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visayanbraindoctor
Member since Jun-04-08 · Last seen Dec-19-14
Good Day to All! Ma-ayong adlaw sa tanan. And my thanks to CG.com for this excellent website. Salamat CG.com. 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 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.

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?

IMO 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. Peak Capablanca probably would have the best score among humans. Talk about another level of playing is fans' subjective and IMO wrong words for their favorite players, unless one talks about chess computers. Chess computers do play at a higher level.

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. Lasker provides a classic example; he was beating Mieses, Blackburne, and Steinitz in the 1890s, and crushing masters versed in the hyper-modern teaching of controlling the center indirectly- Reti, Bogolyubov, and Euwe in the 1920s. In more recent times, we have Victor the Terrible, who learned most of his chess in the 1940s and 1950s, whom we have seen competing successfully with the so-called computer generation even at an advanced age.

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 2014, 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 and Capablanca 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.

Instead, it is the frequencies of a few middlegame pawn structures 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 a smoking gun, bomb proof evidence of the fallacy of Watson's speculation that pre-WW2 masters would not be able to learn 'modern' chess, and Larsen's assertion that he would crush everyone in the 1930s. The glaring fact is that Keres is a 1930s pre-WW2 master whose career extended 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). Tellingly enough Keres beat both Watson and Larsen.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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!

12. 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.)

---

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. There can be a certain amount of disinformation and propaganda in the messages that are retained.

The title of this <'multi-experimental' forum> is:

Biased Journal of a Fourth World Brain Operator

Some abbreviations

CiH = the public City Hospital

PrvH = Private Hospital. There are three main ones. So PrvH 1, PrvH 2, PrvH 3.

ProvH = the public Provincial Hospital

SOL = Space Occupying Lesion

SQ = Subcutaneous tissue layer of the skin or scalp

CVA = Cerebrovascular accident = stroke

EDH = Epidural Hematoma, blood above the dura mater, the outer covering of the brain, and beneath the skull.

SDH = Subdural Hematoma, blood beneath the dura mater.

ASDH = Acute Subdural Hematoma, SDH incurred recently, usually less than a week

CSDH = Chronic Subdural Hematoma, SDH that is more than two weeks old

HCP = Hydrocephalus, too much CSF in the brain's ventricular system

CSF = Cerebrospinal Fluid

CNS = Central Nervous System

CAB = Continuous ambubagging

ETT = Endotracheal tube (for airway purposes)

NGT = Nasogastric tube (for feeding purposes)

NOD = Nurse on duty

The Oracle = personification of the CT (computed tomography) scan.

Magic mirror = the computer monitor where one can see CT scan images.

Witching Hour Admissions or Referrals = 12 midnight to 5am

MF = Motorcycle Fall

Craniectomy = neurosurgical procedure that involves removing a portion of the skull

Tracheostomy = a surgical procedure to create an opening through the neck into the trachea (windpipe)

INTUBATE: To put a tube in, commonly used to refer to the insertion of a breathing tube into the trachea for mechanical ventilation

EXTUBATION: the removal of a tube especially from the larynx after intubation—called also detubation.

Uneventful day = Most likely still a busy day, making daily rounds in the hospitals, following up post-op patients, seeing patients in the OPD, answering referrals, admitting all kinds of patients in the hospitals; nevertheless a day in which nothing interesting has caught my attention.

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

Chessgames.com Full Member

   visayanbraindoctor has kibitzed 6884 times to chessgames   [more...]
   Dec-19-14 twinlark chessforum (replies)
 
...
 
   Dec-18-14 World Chess Championship Candidates (2014) (replies)
 
visayanbraindoctor: <Petrosianic: Yes, but winning by Sonnenborn would hav been as bad as winning on some other tiebreak. There was a time when tiebreaking systems weren't considered good enough to even determine interzonal spots much less a challenger.> I agree. No tiebreaking system ...
 
   Dec-16-14 London Chess Classic (2014) (replies)
 
visayanbraindoctor: <coolconundrum: So only 33% of this tourney was in the Berlin Wall... not bad!> Nakamura vs A Giri, 2014 Caruana vs A Giri, 2014 Caruana vs Nakamura, 2014 Adams vs Kramnik, 2014 Adams vs Anand, 2014 Yes 5 out of 15 games. Caruana only had two whites and ...
 
