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Member since Jun-04-08 · Last seen Apr-30-16
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 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.

This 'inter generational knowledge/theory leveling phenomenon' holds true today and will probably still hold true two decades from now. As of the end of 2015, Kramnik, Anand and Topalov, and a couple of 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. 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.

EBRTL: Equally briskly reactive to light.

SRTL: Slowly or sluggishly reactive to light.

NRTL: Non reactive to light.

NSS: Normal Saline Solution

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. Full Member

   visayanbraindoctor has kibitzed 8104 times to chessgames   [more...]
   Apr-30-16 Annie K. chessforum (replies)
visayanbraindoctor: ‘According to those two GROs I was talking with, they’re imported Alogostanis by the way, he’s a frequent customer of the hotel karaoke club. They say he can get pretty bossy. They also say that one of their friends disappeared after a night with him; no one ever found ...
   Apr-30-16 visayanbraindoctor chessforum
visayanbraindoctor: 30 April 2016. I returned the skull bone of 15F, whom I had previously operated on 7/17/15 for a left hemisphere ASDH. (Replacement of bone left parieto- temporo- frontal. 4/30/16 1:01 to 1:39 pm. No BT.)
   Apr-26-16 twinlark chessforum (replies)
visayanbraindoctor: <twinlark: <visayanbraindoctor> I've been staying away from your forum and any comments about your story until I've finished reading it, as I don't want to be influenced by anyone else's comments.> I've started posting some revised chapters in Annie's forum.
(replies) indicates a reply to the comment.

Kibitzer's Corner
< Earlier Kibitzing  · PAGE 44 OF 44 ·  Later Kibitzing>
Premium Chessgames Member
  twinlark: <visayanbraindoctor>

Good to have you back and looking forward to catching up with events.

What a sad litany of events at the hospital in the previous few posts.

Premium Chessgames Member
  visayanbraindoctor: 11 April 2016.

31M, shot himself on the right temple. Fortunately, the bullet entered the lateral part of the frontal bone and came out of the medial superior part of the bone, traversing only through about 20cm of the frontal lobe. There was gunpowder burn marks on the point of entry. It was a through and through injury, and so the bullet was not in his head anymore.

(Right frontal craniectomy, evacuation of hemorrhagic contusion and bone fragments, repair of dura with periosteum, bone transplant to left hemi-abdomen SQ layer. 4/11/16 12:41 to 2:11 pm. 1 Unit pre-op BT.)

Apr-12-16  GreenLantern: <visayanbraindoctor> Have you seen this:

I think you will like it because of your interest in historical strength of top chess players. The video is entertaining, and maybe a topic for discussion ;-)

Premium Chessgames Member
  visayanbraindoctor: <GreenLantern> Thanks, I'll take a look at it.
Premium Chessgames Member
  visayanbraindoctor: 14 April 2016.

35M, motorcycle fall, driver, by himself. He was anisocoric pre-op, comatose at GCS 7. Bad prognosis.

(Left temporo- parieto-temporal craniectomy, evacuation of ASDH, bone transplant to left hemi-abdomen SQ layer. 4/14/16 2:05 pm to 2:40 pm. No BT.)

(Tracheostomy 4/14/16 2:47 pm to 2:58 pm.)

Premium Chessgames Member
  visayanbraindoctor: 15 April 2016.

Entry 1.

Just past the witching hour, I was on my way to PrH1 operate on 68M, a deteriorating case of CSDH, when I received a call that 35M whom I operated on 4/14, was severely tachypneic. I found out that he had crepitations all over the neck and chest (more on the left). I suspect that something went wrong with my tracheostomy. It's possible that a laceration occurred on the trachea or left bronchus when I inserted the trach tube, allowing air to leak into the lung cavity. 35M is a very short necked and fat individual, and thus the trach tube was inserted low. The result is a pneumothorax. All the staff surgeons were out of town attending some convention, and so I had to do the emergency procedure myself in a hurry.

(Bilateral Tube Thoracostomy 4/15/16 5:05 am to 5:25 am.)

Entry 2.

68M was already in the OR when I did the bilateral chest tube procedure on 35M. He had in fact just been intubated by the Anesthesiologist. He had a month history of headache, and then rapidly became comatose in the last two days, GCS 7. I immediately did him after 35M.

(Right teft temporo- parietal craniectomy, evacuation of CSDH, bone transplant to left hemi-abdomen SQ layer. 4/15/16 5:30 to 6:10 am. No BT.)

