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Member since Jun-04-08 · Last seen Jun-25-17
Good Day to All! Ma-ayong adlaw sa tanan. And my thanks to for this excellent website. Salamat Opinions:

1. World Chess Championship

The true Chess World Champions are the holders of the Traditional Title that originated with Steinitz & passed on in faithful succession to Lasker, Capablanca, Alekhine, Euwe, Botvinnik, Smyslov, Tal, Petrosian, Spassky, Fischer, Karpov, Kasparov, Kramnik, Anand, and Carlsen. The sacredness of this Title is what makes it so valuable.

And how does one become the true Chess World Champion? In general, by beating the previous Titleholder one on one in a Match! Matches are preferred over Tournaments because of the Tradition of the WC Succession & because the chance for pre-arranging a Tournament result is more likely. The only exceptions to this rule:

A. In case where the Candidates and World Champion participate in an event that all the participants agree to be a World Championship event because of extraordinary circumstances.

Thus, the 1948 World Championship Tournament was justifiable because of the death of the Title holder Alekhine.

Likewise, the 2007 WC Tournament was justifiable under the extraordinary circumstances of the Chessworld trying to heal its internal rift over the 1993 Kasparov Schism. Anand himself became the World Champion in this 2007 Tournament & not in 2000 when he won a knock-out FIDE Tournament. Caveat: Some chess fans deem the 2007 WC Tournament as illegitimate, considering that Anand became the World Champion only in 2008, when he beat the previous Titleholder Kramnik in a WC match. From this perspective Anand only became the Undisputed World Champion in 2008.

Karpov lost his Title to Kasparov in 1985, & never regained it in the 1990s events that FIDE labeled as 'world championships'. All solely FIDE Champions that emerged outside WC Traditional Succession elaborated on above, strong as they were, were not true World Champions (eg., Bogolyubov 1928, Khalifman 1999, Ponomariov 2002, Kasimdzhanov 2004, Topalov 2005).//

B. In case the previous Titleholder refuses to attend (or defaults) an event that the Chessworld largely deems as a World Championship event in the Tradition of the World Championship Succession. Thus, Karpov was the true successor to Fischer who resigned (or defaulted) their WC Match in 1975.

2. The strongest chess events in different eras of chess history?

Because of the brain's limitations explained below, the best professional (amateurs don't matter much in top level chess) chess players of each generation beginning in the Lasker era have always played at a similar level - near the maximum allowed by human standards. Now there are larger cohorts of chess professionals post WW2 than preWW2 thanks to government state funding in the Soviet era and presently corporate funding. The result is that large preWW2 tournaments had numerous 'bunnies', relatively weak players. By the Kasparov era, super-tournaments that featured most of the top ten, and no bunnies, had became more common. However, the top 4 or 5 since Lasker's time have always been very strong.

Consequently the smaller the top-player-only tournament, the stronger it gets. For any era. If there was a double round robin tournament in 1914 featuring Lasker, Capablanca, Alekhine, and Rubinstein, and no other, it would be as strong as any present day super-tournament.

Now weed out everyone except the two strongest players in the world. What we (usually) get is the chess World Championship match.

There has been talk of elite tournaments, composed only of the strongest top masters and no weaker bunnies replacing the World Championship match in prestige, probably because of the assumption that they would be the strongest chess events possible. False assumption. The strongest chess events in chess history generally have been World Championship matches. Even the strongest masters in each generation usually do not match the world champion and challenger in chess strength. In a World Championship match, the contestant has to meet the monster champion or challenger over and over again, with no weaker master in between. Capablanca vs Lasker 1921 was just as strong a chess event as the recent Carlsen vs Anand 2013, and far stronger than Zurich 2014. (Imagine having to play 14 straight games with a computer-like errorless Capablanca at his peak.)

3. The strongest chess players in chess history?

First, it's possible to compare chess players from different eras by 'using' players with long careers whose active playing spanned across at least three or four decades. Some historical examples involving World Champions and Almost World Champions are Lasker, Alekhine, Keres, Botvinnik, and Korchnoi. Specifically, Lasker as an old man man in the 1920s was beating the hypermoderns. An 'old' Alekhine meted out crushing defeats to young Flohr and Keres in the 1930s and 40s, and was clearly better than them. Keres whose peak was probably in 1938 to 1943 played terrific chess until the 1970s, and nearly got to be Challenger again in the 1950s and 60s, beating a whole slew of younger players. This included Korchnoi who until the 2000s could give good account of himself playing the teen Grandmasters of the turn of the century.

Second and more important, I believe that we can rationally compare chess players from different eras by using objective computer analysis of their middlegames and endgames (not openings). We can 'ask' the computers how accurately the players are playing. They take the place of the stopwatch. As far as I know, nearly every computer study using various programs has always placed Capablanca at number one or two in terms of accuracy. Computers 'love' Capablanca's play.