   Dec-15-14 visayanbraindoctor chessforum
 
visayanbraindoctor: <SugarDom: Samboy Lim's heart stopped beating for 23 minutes and the brain did not received oxygen for about this long too. I think it's a miracle, he's not brain dead yet.> Since his pupils are reacting, and he apparently has spontaneous respiratory effort, he ...
 
   Dec-15-14 Nakamura vs Adams, 2014
 
visayanbraindoctor: <Ulhumbrus: The commentators pointed out that with his isolated e pawn the rook and pawn ending might have been lost for Black even if he had had an a pawn in addition as in the famous game Karpov vs Hort, 1979 which appeared in Informator as well as in one of Karpov's
 
   Dec-14-14 Anish Giri (replies)
 
visayanbraindoctor: Giri has upped his game recently. He nearly won Qatar open, and was joint winner in London. His recent games show good opening preparation, fine middlegame tactics, good endgame technique, and a willingness to fight it out for the full point. Looking forward to his ...
 
   Dec-14-14 A Giri vs Kramnik, 2014 (replies)
 
visayanbraindoctor: Giri just killed Adams A Giri vs Adams, 2014 with a well played Catalan in a previous round. And he probably wanted to avenge A Giri vs Kramnik, 2014 and Kramnik vs A Giri, 2014 (which isn't strictly a Catalan but was played by Kramnik like one.) I think he and Kramnik ...
 
   Dec-14-14 Savorin Cup (1913)
 
visayanbraindoctor: Capablanca rampages through the mini matches with a 5/6 score, and yet does not get the winner's trophy? Nor the <stakes' side-pot>? I hope the sponsor Monsieur Savorin gave him some kind of appearance fee. In any case, even if he did not receive much monetary ...
 
   Dec-12-14 Kramnik vs A Mista, 2014 (replies)
 
visayanbraindoctor: Kramnik handled the attack well when GM Mista gave him the opportunity. 22. d5 is a fine blocking move, that sequesters most of Black's pieces in the Queenside, and preserves his light colored bishop for the Kingside. Few comments on Kramnik's well played attack. Yet had ...
 
   Dec-12-14 Vladimir Kramnik (replies)
 
visayanbraindoctor: Kramnik, by refusing to play in the Grand Prix, may have has cast his lot in the next World Cup for a possible Candidates qualification. Very chancy. Most probably he won't win it again. Is he hoping for a wild card, if Russia hosts the next Candidates? Then he would be ...
 
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Kibitzer's Corner
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Nov-23-14  LarsenBentYou: Do you have an account on Figure1?
Nov-24-14
Premium Chessgames Member
  visayanbraindoctor: <LarsenBentYou: Do you have an account on Figure1?>

No. This journal is just an experiment. I try to keep the stories here true to life, although I can't possibly tell all of them.

Nov-24-14
Premium Chessgames Member
  visayanbraindoctor: 24 November 2014. Entry 1. In the late afternoon. I did a craniectomy and evacuation of a left hemisphere acute subdural hematoma on 72M, a MF victim. This septuagenarian has a history of drinking and riding motorcycles, and this time it nearly did him in.

He came in yesterday in PrH1 ER drowsy, but his operation was delayed because the family could not pay the required hospital cash advance. This is a common practice among private hospitals, in order to protect their business interests. Perhaps 90% of families easily go bankrupt over private hospital expenses for critically ill relatives; and once that happens they may end up racking debts up to several hundreds of thousand of pesos, which they can never pay to the hospital. A private hospital would quickly go bankrupt. It's why I have to transfer most patients to the public hospital for brain operations. There is even more delay of course. Who is to blame? No one specifically, since it's the whole societal system that creates massive poverty in peripheral areas that is the root cause. Unfortunately changing fundamental societal structures means going into politics, a genre dirtier than an operating field on which a fly from a trash can has landed in.

In any case, 72M was already stuporous when I got him inside the OR. After removing the ASDH on the left, I was also planning to remove a subdural hygroma on the right hemisphere through a Burr hole. It turned out that he was a bleeder, quite common for chronic drinkers. So I did not proceed with the second operation. I am planning to repeat the CT scan on an OPD basis, if he survives, in order to see what would become of the hygroma. Managing the elderly is always difficult because they tend to die of complications.

