Ewing sarcoma (ES) is a malignant neoplasm that affects bones and soft tissues, usually in young patients. Currently, ES is grouped with other tumors that share the same histological and genotypic characteristics, forming the Ewing Sarcoma Family of Tumors (ESFT), which includes ES of bone, extraosseous ES (peripheral neuroepithelioma), Askin tumor, and peripheral primitive neuroectodermal tumor (PNET). Its origin in peripheral nerves is extremely rare, making its diagnosis and treatment very challenging. We describe a case of a 27-year-old male with extraosseous ES originating in the sciatic nerve, which was surgically removed, and discuss the difficulties encountered in the management of this patient.

The authors present an historical review of aspects of the life of Professor Manuel R. Gómez, a Spanish neuropediatrician, who graduated in Havana and is known internationally for his work while he was in charge of Pediatric Neurology at the Mayo Clinic in Rochester, USA. His main contribution was related to the tuberous sclerosis complex, demystifying the Vogt triad previously used as a diagnostic criterion, and he was considered the “father of the tuberous sclerosis complex “ in the USA.

The aim of this study was to investigate whether the use of handrail support during maximal exercise treadmill testing (ETT) would interfere in cardiac autonomic modulation kinetics when compared to not using handrail support. The hypothesis of overestimation in cardiac autonomic dynamics when the ETT is performed using handrail was tested. Thirty-five undergraduates (21.08 ± 2.98 years old) of both sexes, volunteered to undertake two ETT under the Ellestad protocol, in non-consecutive days. The first test (T1) was performed with handrail support and, after 7 days, the second test was performed (T2) without the support. Autonomic function was measured by heart rate variability (HRV) during both tests and resting. Estimated value of peak oxygen uptake (VO2) was 22.4% (p < 0.0001) higher in T1 when compared to T2. Overall, parasympathetic pathway was deactivated earlier in T2 than in T1, with NNxx measures variating in T1 from 10.74 ± 14.59 (ms) and in T2 from 3.48 ± 3.79 (ms). In stage two, mean values of HF in T2 corresponded to 32% of values in T1. Stage three presented a difference of 60% (p < 0.014) in LF between means reached in T1 and T2. Lastly, the association of LF and VO2 persisted longer in T1 stages than in T2 and was verified in early stages (S2 and S3) of both ETTs. Our findings suggest that parasympathetic influences on HR were slightly prolonged during ETT when subjects hold onto the treadmill.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

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