Thus the 1919 version of Capablanca & the 1971 version of Fischer, both of whom played practically error-free chess, are it; updated in opening theory, they should beat anyone in a match.

If computers were self-aware, I have no doubt that they would unanimously choose the 1916 to 1924 Capablanca as the strongest chess player in history. And please no red herring remark that Capa played only 'simple' chess. This young Capablanca played some of the most complicated, sharp, double edged, and bizarre positions possible; and played them without making a single losing error (and by all accounts with unsurpassed quickness), something that has always befuddled my mind when I got to peruse through his games.

We have to take this question in the context of the limits of the human Anatomy and Physiology. A concrete example would be the one hundred meter dash. The human body is designed such that the limit it can run is about 9 seconds. In order for a human being to run faster, we would have to redesign the human anatomy into that of say a cheetah. One can rev up the human Anatomy and Physiology, say with steroids, but this regimen would hit an eventual Stonewall too; the same way that we could rev up human proficiency to learn openings with computer assistance.

Since the Nervous System has physiological limits (example of a limit- neuronal action potential speed don't go up much more than 100 m/s) and so limits the human chess playing ability, increasing the number human chess players, thus expanding the normal curve of players, simply creates more possibilities of players playing like a Fischer in his prime, but will not create a mental superman who plays chess at computer levels. This explains why human and computer analysis indicate that Lasker was playing on a qualitatively similar level as more recent WCs.

'Worse' in chess, any computer assistance ends once the opening is over. After a computer-assisted opening prep, every GM today has to play the game the way Lasker did a hundred years ago, relying on himself alone, with the same fundamental chess rules and chess clock. An Encyclopedic opening repertoire is not a necessity to be a top player. In fact, there are World Champions who did not do deep opening prep; they just played quiet but sound openings that got them into playable middlegames and then beat their opponents in the midlegame or endgame. Just look at Capablanca, Spassky, Karpov, and now Carlsen.

Because of subconscious adherence to the narcissistic generation syndrome, the belief that everything that is the best can only exist in the here and now, many kibitzers would not agree to the above theses. While it is true that there have been more active chess professionals and consequently larger cohorts of top chess masters on a yearly basis since WW2 thanks to Soviet state funding and present corporate funding, the very top chess masters since Lasker's time have always played at a similar level- within the limits imposed by the human brain. There is no physical law that bars a pre-WW2 chess master from playing chess as well as today's generation. The human brain has not changed in any fundamental manner in the past tens of thousands of years.

4. The greatest chess players in history?

A related question is who is the greatest chess player in history. The answer depends on the criteria one uses. Since I place great emphasis on the ability to play world class chess for the longest period of time, Lasker would be it. He was playing at peak form from 1890 age 22 (when he began a remarkable run of match victories over Bird, Mieses, Blackburne, Showalter, and culminating in his two massacres of Steinitz) until 1925 at age 57 (when he nearly won Moscow after winning new York 1924). Kasparov (high plateau from 1980 to 2005) and Karpov (high plateau from 1972 to 1996) would follow. (At their very peak though, I believe that Kasparov was stronger than Karpov, and both were stronger than Lasker; and the peak Capablanca and Fischer were stronger than any of them.)

5. Computers vs Humans, who is stronger?

Another related question is how history's top masters would fare against computers. It's obvious from Kasparov's time that computers would totally crush them all. Opening knowledge would not matter much. Computers swamp human opponents in the middle game, simply by calculating more variations more rapidly by several orders of magnitude.

6. On the game and chess players young and old, past and present:

The proposition that an older player would not be able to adjust to the openings and methods of a younger generation is false, as evidenced by the observation of strong masters whose careers happened to span generations beating the tar out of weaker masters of the next generations. (See #3 above.)

This 'inter generational knowledge/theory leveling phenomenon' holds true today and will probably still hold true two decades from now. As of 2017, Kramnik, Anand and Topalov, and a few years ago Gelfand are living smoking gun proofs that the speculation that the older generation cannot adopt to newer openings is false. Older players have always adapted and will always adapt to the latest openings in the vogue. The present day young players will do the same 20 years from now, faced with a future generation of rising chess players.

The notion that computers are more advantageous to younger players IMO is not quite right. Younger players should have more energy and stamina in studying chess openings and endgames for long hours everyday compared to older players without computers, but the use of computers would tend to make the learning process easier for every one including the older ones.

As a corollary, computers also make it easier today for very young players in their early teens to peak at a younger age than in past eras, although they tend to level off in their early 20s to their high plateau, defined by their inborn talents and determination.

In brief. computers tend to level chess learning for everyone, young and old.