Nov-25-14  SugarDom: How's 61m?
Nov-26-14
Premium Chessgames Member
  visayanbraindoctor: <SugarDom: How's 61m?> Still alive.
Nov-27-14  SugarDom: Well that's a surprise, considering he's got multiple injuries not just brain injury.
Nov-29-14  SugarDom: https://ph.news.yahoo.com/cricketer...

SYDNEY (AP) — Australian cricketer Phillip Hughes died Thursday from a "catastrophic" injury to his head, two days after being struck by a delivery during a match.

Australia captain Michael Clarke, trying to compose himself several times, read a brief statement on behalf of Hughes' parents, brother and sister at a news conference at St. Vincent's Hospital that was broadcast live around Australia.

"We're devastated by the loss of our much-loved son and brother Phillip. Cricket was Phillip's life, and we as a family shared that love of the game with him ... We love you," Clarke read, holding back tears before leaving the room.

Hughes was wearing a helmet Tuesday when he was hit after attempting to hook a short-pitch ball from New South Wales fast bowler Sean Abbott.

Dr. Tony Grabs, a surgeon and director of trauma services who treated Hughes at St. Vincent's, said the 25-year-old cricketer had died from a rare injury — there have been only 100 documented cases of vertebral artery dissection — which resulted in severe bleeding on his brain.

Nov-30-14
Premium Chessgames Member
  visayanbraindoctor: 30 November 2014 Entry 1.

<25 October 2014. Entry 1. I did a tracheostomy on 26M. Four days ago he fell off a motorcycle in a neighboring province. Next day he arrived in PrH 1 ER, where I intubated him and then transferred him to the public CiH for financial reasons. He has remained comatose (GCS 6 to 7) the past 3 days, yet his CT scan just shows a small bifrontal subdural hygroma.

When a patient's brain is anatomically almost normal and he has a patent airway, yet remains comatose, it usually means he has a diffuse axonal injury. It's a condition in which the axons are disrupted and so the neurons fail to communicate with each other. The CT scan sometimes shows hemorrhages in the midbrain and corpus callosum, but may be normal. 26M will take at least two weeks to properly wake up, if he doesn't fall off the pneumonia-sepsis roller coaster ride first.>

26M never regained self-awareness, although after about a month, he began exhibiting regular sleep-wake cycles. He would wake up, eyes open, then fall asleep again, without ever indicating that he recognized peple or even himself. I had removed his tracheostomy tube 2 weeks ago, but then his pneumonia came back. His parents were now financially exhausted. I told the father yesterday that his son was in a persistent vegetative state, and that he would sooner or later die of pneumonia and sepsis. He did just that this morning.

Entry 2. I removed a 40 cc right basal ganglia hemorrhage from 43M, a deteriorating GCS 7 stroke patient, through a small craniectomy and cortisectomy through the frontal lobe. It was pretty deep and I had to tunnel through about 8cm of brain, but I have been doing this kind of surgery through the frontal lobe instead through the more usual temporal lobe for the reason that there are less critical structures that one can hit in the more 'silent' frontal lobe. As usual I did not even have to transfuse blood and I finished in slightly just over an hour.

The public CiH does not have a bipolar cautery cord, and I have to do everything with a monopolar. This means that I would have great difficulties cauterizing a brain artery should I get to hit one. Which means I have to make damn sure that I would not hit an artery in the first place.

Later I buried the bone in his left hemiabdomen subcutaneous layer and did a tracheostomy on him. If he survives, he will be comatose for at least two weeks and will inevitably catch pneumonia.

Nov-30-14
Premium Chessgames Member
  visayanbraindoctor: <Dr. Tony Grabs, a surgeon and director of trauma services who treated Hughes at St. Vincent's, said the 25-year-old cricketer had died from a rare injury — there have been only 100 documented cases of vertebral artery dissection>

The two vertebral arteries are well protected. It's the basis for the posterior circulation of the brain and located under the thick occipital bone and nuchal muscles. He probably had a pre-existing condition, that could have been aggravated by the trauma.

BTW FPJ died of a a pontine infarct from what I have read, and the pons is supplied by the vertebral and basilar arteries. Since it supplies the brainstem (medulla, pons) if a verterbal artery gets occluded or bleeds, the effects are often catastrophic.

Nov-30-14
Premium Chessgames Member
  Annie K.: 'Grabs' is a great name for a surgeon, though. ;s
Dec-01-14  Ulhumbrus: <...3. The strongest chess players in chess history?

IMO 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...>

How about Paul Morphy?

