-year-old woman presented with severe lancinating pain in the area below both knees and involuntary movements of both toes for 18 months. The pain in her legs was not relieved by motion. The involuntary movements comprised flexion, extension, adduction, and abduction of toes with occasional rotatory movements of both feet continuing while awake. She had a history of laminectomy of the lower lumbar spine about 15 years ago. Electromyography findings were consistent with chronic lumbosacral polyradiculopathy. Benzodiazepines, carbamazepine, baclofen, and anti-depressants were not effective in reducing her symptoms. However, gabapentin relieved the sensory and motor symptoms significantly. This is the first case of PLMT syndrome reported in Korea which showed a dramatic response to gabapentin.

Distal Myopathy of Miyoshi Type: 1 Case

Miyoshi myopathy (MM) is a type of distal myopathy that is characterized by an early adult onset and a prominent involvement of the gastrocnemius muscles. Weakness usually appears between 15 and 30 years of age starting in the posterior compartment of the legs. Creatine kinase (CK) values are characteristically elevated to levels 10 to 100 fold above normal range. Here we report one patient who was diagnosed as MM. She developed a motor weakness in her early thirties. There was an early and predominant involvement of the gastrocnemius muscles. Creatine kinase activity was elevated 10 to 15 fold above normal range. Electromyography revealed fibrillations, positive sharp waves, and a myopathic pattern of motor unit potentials, particularly in the distal muscles of the lower limbs. Myopathic features without vacuoles were seen in the vastus lateralis muscle. This is the first case report of MM in Korea, which should be considered in the differential diagnosis of slowly progressive weakness of distal legs.