This is not a rigid rule. The best games I have ever seen played by a 12-13 year old are Capablanca's; and Tal, Karpov, and Kasparov reached their high plateau in their early 20s in a computer-less era, similar to computer age Carlsen. However let it be noted that Carlsen reached his peak sidestepping intensive computer-prepped tactical openings and beating his competitors in the old fashioned way in the middlegame and endgame. These masters peaked early not because of computers by because of their immense chess talent. Perhaps normal rules do not apply to these geniuses.

Another false notion is that the nature of the middlegame today is somehow different from the middlegame in the past. The easiest way to prove the wrongness of this proposition is by observing CG's daily puzzles. Do not peek at the names of the players that played these puzzles, and don't look at the dates. Can you glean from the middlegame play and combinations in the puzzles the date they were played? You can't. You would not know if it was played in 2016, 2000, 1950, or 1900. Chess combinations don't just suddenly change their stripes just because a hundred years have passed.

Another observation is that when the best masters of the past, Lasker, Capablanca, and Alekhine met the occasional 'modern' structures of the Sicilian Scheveningen and Dragon, KID, Modern Benoni, Benko Gambit, they played strategically perfectly, in just the way these opening structures should be played. So how did these masters play openings and the resulting middlegame structures that are deemed incomprehensible to them by some of today's dogmatically 'modern' kibitzers? The answer is that chess rules and principles have not changed. Center, rapid development, open files and diagonals, holes, weak pawns, piece activity, initiative and attack, positional sacrifices and all types of combinations were as familiar to them as to us.

Note that it is the frequencies of a few middlegame pawn structures that have changed since WW2. Not the Ruy Lopez or QGD, but obviously Sicilians and KIDs are much more common post-WW2. Since so many games nowadays begin with the Sicilian and KID, people associate these with being 'modern' (which is a rather vague undefined term IMO). But certainly Lasker and Capablanca understood the middlegame principles behind them and when they did get these positions they played them excellently, like the top masters they are.

Moreover, Keres is another smoking gun, bomb proof evidence of the fallacy of Watson's speculation that 'the best players of old were weaker and more dogmatic than the best players today', and Larsen's assertion that he would crush everyone in the 1920s. The glaring fact is that Keres is a pre-WW2 master who began his career in the late 1920s, and played competitively up to the 1970s, and he did learn (and contributed) to the newer opening variations (the most famous of which is the Keres attack which he invented in 1943). The ideal way for Watson and Larsen to prove their statements is to beat a top pre WW2 master such as Keres. They failed. Tellingly enough an aging Keres beat both a rising Watson and a peak Larsen when they happened play each other.

7. Regarding the topic on Physical compared to Mind prowess.

IMO improvement in 'physical' prowess, is mainly based on muscles and sports equipment and apparel.

So the same methods can't be done for the 'mind'.

Most people miss this out, but there is a big difference between improving muscles and the brain.

Muscles can hypertrophy. One can input in better ways to hypertrophy them, such as specialized gym equipment and exercises, and steroids.

On the other hand neurons do not hypertrophy.

Furthermore the 'hardwiring' of our nervous system mostly occurs when we were kids. Although we keep on learning throughout our lives, the last major upgrade was when the myelinization of our nerve fibers was completed when we were about 4 years old.

The above is the reason why I believe that if we are to produce an upgrade of the Capablanca type of chess genius (extremely rapid and accurate way of playing), we would have to start with kids 4 years old and below.

8. On ratings:

Elo ratings reflect relative and not absolute chess strength.

Chessplayers are naturally arranged in populations partitioned by geopolitical regions & time periods that have infrequent contacts with one another. Within such a population, players get to play each other more frequently, thus forming a quasi-equilibrium group wherein individual ratings would tend to equilibrate quickly; but not with outside groups. With caveats & in the proper context, FIDE/Elo ratings are simply fallible descriptors & predictors of an active player's near-past & near-future performances against other rated players, & only within the same quasi-equilibrium group.

As corollaries: the best way to evaluate a player's strength is to analyze his games & not his ratings; one cannot use ratings to accurately compare the quality of play of players from the past and present, or even the same player say a decade ago and today; & care should be taken in the use of ratings as a criterion in choosing which players to seed into the upper levels of the WC cycle. All the above often entail comparisons between players from different quasi-equilibrium groups separated by space and/or time.

Regarding inflation deniers, they imply that Elo ratings reflect absolute and not relative chess strength. Professor Elo himself would condemn their view. If the top 20 players were to suffer a serious brain injury and begin playing like patzers, but play no one else for the next decade, they would more or less retain their 2700s ratings, although they would be playing terrible patzerish chess.