Dec-01-14
Premium Chessgames Member
  visayanbraindoctor: <How about Paul Morphy?> Potentially he could have been. Morphy was said to be capable of memorizing dozens of law books (and he would do the same for opening variations if he were born later), saw through combinations and tactics 'instinctive' fast, and could evaluate positional advantages in a like manner. Unfortunately I can't evaluate him properly because competitive conditions during his era was not standardized. Same is true for most of the early Steinitzian era. It was Lasker among the great masters that played all his life under relatively stable 'standard' competitive conditions. The key I believe was the introduction of the chess clock in the London 1883 tournament.

According to computer analysis by Bridgeburner which are posted in the game pages, in the 1910 Lasker vs Schlecter WC match, both players were playing at a similar level of accuracy as the more recent Kasparov vs Kramnik and Kramnik vs Anand WC matches. This actually came as a mild surprise to me at that time. We are biased because of the 'narcissistic generation syndrome' (my term), and so the key to analyzing these games is to imagine that they were played just yesterday. Then all the drama, tension, and awesomeness of their play comes to life, every bit as real as say the Kasparov vs Kramnik 2000 WC match.

I see Capablanca, Lasker's successor World Champion, making less losing errors than any other other master, past or present.

These tell me that sometime during the Lasker era, human chess playing ability in the middlegame and endgame hit the stonewall defined by the limits of the human brain's chessic capacity. The very top masters of each generation has since then played near this limit. There were eras marked by dominant chess geniuses and eras inhabited by first among equals. There were eras where there were relatively few top master events. There were eras where there were smaller and larger pools of chess professionals (notably in the Soviet era where the Eastern European states financed thousands of chess professionals). In any era however, the very top masters all played near this limit.

Chess can be played at a significantly higher (more accurate) level, but only by computers.

Dec-03-14
Premium Chessgames Member
  visayanbraindoctor: 3 November 2014. Entry 1. I debrided and sutured multiple facial lacerations on 6M, a child that got hit by a tricycle. I decided to do it in the ward in CiH under local anesthesia because it's too much hassle to schedule it in a public hospital's OR, which nearly always has a packed schedule. Suturing wounds on children under LA can be difficult because they don't understand what's going on and they always cry and resist. I sedated him with Diazepam first and had a male nurse hold his head down. Fortunately, after initially crying a bit, he dozed off for most of the procedure.
Dec-05-14
Premium Chessgames Member
  visayanbraindoctor: 5 December 2014. Entry 1. < 23 November 2014. I did bifrontal craniectomies on 61M, a pedestrian who got hit by a motorcycle a week ago. He incurred significant bihemisphere subdural hygromas. This is CSF fluid that accumulates in the subdural space due to a traumatic tear in the underlying arachnoid layer. A ball valve mechanism prevents the fluid from returning into the subarachnoid space, from where it is normally absorbed. 61M has remained drowsy to stuporous since then, and I finally decided it would help if the pressure effects from his subdural hygromas were alleviated.

I began the craniectomies simultaneously with an Orthopedic Surgeon. He was operating on 61M's left shin, which had incurred an open tibia-fibula fracture. Such simultaneous operations can be done in this case because the leg is located far from the head. I would usually not consent to a simultaneous operation on an arm because it would interferes with my operating field. The Ortho did an external pinning procedure. By doing two operations at the same time, we save on Anesthetic gas, which often runs out in the public CiH.>

61M has completely awoken and is ready for discharge.

<24 November 2014. Entry 1. In the late afternoon. I did a craniectomy and evacuation of a left hemisphere acute subdural hematoma on 72M, a MF victim. This septuagenarian has a history of drinking and riding motorcycles, and this time it nearly did him in.>

72M went home this afternoon. He still suffers from urinary bladder retention, and so I discharged him with a Foley catheter still inserted. This sometimes occurs in Neuro patients, especially the elderly. I gave instructions to his family on bladder training. They clamp the catheter with a hemostat for four hours, and then release for 5 minutes in order to allow the bladder to drain off accumulated urine, like taking a pee every four hours in layman's terms.

Other deficits: 72M still has not fully regained the use of his legs, and so had to be wheeled out on a wheelchair.

72M also exhibits signs of receptive aphasia. He can't comprehend normally. (A sign that something is wrong with his Wernicke's area, the area for comprehension located in the gyri posterior to the left temporal fissure.) He keeps on talking but since he doesn't understand what he says, he keeps on saying nonsensical sentences.

