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Member since Jun-04-08 · Last seen Oct-22-16
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

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

BT: Blood Transfusion

CAB = Continuous ambubagging

CiH = the public City Hospital

CNS = Central Nervous System

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

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

CSF = Cerebrospinal Fluid

CVA = Cerebrovascular accident = stroke

EBRTL: Equally briskly reactive to light.

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

ETT = Endotracheal tube (for airway purposes)

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

FWB = Fresh Whole Blood

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

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

MF = Motorcycle Fall

NGT = Nasogastric tube (for feeding purposes)

NOD = Nurse on duty

NRTL: Non reactive to light.

NSS: Normal Saline Solution

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

ProvH = the public Provincial Hospital

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

SDH = Subdural Hematoma, blood beneath the dura mater.

SOL = Space Occupying Lesion

SQ = Subcutaneous tissue layer of the skin or scalp

SRTL: Slowly or sluggishly reactive to light.

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

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.

Witching Hour Admissions or Referrals = 12 midnight to 5am.

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

   visayanbraindoctor has kibitzed 8561 times to chessgames   [more...]
   Oct-22-16 Annie K. chessforum
visayanbraindoctor: Huna thought for a moment. ‘See that tall pagoda several buildings away? One of these shifting Branching Passages blinks in and out of phase with a Portal in the interior of it. We ghosts of this Polytemple can probably hold it open longer by our will. We can also mask ...
   Oct-21-16 twinlark chessforum (replies)
visayanbraindoctor: Regarding the hype in the UK London press about the Russian aircraft carrier passing by close to home. <UK and NATO assets routinely monitor warships from other nations when they enter our area of interest and this will be no different,” a Ministry of Defense ...
   Oct-17-16 Short - Hou (2016) (replies)
visayanbraindoctor: They should hold a Hou vs Torre match too.
   Oct-13-16 visayanbraindoctor chessforum
visayanbraindoctor: 12 October 2016. 52F, motorcycle fall, backrider, by themselves, GCS 5 (decorticate posturing), anisocoric (3mm and 2mm pupillary sizes). CT scan showed a huge 70cc epidural bleed. I ordered for stat craniectomy. (Right temporo- parietal craniectomy, evacuation of ...
   Oct-03-16 Jose Raul Capablanca (replies)
visayanbraindoctor: <OhioChessFan: The hard part is we can take a stopwatch and compare runners across the ages and know the runners of today are faster. I don't know if that works in the world of the mind> Interesting question. I believe that we can if we use computer analysis. We can
   Oct-02-16 Vladimir Kramnik (replies)
visayanbraindoctor: <devere> I don't want to discuss things with you, because you clearly intend to talk from an orifice located anterior to your coccyx. However, I have to correct this statement that you attribute to me, for the sake of other readers. <you have defined Kramnik's ...
   Sep-14-16 E Torre vs M Ly, 2016 (replies)
visayanbraindoctor: <optimal play: But getting back to an earlier part of the game, I don't understand why Moulthun Ly played 26...Rxe6?> In the position above, the Black c7 pawn looks like an obvious weakness. I think Torre can hit it immediately with Qe5, Ra1, Ra7. The unfortunate ...
(replies) indicates a reply to the comment.

Kibitzer's Corner
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Premium Chessgames Member
  visayanbraindoctor: 20 July 2016.

<13 June 2016.

Large pontine hemmorhages usually kill the patients, but a few do survive comatose for several weeks or months. One was referred to me 10 days ago. 57M is still alive, but comatose at GCS 6. His ETT as expected had partially clogged with dry sticky mucus secretions. I usually recommend tracheostomy for these long term cases, in order to secure the airway and to do pulmonary toilette.

(Tracheostomy. 6/13/16 9:55 to 10:14 am.)>

Amazingly, the patient has woken up. He is now for discharge, with his tracheostomy still on. I will probably remove it after 1 more month.

Premium Chessgames Member
  Annie K.: Great to see you back, Doc!

I was going to ask you to talk about the levels of responsiveness indicated by the GCS numbers in more detail sometime, but then I decided not to waste your time on that and just looked up the Wiki article at: (for any other curious readers).

But if you want to add anything to that article, I'm all ears of course. :)

PS - I'm not sure how refusing to obey commands should count... ;s

Premium Chessgames Member
  visayanbraindoctor: <Annie K.:> I mainly use the GCS system in order to

1. Aid me in making a decision to operate or not. Usually the patients I operate on fall in the GCS 5 to 14 range. The lower it is, the better to operate earlier. Once the patient falls to 4 or 3, prognosis is almost hopeless.

2. To determine the baseline sensorium. After a or more, if it increases, fine. If it decreases, with all other things being equal, operate.