9. Best Qualifiers?

The credible, fair, tried & tested Zonals - Interzonals - Candidates (with known strong players directly seeded into the Interzonals & Candidates; & here ratings may be used with caveats) over the random World Cup and the elitist Grand Prix. If possible long Candidate matches and 16 to 24 game World Championship matches. However, with the passing of the state-funded chess era of Soviet times, I begin to doubt if the strict money guzzling qualification process above can be re-installed.

10. The 1993 Chess Rift and Kramnik:

Regarding the Rift in the chessworld after Kasparov split in 1993, I believe that Kramnik has done more than any other individual in helping heal it by concrete actions - agreeing to a WC Match with Topalov in 2006 & not walking out when he could have done so with the support of most of the world's top GMs after getting accused of cheating; & agreeing to Defend his Title in a WC Tournament in 2007, the first time a living Titleholder has agreed to do so in chess history. My eternal gratitude to him.

11. Finances of a would-be Challenger:

Regarding all kinds of problems chessplayers outside of Europe & the USA face in their quest for the Title, Capablanca & Anand have proven it's possible for a non-European non-USA chessplayer to be World Champion; but apparently only if you have the chess talent of a Capablanca or Anand! For others, I guess they would have to try to get monetary support & good seconds somewhere to have some hope for a Title shot.

12. Ducking a World Championship re-match:

Alekhine vs. Capablanca - Not definitively resolved. If pushed, I would tend to favor Capablanca given that pre-WW 2, there was no definitive cycle to choose the Challenger &, after all is said and done, it was the Champion who set the conditions & who chose his Challenger. AAA could & should have chosen Capa; & there was ample time, more than a decade, to do so before WW2. On the other hand, Capa's pride may have caused him to behave arrogantly & thus offend AAA. The issue is very much debatable. //

Kramnik vs. Kasparov - For me, it's resolved. Kudos to Kramnik for trying his best to install a decent Qualifying Event. Kasparov for his reasons clearly did not want to go through the Qualifying Event that he himself had pledged before losing his Title; & did not even seem serious in playing the solely FIDE champions. Why? I can only speculate that Kasparov would rather retire than risk a loss in a Qualifier or a match to either a FIDE champion or to Kramnik. If he regained his Title, he would be the greatest Champion in history, but there was risk involved. If he retired, he would still be the greatest Champion in history, but there would be no risk involved. Kasparov chose the latter & no one should blame him for that decision; & more so don't blame Kramnik!

13. Predictions for Hypothetical World Championship Matches:

Lasker vs. Pillsbury, Rubinstein, Maroczy - Lasker wins 2, loses 1 match //

Lasker vs. Capablanca (inexperienced) 1914 - Lasker close win //

Capablanca (not overconfident & not having TIAs) 1929 to 1937 vs. Alekhine or any other master - Capa win //

Alekhine (sober & prepared) vs. Capablanca (w/ severe HPN & numerous past strokes), Botvinnik, Keres, Fine, Reshevsky, Flohr 1939 - Alekhine win //

Alekhine (alcoholic, ill, & depressed) vs. Botvinnik 1946 - Botvinnik win //

Fischer (inactive for 3 years) vs. Karpov 1975 - Karpov win//

Kasparov vs. Shirov 2000 - Kasparov win. (But GKK should still have given it to Shirov. And don't blame Kramnik. Had Kramnik declined, GKK would have chosen another; & Shirov would still be frustrated.)

14. My thoughts regarding the quick game tiebreakers for the World Championship Match:

i. Ideally the Champion must have beaten the old one to be Champion.

ii. I hate these FIDE quick game tie-breaks to decide the Classical Champion.

iii. The tiebreakers should be as fair as possible.

Notice that in the traditional Champion-retains-Title-in-a-tie, all the Champion needs is a tied match to retain his Title. Advantage Champion.

My recommendation is we give more Whites to the Challenger. Advantage Challenger.

So things even out.

We still retain the tradition of the Challenger beating the Champ to get the Title.

The Challenger gets to do it in a classical game, not a quick game.

Thus suggestion if the World Championship match ends in a tie:

Additional classical games with a limit, wherein the Challenger receives more Whites. If the Champion manages to tie or win at the end, he retains the Title.

Thus the tiebreaker can be one extra White game for the Challenger. Or two, three, or four. We could even vary further, say one Black followed by one to three Whites for the Challenger. Studies can be made in order to determine the best specific format (of Blacks and Whites) that can afford the Challenger a fair chance at winning.

IMO this would probably be welcomed by most of the chess world in terms of the sporting excitement it affords. Here we have the Challenger; forced to try all means to win in classical games against a sitting Champion that only needs to draw all the tiebreak games (or game). A real drama at the end of the match. If the match still ends in a tie, the Champion retains his Title, and deservedly so since he got more Blacks.

This way the Challenger must beat the Champion in a classical game (not a quick game) in order to grab the Title, and in so doing win the match outright.