Dec-05-14
Premium Chessgames Member
  WannaBe: I guess we also have a few CG.com member that have something wrong with their Wernicke's area.
Dec-12-14
Premium Chessgames Member
  visayanbraindoctor: 8 December 2014. Entry 1. I saw two critical patients in CiH ward this morning, both motorcycle fall victims. 39F was already brain dead and beyond help (she had a huge left hemisphere acute subdural hematoma from a burst temporal lobe). 35M was still localizing to pain (GCS 7), although severely aspirated. I can still do something for such patients, and I immediately intubated him. Having stabilized his condition, I then scheduled him for a craniectomy and evacuation of right hemisphere acute subdural hematoma and tracheostomy, as soon as his family would be able to secure OR needs. They did not that day, but I was expecting that he would make it until the morrow, as I had already secured his airway (having intubated him). To my chagrin, the night shift charge nurse informed me later in the night that 35M was on CP arrest. Another mucus plug mortality, I suspect. Instead of furiously berating the NOD, I just requested her that she and the other ward nurses should request the ICU nurses to teach them how to suction intubated patients properly.
Dec-12-14
Premium Chessgames Member
  visayanbraindoctor: 12 December 2014. Entry 1. I operated on 42F in the morning in CiH. She has a left temporal brain tumor (probably an astrocytoma or a metastasis) which had already caused a subfalcial herniation of her cingulate gyrus underneath the falx. In other words, a part of her left brain had been pushed into her right brain. Dexamethasone (a steroid which theoretically helps prevent vasogenic edema caused by brain tumors) and Mannitol (an osmotic diuretic that shrinks normal brain) had temporarily stopped the intracranial pressure from increasing for nearly a week. She exhibits sleep wake cycles, but is aphasic and has right hemiparesis (can't comprehend, talk, nor move her right extremities) This condition would likely continue even after an operation, and so the aim of my planned operation is merely to prolong her life by preventing the brain from getting squashed by the tumor and its edematous effects on the surrounding brain.

I told her husband, daughter, and siblings beforehand that I may not be able to remove all of the tumor because it is deeply located and because the CT scan shows that it isn't well differentiated from adjacent normal brain. That assessment is precisely what I met when I opened her up. I did a cortisectomy on the left superior temporal gyrus and began digging in, carefully suctioning out some of the underlying white matter. I had to cauterize two arteries with a monopolar cautery, not an easy task (the public CiH has no bipolar). The arteries tend to stick to the monopolar pen tip, and instead of effecting hemostasis you get a torn artery which bleeds further. About 6cm down, I began to encounter what seemed to me to be the tumor, but I could not clearly distinguish its border visually from normal brain.

In my old training days, I know I would have tried to do further resection of the tumor. Bitter experience has taught me that it does not matter if you remove more or less of such a spread-out cancerous growth. The cancer always recurs, although you are supposed to debulk it so that any future radiotherapy can be more helpful. I already knew the family had no plans for further intervention because of dire financial conditions. I should just stick to my hoped-for treatment outcome, to prolong the patient's life. Time to stop. I went out and informed the family I could not differentiate the tumor's boundaries from normal brain, and with the tumor located very deeply (adjacent to the basal ganglia and thalamus), I would be risking a table death if I were to be more adventurous. I told them I would not return the craniectomized skull bone (parts of the temporal, parietal, and frontal bones) in order to afford more space for the brain to expand. Then I went back to the OR, expanded the craniectomy by sawing off more bone, and closed up. The patient now has a huge skull defect on her left, but this should prolong her life for a few more months (if she does not die of pneumonia first, which is also common in bedridden patients). Her acute problem was a herniating brain, and to this I have given the only possible solution under local conditions.

My anesthesiologist made a remark, which I agreed with. Let's just try to make sure she survives to Christmas. Her personality and self awareness are already gone- unable to comprehend, talk, recognize her relatives and her own existence. But her family would appreciate it, seeing her still alive in December.

Dec-13-14  SugarDom: <61M has completely awoken and is ready for discharge.>

Due to the advanced age and extent of injuries, i didnt expect him to live along with 72m. Congrats?

Dec-13-14
Premium Chessgames Member
  visayanbraindoctor: 13 December 2014. Entry 1. Monitoring in public hospitals can get pretty sloppy at times. The NODs sometimes only become aware that there is a problem when a relative goes up to the nurses station telling them that their patient isn't breathing anymore.