GCS 4 and 5 indicate decerebrate and decorticate posturing. Bad prognosis.

If a patient has taken alcohol or other depressants, GCS is not so accurate. The patient always presents with a low GCS score, even if there is nothing wrong with the brain.

<command> just means following any simple instruction. You can just tell the patient to raise an arm. You have a point though.

It's possible that some patients have personalities that are simply uncooperative.

There is also the problem of sensitivity to pain. Different people even when fully awake react differently to pain. Pain has a subjective or psychological component to it.

Another problem is assessing GCS if a patient is intubated. Verbal output is zero, but it does not necessarily mean she can't talk if the tube is pulled out.

Premium Chessgames Member
  Jonathan Sarfati: Another abbreviation FWB = fresh whole blood?
Premium Chessgames Member
  visayanbraindoctor: <Jonathan Sarfati: Another abbreviation FWB = fresh whole blood?>

Yes. Sorry I tend to assume every one knows these abbreviations. In fact, a few even vary from one hospital to another.

In my Alma mater hospital for example there are abbrviations such as NNO meaning no new order, or CAB meaning continuous ambubagging, which I found other hospital staff don't understand.

Premium Chessgames Member
  visayanbraindoctor: 23 July 2016.

42M, motorcycle fall, driver, hit a truck, GCS 6.

(Right temporo- parietal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 7/23/16 11:18 am to 12:12 pm. No BT.)

(Tracheostomy. 7/23/16 12:25 to 12:40 pm.)

Premium Chessgames Member
  visayanbraindoctor: 7 July 2016.

I returned the skull bone of 13M, whom I had previously operated last 1/4/16 for a subdural hematoma following a motorcycle fall.

(Replacement of bone left fronto- temporo- parietal. (7/28/16 9:46 to 10:12 am. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 8 August 2016.

Two years ago, I removed a brain metastatic tumor from a lung primary in the right temporal lobe of 61F. It turned out to be adenocarcinoma. A day PTA now 63F experienced a sudden decrease in sensorium and right hemiparesis. Another mets had occurred this time in the left frontal lobe.

When I opened up, the tumor turned out much bloodier than the previous one. I had recruited branches from the Anterior Cerebral Artery to feed itself. After some difficulty with the bleeders, I managed to excise most of the tumor. It had cystic and solid components to it.

(Left frontal craniectomy, excision of brain tumor left frontal lobe, bone transplant to left hemi-abdomen SQ layer. 8/8/16 10:23 am to 12:29 pm. 2 units BT.)

Premium Chessgames Member
  visayanbraindoctor: 20 August 2016.

65M, sudden loss of consciousness and right hemiparesis. When he got referred to me, he was comatose and was suffering from severe aspiration pneumonia. I had to intubate him in the ICU of CiH. Next day, the family bought OR needs.

65M had a huge infarct involving most of the lateral left hemisphere. Probably due to an embolus in the Right Middle Cerebral Artery.

(Left temporo- parietal decompressive craniectomy, bone transplant to left hemi-abdomen SQ layer. 8/20/16 4:25 to 4:59. No BT.)

(Tracheostomy. 8/20/16 5:06 to 5:18 pm.)

Premium Chessgames Member
  visayanbraindoctor: 21 August 2016.

28M, motorcycle fall, hit a truck. He came in comatose at GCS 7. I rushed him to the OR.

He is a nurse from an adjacent province.

(Left parieto- temporal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 8/21/16 12:00 to 12:48 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 22 August 2016.

63F above is still alive and awake, but has developed severe pneumonia. The family refuses a tracheostomy. I'm making sure they turn the patient full lateral decubitus position every two hours in order to drain out one lung at a time alternately by gravity.

65M above died of pneumonia and sepsis.

28M above is more awake. I think he'll make it.

Premium Chessgames Member
  visayanbraindoctor: 26 August 2016.

Entry 1.

<63F above is still alive and awake, but has developed severe pneumonia. The family refuses a tracheostomy. I'm making sure they turn the patient full lateral decubitus position every two hours in order to drain out one lung at a time alternately by gravity.>

The nurses texted me that she had no moire viable veins left. The family finally agreed to all my proposals. I did an IV cut down, tracheostomy, and NGT insertion.

Entry 2.

22M, motorcycle fall, hit a pedestrian, He came in awake at GCS 15. CT scan showed an epidural hematoma. After a classic lucid interval of several hours, which often happens in EDH cases, he suddenly became comatose at GCS 7 and hemiparetic. I had to rush him to the OR stat.

(Right temporo- parieto- frontal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 8/25/16 8:04 to 9:15 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 3 September 2016.