I have opened a <'multi-experimental' forum> below. Its nature is that of several secret social and psychological experiments, whose objectives and parameters, and the rules that follow, are strictly defined and which I may or may not reveal. Readers of this forum might be able to deduce some of these rules. Accordingly messages shall be retained or removed with or without explanation, even those from my dear friends here in CG, although I am making it clear here that absolutely no offense is intended to any one in this experiment. I may or may not respond to certain questions and messages, also according to the rules. To my friends: Please bear with me in this matter.


Ongoing project to preserve and teach non-Tagalog minority Philippine languages (in danger of disappearing).

>> Click here to see visayanbraindoctor's game collections. Full Member

   visayanbraindoctor has kibitzed 9164 times to chessgames   [more...]
   Jun-25-17 Annie K. chessforum
visayanbraindoctor: Too late. A glittery Pentagram appeared on the wall. ‘A pre-set Folded Connection, triggered by an amulet spell,’ Lupad clinically observed. Kusgan’s combat avatars were already rushing toward the Portal. A handful of the Possessed managed to get out. Moving too rapidly ...
   Jun-23-17 twinlark chessforum (replies)
visayanbraindoctor: <twinlark: If Turkey invoke the NATO charter> As I understand it, the NATO charter can only be invoked if the NATO country is attacked in its home soil. Since the Turkish base is in a foreign country, it follows that Turkey can't invoke it. (I may be wrong though.) ...
   Jun-16-17 Altibox Norway (2017) (replies)
visayanbraindoctor: <ndg2: Congratulations to Levon, he's back to 2014 form it seems.> Aronian played fantastically well. This may be his best tournament ever. <perfidious ... It will be remembered also that, after Alekhine's purple patch of 1930-1934, until Karpov gained the title,
   Jun-16-17 visayanbraindoctor chessforum
visayanbraindoctor: 6 June 2017. 54F, whom I operated on for right falcine meningioma last 6/7/16. (Replacement of bone flap bi-frontal. 6/6/17 9:20 to 10:30 am. No BT.)
   Jun-14-17 Aronian vs Carlsen, 2017 (replies)
visayanbraindoctor: Aronian does an Aronian's immortal. Organizers should bring back the old brilliancy prizes (with corresponding cash awards). This is the most brilliant attack I have seen for this year. Aronian plays not only against Carlsen's psyche (the Wold Champion is a known pawn ...
   May-29-17 Karpov vs Kramnik, 1994
visayanbraindoctor: IMO 15. e5 is a profound positional sac. It looks as if black is quite OK after Qxe5, but White's intentions becomes clearer after he exchanges off Black's Knight on c5 with his dark square Bishop, with the maneuver 16. Re1 Qd6 17. Qd6 Bd6 18. Be3 O-O 19. Rad1 Be7 20. Bc5
   May-23-17 Eugenio Torre (replies)
visayanbraindoctor: <Nonnus: Who's that girl? She's pretty.> Thank you for the compliment. She's my niece. I wrote the syllabus. It's purpose is to give a speaking knowledge of Ilonggo and to explain its grammatical rules for teachers and non-Ilonggos, especially now that mother ...
   May-02-17 Euwe - Keres (1939/40)
visayanbraindoctor: <offramp: This one has been brought into sharp focus by a superb introduction by User: Chessical. Many thanks to him for a enlightening text.> I second that! Thank you to <Chessical>! BTW here is an interesting scenario. At that time, the World Champion chose ...
   Apr-25-17 Alekhine vs Keres, 1942
visayanbraindoctor: <Jack Kerouac: Paul was quite good, but his temperament allowed him to be dominated by the elite masters.> If I may disagree, Paul Keres was never dominated by any leading master, except for Botvinnik (and only in the 1940s upward, as he probably played stronger ...
   Apr-25-17 Kramnik vs Harikrishna, 2017 (replies)
visayanbraindoctor: Probably the most remarkable game I have seen so far in 2017. Congratulations to Kramnik for producing such a brilliant gem. It's not perfect though. Kramnik I believe lost thread of the game early on during the sequence 18. Bg5 Nc5 19. Ba2 h6 20. Bh4 g5 Some comments:
(replies) indicates a reply to the comment.

Kibitzer's Corner
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Premium Chessgames Member
  visayanbraindoctor: 14 May 2017.

52M, motorcycle fall, driver, alone. The patient not only had the usual frontal hemorrhagic contusion; he also had a right frontal lobe infarct following the anterior cerebral artery (ACA) territory. (This shows up in the CT scan as a vaguely triangular hypodense area with clear-cut borders.) He came in GCS 13, but was deteriorating.

(Right fronto- parietal craniectomy, partial right frontal lobectomy, bone transplant to left hemi-abdomen SQ layer. 5/14/17 5:05 to 6:30 am. No BT.)