I went on rounds in the morning and 42F, whom I had operated on yesterday was awake (although still aphasic and paralyzed on her right). Even pre-op, she already had difficulty in swallowing, a consequence of her large brain tumor. I inserted an NGT for feeding purposes and medications.

I told the family that I was hoping that she could get discharged in a week, but informed them that large spread-out brain cancers really don't have a cure and she isn't expected to last more than a year.

Around 9pm, the NOD texted me that 42F's pulse oximeter indicated O2 saturation at 20%. In other words, oxygen was not getting into her bloodstream. I told the NOD that 42F had aspirated, and to call a physician on duty in the hospital for help. Too late. A few minutes later, the physician on duty pronounced 42F dead.

Dec-13-14
Premium Chessgames Member
  visayanbraindoctor: <WannaBe: I guess we also have a few CG.com member that have something wrong with their Wernicke's area.>

(",) (",) (",)

<SugarDom: <61M has completely awoken and is ready for discharge.>

Due to the advanced age and extent of injuries, i didnt expect him to live along with 72m. Congrats>

Thanks.

Dec-13-14  SugarDom: The case of 42F is unfortunate. I guess the tumor was not detected early enough by the patient. Was this the case? Or are there screening tests for these?
Dec-15-14
Premium Chessgames Member
  visayanbraindoctor: 15 December 2014.

Entry 1.

<25 October 2014. Entry 2. I removed a 40 cc right basal ganglia hemorrhage from 43M, a deteriorating GCS 7 stroke patient, through a small craniectomy and cortisectomy through the frontal lobe. It was pretty deep and I had to tunnel through about 8cm of brain, but I have been doing this kind of surgery through the frontal lobe instead through the more usual temporal lobe for the reason that there are less critical structures that one can hit in the more 'silent' frontal lobe. As usual I did not even have to transfuse blood and I finished in slightly just over an hour.

The public CiH does not have a bipolar cautery cord, and I have to do everything with a monopolar. This means that I would have great difficulties cauterizing a brain artery should I get to hit one. Which means I have to make damn sure that I would not hit an artery in the first place.

Later I buried the bone in his left hemiabdomen subcutaneous layer and did a tracheostomy on him.>

Two days ago, I removed 43M's tracheostomy tube, as he was now mostly awake and the secretions had from yellowish (a sign of infection) to whitish. Yesterday and this morning, he was still awake and breathing comfortably and normally through his nose. I told his wife the good news that he would probably live, although with left sided hemiparesis.

Entry 2.

<10 November 2014. Entry 2. I did an emergency tracheostomy on 68F right after finishing with 23F. 68F is a case of a hemorrhagic stroke on the right basal ganglia (60% of hypertensive brain hemorrhages occur in the basal ganglia), but it's small enough that it does not require an evacuation.>

This morning I also removed the tracheostomy tube of 68F. She was able to tolerate it afterward.

Dec-15-14
Premium Chessgames Member
  visayanbraindoctor: <SugarDom: The case of 42F is unfortunate. I guess the tumor was not detected early enough by the patient. Was this the case? Or are there screening tests for these?> In rural areas, the usual habit of patients and their relatives is to seek consult only when their ailment becomes intolerable. The family had no choice but to have her admitted because she had stopped talking and walking. I am pretty sure she had been symptomatic for months.
Dec-15-14  SugarDom: http://www.philstar.com/sports/2014...

Samboy Lim's heart stopped beating for 23 minutes and the brain did not received oxygen for about this long too. I think it's a miracle, he's not brain dead yet.

Dec-15-14
Premium Chessgames Member
  visayanbraindoctor: <SugarDom: Samboy Lim's heart stopped beating for 23 minutes and the brain did not received oxygen for about this long too. I think it's a miracle, he's not brain dead yet.>

Since his pupils are reacting, and he apparently has spontaneous respiratory effort, he definitely isn't brain dead. It does not mean that he would not go into a persistent vegetative state, in which case his mind and self awareness will never return..

I seriously doubt that he wasn't breathing for more than 20 minutes. He would be brain dead by then or just DOA. In literature, I have read of possible rare cases wherein people fall into a frozen river and the brain goes without oxygen for more than 5 minutes and survive relatively unaffected, but in these cases the patient was subjected to hypothermia.

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