Premium Chessgames Member
  Jonathan Sarfati: <GreenLantern> the video backs up Capa's own assessment of his peak in late 1919 after the Kostic match. Although it claims that Capa's peak rating of 2870 occurred in August of that year while that match was played in March–April. Capablanca - Kostic (1919)

Alekhine is rated as #1 again in 1943 although Botvinnik before that. After the war, Najdorf was #2 behind Botvinnik, which confirms that it was a travesty that he was not invited to the World Championship tourney of 1948 FIDE World Championship Tournament (1948)

Fischer, Karpov, Kasparov, and Carlsen are as dominant as would be expected.

Apr-16-16  GreenLantern: <Jonathan Sarfati> Thanks for your comments. I think the video and article leading to it present interesting talking points on assessing player strengths throughout the years in general and to specifics as you have pointed out. I also see insights into ELO inflation.
Premium Chessgames Member
  Jonathan Sarfati: <GreenLantern>, thank you for posting that page.

As I am interested in the game of go/weichi/baduk as well, although not to the same degree as chess, it was interesting to see the similar video go players. However, this was only players since 1974, so it didn't include the great Go Seigen who totally dominated the mid 20th century, and Honinbo Shuei who was at least a stone stronger than any rival around the turn of the 20th century.

Premium Chessgames Member
  visayanbraindoctor: <Jonathan Sarfati: Alekhine is rated as #1 again in 1943>

I already am of the opinion that Alekhine was the best chess player in the world in the years 1942-1943. This is based on his games from this time period that I have replayed.

<the video backs up Capa's own assessment of his peak in late 1919 after the Kostic match.>

If any human deserves the adjective 'chess perfection', it was this Capablanca. The accuracy of his games then, even in complicated bizarre positions, defies belief. Until now, there are silly posters who keep saying that Capablanca would only be a 2600 player today. I believe that these people haven't really studded and understood his games; or simply suffer from a mental block, the narcissistic generation syndrome, and automatically assume everything in the here and now is better than in the past.

Premium Chessgames Member
  visayanbraindoctor: 16 April 2016.

<15 April 2016.

Entry 1.

Just past the witching hour, I was on my way to PrH1 operate on 68M, a deteriorating case of CSDH>

68M remained anisocoric after all his operations. He died this morning.

Premium Chessgames Member
  visayanbraindoctor: 18 April 2016.

Four hours after arriving from the airport (I went out of town to attend my cousin's funeral), I was back in the OR again, operation on 75M, a case of bihemisphere chronic subdural hematomas. He's awake post-op.

(Left fronto- parietal craniectomy and right frontal craniectomy, evacuation of CSDHs, bone transplant to left hemi-abdomen SQ layer. 4/18/16 5:30 to 6:45 pm. 1 unit BT started pre-op.)

Premium Chessgames Member
  visayanbraindoctor: 19 April 2016.

<4 February 2016.

One of those cases that makes me (temporarily) think of quitting my job.

Young 13M has a one month history of progressive headache and drowsiness. When I first saw him 5 days ago he was stuporous at GCS 9. CT scan showed a deeply located medial to left frontal brain tumor that also impinges on the ventricle, thus causing hydrocephalus. I placed him on Mannitol and Dexamethasone (a steroid that lessens the vasogenic brain edema caused by tumors). He woke up in a couple of days (GCS 15). I then transferred him to the public CiH for financial reasons.

(Bi fronto-parietal craniectomy, right frontal tube ventriculostomy and CSF drainage, bone transplant to left hemi-abdomen SQ layer. 2/4/16 10:54 am to 1 pm. BT 2 units FWB.)

Since I had decided to remove parts of both fronto parietal bones for decompression. I knew I had to cross the midline where the sagittal sinus is located. This is the major drainage vein for the cerebral hemispheres and is located on the midline just beneath the bone, running antero posteriorly where it joins the torcula of Herophili. Any operation that removes bone on the midline always carries the risk of heavy bleeding from the sagittal sinus and the adjacent venous lakes.

Thus pre-op, I had two units of fresh whole blood properly typed and cross matched prepared and standing by in the hospital blood bank.

My Anesthesiologist requested for the blood to be brought shortly after I began cutting. The OR nurse called up the ward nurse two times. By the time I lifted the bone from the sagittal sinus, there was still no blood. Profuse bleeding had already begun.

Then my Anesthesiologist announced: "The O2 sat is dropping."

Another call to the ward nurses: "Hurry up with the blood."

Still no blood.

Anesthesiologist: "Pulse oximeter says there is no 02 sat."

Then: "I can't detect any BP anymore."

I quickly placed absorbable hemostatic gel sponge and OS on top of the sagittal sinus and temporarily closed the scalp with towel clips in order to tamponade the bleeding.