I decided to remove the infarcted and severely contused portions of his right frontal lobe. There was minimal intracerebral hemorrhage.

Premium Chessgames Member
  visayanbraindoctor: 16 May 2017.

37M, motorcycle fall, driver, alone. GCS 10 (stuporous). CT scan showed a large bifrontal- right temporo- parietal hemorrhagic contusion.

The patient's sensorium was deteriorating, so I operated even near midnight.

(Right fronto- parietal- temporal craniectomy, evacuation of cerebral hemorrhage, bone transplant to left hemi-abdomen SQ layer. 5/16/17 11:01 to 11:56 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 18 May 2017.

18M, whom I operated on for left occipital epidural hematoma last 9/6/16. Case of motorcycle fall, driver, alone.

(Replacement of bone flap left occipito- parietal. 5/18/17 6:45 to 7:20 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: Mortalities:

Entry 1.

<13 May 2017.

49F, sudden loss of consciousness.CT scan showed a 50 cc right frontal intracerebral hemorrhage and right hemisphere acute subdural hematoma. Pupils 1.5 mm ESRTL.

She had already aspirated, and was running a high fever due to pneumonia. Bad prognosis, but with the family cooperative, I decided to proceed.

(Right frontal craniectomy, evacuation of acute subdural hematoma, cortisectomy, evacuation of frontal lobe hemorrhage, bone transplant to left hemi-abdomen SQ layer. 5/13/17 3:24 to 4:30 pm. No BT.)

(Tracheostomy. 3/23/17 4:38 to 4:53 pm.)>

Next day on D1, the patient was awake and followed orders. On D2, she was GCS 3. I suspect she had another stroke. She died.

Entry 2:

<11 May 2017.

68M, sudden loss of consciousness.CT scan showed a 50 cc right thalamic hemorrhage. Pupils 1.5 mm ESRTL.

I usually do not operate on these cases as the prognosis is very poor, but in this case, the patient was still localizing to pain (GCS 7). The family was also aggressive.

(Right fronto- parietal craniectomy, cortisectomy evacuation of thalamic hemorrhage, bone transplant to left hemi-abdomen SQ layer. 5/11/17 1:23 to 3 pm. No BT.)

(Tracheostomy. 3/23/17 3:25 to 3:42 pm.)

Thalamic hemorrhages are located deeply. I approached it the safest way- a frontal approach anterior to the pre-central gyrus (which is the motor cortex), I had to dig through 10 cm of cortex and white matter in order to reach it. I then proceeded to evacuate nearly all of it.

I did not have any problems during the operation. There was little bleeding. (The secret here is to cauterize all blood vessels first on the cortisectomy site, do not pull on them but instead transect them with scissors, and suction out the surrounding brain parenchyma carefully.) I hope he survives, but give his age, I am not that confident.>

Day 1 post-op, patient was awake and followed orders. On D2, he was comatose at GCS 7. CT scan showed hydrocephalus. Some of the thalamic hemorrhage had spilled into the ventricles.

In many of these cases, the HCP resolves. In this case though, the prolonged bedridden hospital stay and the patient's advanced age is a sure ticket into the pneumonia-sepsis roller coaster ride. 68M began to run a high fever and died of sepsis.

Premium Chessgames Member
  visayanbraindoctor: 20 May 2017.

23M, motorcycle fall, driver, hit by a truck. GCS 9 (stuporous). CT scan showed a bifrontal hemorrhagic contusion.

(Bi frontal craniectomy, evacuation of subdural hygromas, bone transplant to left hemi-abdomen SQ layer. 5/20/17 5:59 to 7:25 pm. BT 1 unit FWB.)

The sagittal sinus bled during the operation. I had to tack and fold dura over it in order to stop the bleeding.

Premium Chessgames Member
  Jonathan Sarfati: Sorry about the mortalities on 18 May, especially after both regained consciousnes.

I looked up HCP and could find only hereditary coproporphyria, which doesn't make sense, so I suppose hydrocephalus.

49 is young for a hemorrhage almost as large as Capablanca's. If she had another stroke, presumably bad hyperension?

Sepsis and pneumonia in hospitals is a concern. I thought they were quite antiseptic places.

Premium Chessgames Member
  visayanbraindoctor: <Jonathan Sarfati: I looked up HCP and could find only hereditary coproporphyria, which doesn't make sense, so I suppose hydrocephalus.>

Yes. It's common in thalamic hypertensive hemorrhages. The thalamus is located right next to the third ventricle, so large hemorrhages in the thalamus often rupture into the ventricular system, which then blocks proper CSF flow, causing communicating hydrocephalus. In this case, the pre-op CT scan did did not show HCP yet; it developed post-op.

<49 is young for a hemorrhage almost as large as Capablanca's. If she had another stroke, presumably bad hyperension?>

Yes. However, as with most indigent patients, they hardly consult doctors; and so the relatives don't really know.