Entry 1.

Sometimes there are once in a lifetime cases that pass off as uneventful. A 10 year old girl was unexpectedly mauled two days ago with a metal cable by a wandering insane man. I've never heard of such a thing happening before. Fortunately she just incurred a small epidural hematoma from a left occipital linear fracture. She's now GCS 15 and I'm discharging her tomorrow.

Entry 2.

Malls and churches today are guarded by police and army soldiers.

Entry 3.

One of the earthquakes here made it to international news. It was much worse in an adjacent province, where they had to close down a mall, and probably other buildings as well. Just a few minutes ago, there was an aftershock, and I got ready to rush out of my building in case it worsens. There will probably be more aftershocks in the next few days; they're usually weaker, but they still give everyone a good dose of fright.

Premium Chessgames Member
  visayanbraindoctor: 6 September 2016.

Entry 1.

A witching hour operation, but it could not wait or the patient, a teenager, might have died straightaway.

17M, motorcycle fall, driver, by himself, GCS 8.

The patient was accompanied not only by his worried father, but also by a grandmother. She kept hovering around her beloved comatose grandchild.

Lesson: If you're a doting grandparent, don't let your grandchildren zoom around in motorcycles, or you might lose them.

(Left occipito- parietal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 9/6/16 2:52 to 3:52 am. No BT.)

Entry 2.

They come in pairs.

Another teenager, 18M, on a mining company truck that fell down a roadside bank. GCS 9.

He was first admitted in the public CiH. I advised the relatives to transfer to a private hospital, since the company was supposed to pay for the hospital expenses, and service there would be much faster and better, which could spell the difference between life or death for a critical patient.

A beautiful mestiza girl in civilian clothes approached me while I was making notes on the patient's chart in CiH, asking a series of annoying questions. I thought that she was the patient's sister or GF, and answered while still writing. Then I realized she was asking medical questions, and asked her if she was the company nurse. She was. (Mining companies seem to preferentially choose pretty nurses.) I showed the huge 70cc epidural hematoma in the CT scan to the nurse. I convinced her that an operation was needed fast. She convinced the company manager by phone. That facilitated the transfer and the company's pledge to shoulder the expenses, and I was able to operate ASAP.

(Right temporo- parietal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 9/6/16 8:56 to 9:35 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 13 September 2016.

61M, progressive decrease in sensorium for a week. Often drinks. Quite typical of a chronic subdural hematoma.

He woke up post-op.

(Right fronto- parietal craniectomy, evacuation of chronic subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 9/13/16 10 to 10:48 am. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 16 September 2016.

8M, riding with his 76 year old grandfather on a motorcycle. Witnesses claim that grandpa lost control and hit a PUV.

Grandpa arrived in the ER GCS 3 and died 6 hours after the accident. Grandson incurred a right frontal open depressed fracture, which I could feel after exploring the wound under local anesthesia in the ER. If there was none, I would have sutured the forehead laceration in the ER. Instead, I operated in the OR under GA.

Fortunately, operative finding showed no dura tear. So I just removed the crushed bone fragments and the small underlying hematoma. In kids with intact dura, the bone usually grows back.

(Right frontal craniectomy, evacuation of epidural hematoma. 9/16/16 11:10 to 11:35 am. No BT.)

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  visayanbraindoctor: 23 September 2016.

The world shook and woke me up early in the morning. The earthquake nearly sent me scurrying out of my apartment building.

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  visayanbraindoctor: 24 September 2016.

76M, progressive left hemiparesis and decrease in sensorium for two weeks, after a fall. The CT scan showed a chronic subdural hematoma. Unlike most such cases he isn't a drinker.

He woke up post-op.

(Right fronto- parietal craniectomy, evacuation of chronic subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 9/24/16 10:35 to 11:15 am. No BT.)

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  visayanbraindoctor: 27 September 2016.

44M, motorcycle fall, driver, by himself, GCS 15. The accident happened two months ago, and since then he has experienced progressive left sided hemiparesis. He also has a history of chronic alcoholic intake.

That's typical of a Chronic Subdural Hematoma case.

So I operated on him. He woke up post-op. His paresis was gone within 24 hours.

(Right fronto- parietal craniectomy, evacuation of chronic subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 9/27/16 9:54 to 10:45 am. No BT.)

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  visayanbraindoctor: 2 October 2016.

<8 August 2016.

Two years ago, I removed a brain metastatic tumor from a lung primary in the right temporal lobe of 61F. It turned out to be adenocarcinoma. A day PTA now 63F experienced a sudden decrease in sensorium and right hemiparesis. Another mets had occurred this time in the left frontal lobe.

