Medical survey of female boxing in Italy in 2002-2003.

BACKGROUND: Female boxing has been permitted in Italy since 2001. According to the latest Italian laws, athletes applying to become boxers have to pass a pre-participation medical examination. OBJECTIVE: To collect novel medical information from the pre-participation visits and mandatory pre-competition and post-competition examinations for all fights involving Italian female boxers in 2002-2003. METHODS: A retrospective study on all official female boxing competitions in Italy from January 2002 to October 2003 was conducted. A prospective study on 28 amateur female boxers was also carried out. RESULTS: Retrospective study: data from 664 examinations were collected. Pre-match examinations were negative. After competitions, 19/645 visits showed some injuries, with mild, soft tissue facial lesions, epistaxis, and hand-wrist problems being the most common. Prospective study: no major lesions were found during the study. One fibroadenoma, one ovarian cyst, and one intramural uterine myoma were found. One boxer was referred to a neurologist because of non-specific electroencephalographic (EEG) abnormalities, which persisted six months later. On a re-admission examination, which was needed because of a contest that was stopped because the referee judged that she was receiving blows to the head that were dangerous, one boxer showed non-specific EEG alterations and nystagmus. A cerebral magnetic resonance imaging scan was normal. She was allowed to participate in competitions again when her EEG returned to normal and clinical signs disappeared. Deviation of the nasal septum was quite common (68%). No major eye injuries were reported. CONCLUSION: Probably because of the correct preventive medical approach, female boxing is much safer than expected, and no major lesions (requiring hospital admission) were reported. Any lesions to the breast and reproductive system could not be considered to be boxing related.

Boxing and "commotio cordis": ECG and humoral study.

The objective of the study was to analyze the presence of myocardial damage in relation to official boxing matches. Low-energy chest wall impact could be responsible for sudden cardiac death, i.e. commotio cordis. As boxing is a traumatic sport in which thoracic hits usually occur, it seems interesting to know if there are any significant cardiac changes during official bouts. Fifteen amateur boxers, participating in the semifinals of the Italian Championship were investigated. A standard ECG before, immediately after, 1 hour and 12 hours after the match were obtained from each athlete to analyze atrio-ventricular conduction, QRS axis and duration, and ventricular repolarization. A blood sample was also obtained before and 12 hours after the match for analysis of total-creatin-phosphokinase, myoglobin, and T-troponin. After the fight, the following significant changes were encountered: higher QRS voltages, lowering of J-point and ST segment in lateral leads, higher ST-slope, lower T-wave amplitude, shorter T-wave peak time, and shorter QT interval. When the last 2 parameters were corrected for heart rate, no differences were observed for QTc, while T-wave peak time significantly increased. All these changes persisted until one hour after the match. Moreover, 3/15 boxers (20 %) showed marked ventricular repolarization anomalies in lateral leads after the contest, persisting for 12 hours in one case. However, no athlete had clinical and humoral signs of myocardial damage following the match. It was concluded that no clinical and humoral signs of myocardial damage were found after amateur boxing matches, although ventricular repolarization abnormalities can be found on ECG in 20 % of boxers, probably due to sympathetic hyper-activity related to the agonistic event.

Resurfacing of thumb-pulp loss with a heterodigital neurovascular island flap using a nerve disconnection/reconnection technique.

The problems of late deterioration of sensation and a "double sensibility" phenomenon, either in the thumb or donor finger, are a known deficiency of the conventional heterodigital neurovascular island flap. This is probably related to unsatisfactory cortical reorientation following flap transfer. To obviate this problem, the authors have used a disconnection/reconnection technique for heterodigital island flaps in 17 patients, to resurface defects in the skin of the thumb. All patients were followed-up for 1 year, while 15 were followed-up for 2 years or more. There were no flap complications or failures, and the length of the thumb tip was preserved in all cases. The classic two-point discrimination was less than 6 mm in eight of these patients, and the remaining nine patients had two-point discrimination of between 6 and 8 mm. This technique was found to provide sensitive, supple, and well-vascularized skin with proper cortical representation, to replace the loss of the tactile pump of the thumb tip in one operative stage.