<Sepsis and pneumonia in hospitals is a concern. I thought they were quite antiseptic places.>

Unfortunately bedridden comatose patients, especially the elderly, often get pneumonia. It's the rule, not the exception. If you can't cough up your secretions, it stays in your lungs, bronchi, and trachea, and becomes a smorgasbord for bacteria.

Premium Chessgames Member
  Jonathan Sarfati: Would such a patient routinely be measured for HTN? Capablanca was measured at 280/140 when admitted after his thalamic hemorrhage.
Premium Chessgames Member
  visayanbraindoctor: <Jonathan Sarfati: Would such a patient routinely be measured for HTN? Capablanca was measured at 280/140 when admitted after his thalamic hemorrhage.>

Yes. Capablanca would have been admitted too had he lived in our times. He was way over the criterion for a hypertensive crisis of BP = 180/110.

The most common symptom among these patients is headache. Note that Capa was often complaining of severe headaches.

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  visayanbraindoctor: <paavoh> You'll find case histories such as the above all over in medical books, scientific papers, and the internet. They all do not mention names. It's acceptable practice.

If you really want to find out the names of such patients mentioned in case histories, as far as I know you will have to go to the hospital where they got admitted with a subpoena from a judge asking for the chart.

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  visayanbraindoctor: <paavoh: if someone is willing to go through the trouble>

This is the point. No one does. If anyone really goes through the trouble, he or she should be able to get the names of the patients even in typical <textbooks and case reports>.

If you are going to argue that a reader might be able to glean the identity of a patient from the case history narrated by a doctor, then one should not narrate any case history at all, because <if someone is willing to go through the trouble> then this someone will sooner or later get the names of such patients.

To put it in anther way, a doctor narrates a case history without a date, age, or even gender (as what you seem to be suggesting). Some possessed reader decides to make it his obsession to find out the patient's name. Can he get the identity? Yes, if he is <willing to go through the trouble>. He scopes out the hospitals the narrating doctor is publicly associated with, asks around (or maybe bribes) nurses, IWs, and records personnel to give him info, and sooner or later, he will get the the id of the patient.

But why in the world would anyone want to do that?

Same with the cases I narrate above. Perhaps they give a bit more info than a typical case history, but why in the world would anyone want to know these patients' identities?

Chances that someone will read my writings above, make it his obsession to find out who my patients are, determine who I am, determine where I practice, fly all the way to my island, ride into my city, scope out the hospitals I am associated with, interview hospital personnel, etc.. are just about astronomical.

I can confidently state that no one will.

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  thegoodanarchist: I found this in your profile:

<B. In case the previous Titleholder defaults an event that the Chessworld largely deems as a World Championship event in the Tradition of the World Championship Succession. Thus, Karpov was the true successor to Fischer who defaulted their WC Match in 1975.>

It is an established fact of history that Fischer resigned his FIDE World Championship title.

He did not "default" an event, rather, he resigned his title before the event, much as Lasker resigned his title, and would only play Capablanca as "The Challenger".

However, I consider Lasker's resignation, and subsequent title "challenge", to be weirder than anything Fischer did! Just my opinion.

Anyway, I view the FIDE decision to award Karpov the title in 1975 to be reasonable. There were other options, of course, and so the decision is not outside of the realm of criticism. But also the decision *is* debatable.

Anyway, have you thought about the fact that Fischer resigned his title, and this in truth wasn't a default of an event?

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  visayanbraindoctor: <thegoodanarchist> I'm thinking of replacing the word 'default' with 'resign' or maybe use both.
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  visayanbraindoctor: 28 May 2017.

27M, hit by a motorcycle. GCS 14 deteriorated to 9 (stuporous) pre-op.

(Bi frontal craniectomy, evacuation of right frontal acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 5/28/17 6:20 to 7:42 am. No BT.)

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  visayanbraindoctor: 28 May 2017.

68M, hit by a motorcycle. The family initially did not give consent for operation. After 13 days, with the patient deteriorating with pneumonia and sepsis, they finally did, and bought OR needs.

(Left frontal craniectomy, evacuation of subdural hygroma. 5/28/17 2:09 to 2:32 pm. No BT.)

(Tracheostomy. 5/28/17 2:09 to 2:32 pm.)

I don't think he'll live, given his age and pneumonia/sepsis.

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  Jonathan Sarfati: It's instructive to post here. One lesson is head injuries probably need to be seen to quickly even if imperfectly rather than a delay to get the best neurosurgery.

In this hospital system, are antibiotics too expensive for a lot of familes, even generic ones? My local pharmacy gives prescription amoxycillin free (as with some unrelated drug lisinopril, which probably would have saved Capablanca's life had it been available, and metformin for insulin-resistance).