When I opened up, the tumor turned out much bloodier than the previous one. I had recruited branches from the Anterior Cerebral Artery to feed itself. After some difficulty with the bleeders, I managed to excise most of the tumor. It had cystic and solid components to it.

(Left frontal craniectomy, excision of brain tumor left frontal lobe, bone transplant to left hemi-abdomen SQ layer. 8/8/16 10:23 am to 12:29 pm. 2 units BT.)>

After tracheostomy and an intravenous cut-down, 63F improved. She got to the point where she could communicate by signs (not verbally because of the tracheostomy). I eventually discharged her.

Around four days ago, her NGT clogged (the family had refused a gastrostomy operation before). So they had her admitted under Medicine. I think they were thinking of having a percutaneous endoscopic gastrostomy, which is done hereabouts by Gastro-enterologists. (Actually I was informed of this most recent admission only yesterday; I was not in service anymore.)

Today, I heard that from a fully awake communicative state, she just suddenly expired. The Internists think she had a myocardial infarct or arrythmia.

So much work here- a difficult craniectomy and excision of brain tumor, tracheostomy, IV cut down, and patient improves. Then she just dies of a medical problem.

Premium Chessgames Member
  visayanbraindoctor: 4 October 2016.

55F, sudden right sided hemiparesis and numbness. Without trauma, this usually indicates a stroke. The CT scan did show a mixed density space occupying lesion in the left temporal lobe, with hyperdense ring to elliptical shaped hyperdensities. These hyperdensities are traditionally described as 'worm-like' structures, and indicate an arteriovenous malformation (AVM) in the brain.

It's unusual in her case, because most cerebral AVMs occur in males below 40 years old.

(Left tempporo- fronto- parietal craniectomy, excision of arteriovenous malformation, bone transplant to left hemi-abdomen SQ layer. 10/4/16 10:08 am to 12:02 pm. 1 unit BT.)

I had some difficulties because the numerous abnormal vessels I had to cauterize tended to bleed. I excised all that I could visualize. The public hospital dos not have clips, so I had to use bipolar cautery on the blood vessels.

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  visayanbraindoctor: 6 October 2016.

17M, motorcycle fall, backrider, by themselves, GCS 6. He also had beginning anisocoria (3mm and 2mm pupillary sizes) and occasional decorticate posturing. The epidural bleed though was not so large, just about 30 cc. This indicates that the patient also had diffuse axonal injury (DAI) or was hypoxic, or both. So I did a tracheostomy immediately after my stat craniectomy.

(Left occipito- parietal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 10/6/16 9:45 to 10:45 pm. No BT.)

17M did not wake up post-op but remained stable at GCS 5, pupils slightly anisocoric but reactive. This supports my pre-op hypothesis that he had DAI.

An hour post-op, the ICU nurses called me that 17M was in respiratory distress and had crepitus in his neck and upper chest. I told them to inflate the tracheostomy tube's balloon, which they had neglected to do. In an hour, they texted me that the RR had gone back to normal. I instructed them to check the balloon every 30 minutes and make sure it was inflated. In some cases post-tracheostomy, the air vented in at positive pressure by a mechanical ventilator leaks into the subcutaneous tissue at the tracheostomy site if the balloon isn't inflated.

Premium Chessgames Member
  visayanbraindoctor: 7 October 2016.

<4 October 2016.

55F, sudden right sided hemiparesis and numbness.

(Left tempporo- fronto- parietal craniectomy, excision of arteriovenous malformation, bone transplant to left hemi-abdomen SQ layer. 10/4/16 10:08 am to 12:02 pm. 1 unit BT.)>

I made a blunder. I allowed the patient to eat, soft diet, in my morning rounds today. I thought it would be safe since it was 3 days post-op and the patient was awake. At around noon, the nurses texted me that the 55F was in severe respiratory distress.

I rushed back to CiH. She was severely aspirated, gasping for breath badly, comatose. I intubated her at once. Too late. After about 4 more hours she expired.

Premium Chessgames Member
  visayanbraindoctor: 8 October 2016.

I returned the skull bone of 73M, whom I had previously operated last 4/18/16 for bihemisphere chronic subdural hematomas following a motorcycle fall.

(Replacement of bones left and right fronto- parietal. (10/8/16 9:28 to 10:12 am. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 12 October 2016.

52F, motorcycle fall, backrider, by themselves, GCS 5 (decorticate posturing), anisocoric (3mm and 2mm pupillary sizes). CT scan showed a huge 70cc epidural bleed. I ordered for stat craniectomy.

(Right temporo- parietal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 10/12/16 1:28 to 2:15 pm. No BT.)

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