In the panicky haze that ensued, the OR nurses kept calling the ward nurses to deliver the blood. My Anesthesiologist gave several ampules of epinephrine just to keep the heart beating. I had 500cc of Voluven (a synthetic colloid used in plasma volume replacement) fast dripped into the patient. One of the ward nurses finally went to the hospital blood bank to get one unit. I had it transfused ASAP. I went out and called in the ward nurses - Why were they sitting on the order to bring in blood? Another one went to get the second unit. When I went back inside the OR, CPR was being done on the patient.

I thought- It's over. An unnecessary table death. Just because the prepared blood already sitting in the hospital blood bank could not be brought up to the OR in time.

I went out into the OR corridor again and asked the assembled ward nurses: Who was receiving the calls from the OR and why were they sitting on the order. No clear answer. I went back to the OR.

To my relief, the Anesthesiologist tells me that O2 sat was back to 70 and climbing, and the pulse was strong. After a few more minutes, he announces that BP was back at 100.

I waited for the first unit of FWB BT to be done. Then I removed the towel clips and reopened the scalp. The sponge had soaked up with coagulated blood and was sticking on the sagittal sinus, thus stopping the bleeding. I proceeded with a tube ventriculostomy, and then closed up. The second unit of FWB arrived and my Anesthesiologist immediately began transfusing it.

13M much to the relief of every one woke up post op. I told the family I might do a ventriculo peritoneal shunting procedure after a week, but that the tumor operation will have to wait for three more months in order to allow their child to recover.>

13M, now 14 years old, survived his ordeal. His hydrocephalus did not resolve post-op, but continued to progress. The family did not follow up for a long time, but when they did, 14M had become paraparetic due to his HCP. So I shunted him. He should be able to walk after the procedure.

(Right occipital ventriculo-peritoneal shunt. 4/19/16 4:46 to 5:45 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 21 April 2016.

<15 April 2016.

Entry 2.

68M was already in the OR when I did the bilateral chest tube procedure on 35M. He had in fact just been intubated by the Anesthesiologist. He had a month history of headache, and then rapidly became comatose in the last two days, GCS 7. I immediately did him after 35M.

(Right teft temporo- parietal craniectomy, evacuation of CSDH, bone transplant to left hemi-abdomen SQ layer. 4/15/16 5:30 to 6:10 am. No BT.)>

68M woke up fully but began complaining of headache two days post op, and became drowsier. A repeat CT scan showed another extra axial fluid collection, this time on his left hemisphere. He transferred from PrH1 to the public CiH for financial reasons.

(Left temporo- parieto- frontal craniectomy, evacuation of CSDH, bone transplant to left hemi-abdomen SQ layer. 4/21/16 11:48 am to 12:31 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 22 April 2016.

I had been observing 47M for two days now. He had a 50cc left basal ganglia hemorrhage, but as much as possible, I try to avoid operating on left sided hypertensive hemorrhages because they're on the dominant hemisphere, and I don't want to dig around in this part of the brain. When 47M deteriorated, I had a repeat CT scan done, and it confirmed my suspicion of an expanding bleed. So I did an emergency operation.

(Left fronto- parieto- temporal craniectomy, cortisectomy, evacuation of basal ganglia hemorrhage, hemostasis, bone transplant to left hemi-abdomen SQ layer. 4/22/16 9:21 to 10:40 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 24 April 2016.

I had to do an emergency procedure on a motorcycle fall victim, 48M, this morning, as he had aspirated and developed severe respiratory distress. CT scan showed minimal bihemisphere subarachnoid hemorrhage; no indication for a brain operation.

(Tracheostomy 4/24/16 8:10 to 8:20 am. GA.)

Premium Chessgames Member
  Jonathan Sarfati: <visayanbraindoctor>, that video does seem to back up what you had already concluded.

<Until now, there are silly posters who keep saying that Capablanca would only be a 2600 player today.>

That's nothing. Someone in Australia quite seriously said about Lasker, Capablanca, Alekhine a few years ago: "IMO, they would play at master level, say 2200-2300, but modern GMs would beat them quite consistently."

Premium Chessgames Member
  Jonathan Sarfati: Although to be fair to that person, he was prepared to listen to the evidence and withdraw that claim.
Premium Chessgames Member
  Jonathan Sarfati: <visayanbraindoctor>, that 47M with 50cc left basal ganglia hemorrhage sounds in a bad way, given that Jose Raul Capablanca (53M) could never have survived his 60cc thalamic hemorrhage. But it seems like you have rescued the former.
Premium Chessgames Member
  visayanbraindoctor: 25 April 2016.

I returned the skull bone of 24M, whom I had previously operated last November 2015, when he bled in his a left occipito-parietal lobe while having Dengue fever.