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  visayanbraindoctor: <Jonathan Sarfati: One lesson is head injuries probably need to be seen to quickly even if imperfectly rather than a delay to get the best neurosurgery.>

Correct! As you can see from my narrations though, in public hospitals, the usual delay is up to three days or more. (Due to late referrals, or more often, no finances for the family.) Most unecessary mortalities and morbidities in the fourth world IMO is due to this.

<In this hospital system, are antibiotics too expensive for a lot of familes, even generic ones? My local pharmacy gives prescription amoxycillin free (as with some unrelated drug lisinopril, which probably would have saved Capablanca's life had it been available, and metformin for insulin-resistance).>

Good for you! Hereabouts, poor finances are always the problem. Many families (especially those from the far-flung interior) barely even have enough money to buy fare in order to go to the hospital.

The DOH and Philhealth have a system that allows indigent patients to avail of drugs in the pharmacy of a public hospital for free. Unfortunately, most public hospitals do not have any stocks of most of the important meds. Unable to buy antibiotics from outside pharmacies, many of my patients die of sepsis.

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  visayanbraindoctor: 31 May 2017.

31M, whom I operated on for right temporal epidural hematoma last 2/28/17. Case of motorcycle fall, driver, alone.

(Replacement of bone flap right temporal. 5/31/17 9:30 to 10:13 am. No BT.)

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  visayanbraindoctor: 5 June 2017.

29M, hacked with a machete by a known assailant.

Many of these cases end up being operated upon because the weapon's sharp edge often penetrates into the skull, resulting in open depressed fractures which need to be cleaned. If there is any dural tear, it also needs to be repaired.

(Right occipital craniectomy. 6/5/17 9:48 to 10:32 am. No BT.)

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  visayanbraindoctor: 10 June 2017.

28M, motorcycle fall, driver, hit by a private vehicle 6 days ago. The patient remained drowsy, and so I suspected that his acute subdural hematoma was transforming into a chronic one.

(Right parieto- frontal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 6/10/17 9:15 to 10:12 pm. No BT.)

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  visayanbraindoctor: 11 June 2017.

52F, sudden decrease in sensorium. CT scan showed a midbrain right thalamic hemorrhage, a hypertensive bleed. There also was associated obstructive hydrocephalus, because the bleed was pushing against the aqueduct of Sylvius and third ventricle.

I decided to do a decompression craniectomy and to attempt a tube ventriculostomy.

(Right frontal craniectomy, bone transplant to left hemi-abdomen SQ layer. 6/11/17 2:25 to 3:23 pm. No BT.)

Unfortunately, I could not hit the frontal horn of the right ventricle. I deduced that it has probably collapsed because of the pressure exerted by the hemorrhage. Instead, I got some old dark blood clots on the tip of the tube I inserted. (I use Foley catheters because there are no available silastic tubings in my setting.)

I surmised that I had probably hit the blood clot itself. Since the brain collapsed to below the inner table (which meant that I had decompressed the brain), I decided to abort the procedure.

I do not like this development. Doing tube ventriculostomies on these hemorrhages can be dangerous because the blood clot skews the normal anatomy, and i am doing the procedure blind. (I aim through the intersection of the planes demarcated by the nose or medial canthus and the ear, and insert the tube 6 cm deep.) I could have done more harm than good by damaging some important brain structure, or even by dislodging a clot which was exerting tamponade on a vessel that's about to bleed again.

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  visayanbraindoctor: 12 June 2017.

16M, motorcycle fall, driver, by himself, drunk while driving. Comatose and anisocoric upon arrival in a private hospital, so I intubated him. The family had no money for a private admission, so I transferred him to the public city hospital. Then the family was delayed in buying necessary OR needs. It was only after more than 24 hours that I finally got to operate on him.

(Left frontal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 6/12/17 9:59 to 10:49 pm.)

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  Jonathan Sarfati: <visayanbraindoctor>, how would you treat someone with a minor stroke but a crisis-level BP, say 190/130? Is there a drug of choice to bring this down safely and quickly?
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  visayanbraindoctor: <Jonathan Sarfati: <visayanbraindoctor>, how would you treat someone with a minor stroke but a crisis-level BP, say 190/130? Is there a drug of choice to bring this down safely and quickly?>

In my setting internists (and me as well) usually give IV Nicardipine drip.

Sometimes in my setting, this isn't available. If there is any Hydralazine (Apresoline) amp, I give it IV.

In case you're away from the hospital with no way to insert an IV line, you could give Nifedipine sublingual.

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  visayanbraindoctor: 6 June 2017.

54F, whom I operated on for right falcine meningioma last 6/7/16.

(Replacement of bone flap bi-frontal. 6/6/17 9:20 to 10:30 am. No BT.)

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