(Replacement of bone left occipito- parietal. (4/25/16 4:02 to 4:40 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: <Jonathan Sarfati: <visayanbraindoctor>, that 47M with 50cc left basal ganglia hemorrhage sounds in a bad way, given that Jose Raul Capablanca (53M) could never have survived his 60cc thalamic hemorrhage. But it seems like you have rescued the former.>

Thalamic hemorrhagic strokes carry even worse prognosis than basal ganglia strokes.

If this happened in the 1940s though, and they did a lumber tap, I think 47M might have herniated.

At that time I also don't know about the status of the bipolar cautery machine. It's possible to operate on basal ganglia bleeds using only monopolar cautery, but it's hard. I used to do this all the time in the public City Hospital when it still did not have a bipolar cautery machine, and from experience I know it's much harder to control bleeding when you are digging through more than 4 cm of brain cortex, which you have to do in order to access basal ganglia hemorrhages. Moreover, there was no CT scan back then, and a Neurosurgeon might well have begun digging in the wrong place on the cortex, at a point far from the bleed.

Premium Chessgames Member
  visayanbraindoctor: <Jonathan Sarfati: <visayanbraindoctor>, that video does seem to back up what you had already concluded.

<Until now, there are silly posters who keep saying that Capablanca would only be a 2600 player today.>

That's nothing. Someone in Australia quite seriously said about Lasker, Capablanca, Alekhine a few years ago: "IMO, they would play at master level, say 2200-2300, but modern GMs would beat them quite consistently.">

I have noticed that many modern kibitzers seem to get into a biased mood when replaying a pre WW2 chess game. They keep on thinking that a modern master would find a better move all the time. Yet I have seen computer analyses that find these games as well played as modern ones. See for example Bridgeburner's analysis for the 1910 World Championship Match.

I strongly suspect that if a computer were to go through the 1921 and 1927 WC matches, it would find them at least as well played as modern ones, probably even better than most. Lasker, Capablanca, and Alekhine were playing fantastically accurate and sound chess in these matches.

Perhaps the easiest way to argue against these people is to tell them to analyze the games from these matches with a computer and compare with modern ones. Computers don't have any bias.

However from experience here in CG, even this does not work for some unreconstructed blockheads. They pour over these pre WW2 games with a computer. The computer tells them the games are as accurate as modern ones. The blockheads still insist that the masters playing them could never be as good as modern ones. It's like they see a leaf colored green, and still insist it's brown. There's really nothing to say to convince them otherwise.

Premium Chessgames Member
  visayanbraindoctor: 27 April 2016.

67M had been hit by a motorcycle 11 days ago, yet has remained in a stuporous state until now. CT scan shows a pure hemorrhage in his right temporo-parietal lobe, with no surrounding hypodensity indicative of a contusion. My findings in the operation showed the same thing. I did a cortisectomy on his parietal lobe in order to access the bleed 5 cm beneath the surface. The brain did not show any contusion. I've concluded that 67M suffered from a hemorrhagic stroke right after or during the time of his accident.

(Right parieto- temporal craniectomy, cortisectomy, evacuation of intra lobar hemorrhage, hemostasis, bone transplant to left hemi-abdomen SQ layer. 4/27/16 10:05 to 11:06 am. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 29 April 2016.

<68M was already in the OR when I did the bilateral chest tube procedure on 35M. He had in fact just been intubated by the Anesthesiologist. He had a month history of headache, and then rapidly became comatose in the last two days, GCS 7. I immediately did him after 35M.

(Right teft temporo- parietal craniectomy, evacuation of CSDH, bone transplant to left hemi-abdomen SQ layer. 4/15/16 5:30 to 6:10 am. No BT.)>

<68M woke up fully but began complaining of headache two days post op, and became drowsier. A repeat CT scan showed another extra axial fluid collection, this time on his left hemisphere. He transferred from PrH1 to the public CiH for financial reasons.

(Left temporo- parieto- frontal craniectomy, evacuation of CSDH, bone transplant to left hemi-abdomen SQ layer. 4/21/16 11:48 am to 12:31 pm. No BT.)>>

68M had developed pneumonia and sepsis. The financially hard-up family decided not to be aggressive anymore (in spite of my protests) and a few days ago stopped buying antibiotics. 68M died today.

Premium Chessgames Member
  visayanbraindoctor: 30 April 2016.

I returned the skull bone of 15F, whom I had previously operated on 7/17/15 for a left hemisphere ASDH.

(Replacement of bone left parieto- temporo- frontal. 4/30/16 1:01 to 1:39 pm. No BT.)

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