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visayanbraindoctor
Member since Jun-04-08 · Last seen Mar-23-17
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?

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

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

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

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

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

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

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

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

4. The greatest chess players in history?

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

5. Computers vs Humans, who is stronger?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

On the other hand neurons do not hypertrophy.

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

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

8. On ratings:

Elo ratings reflect relative and not absolute chess strength.

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

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

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

9. Best Qualifiers?

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

10. The 1993 Chess Rift and Kramnik:

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

11. Finances of a would-be Challenger:

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

12. Ducking a World Championship re-match:

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

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

13. Predictions for Hypothetical World Championship Matches:

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

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

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

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

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

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

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

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

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

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

iii. The tiebreakers should be as fair as possible.

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

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

So things even out.

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

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

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

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

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

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

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

---

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

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

Chessgames.com Full Member

   visayanbraindoctor has kibitzed 9006 times to chessgames   [more...]
   Mar-23-17 Salzburg (1943)
 
visayanbraindoctor: Fittingly won by World Champion Alekhine and Almost World Champion Keres. This was probably Alekhine's last strong tournament. Keres managed to tie him for first, after failing to do so in three recent occasions. AAA and Keres carried on a strong rivalry between them ...
 
   Mar-23-17 visayanbraindoctor chessforum
 
visayanbraindoctor: 23 March 2017. 49F, sudden loss of consciousness, with right hemiparesis. GCS 6 peo-op. CT scan showed a 50 cc left basal ganglia hemorrhage. This patient probably has had a history of Hypertension. (Left fronto- parieto- temporal craniectomy, cortisectomy, evacuation of
 
   Mar-23-17 Annie K. chessforum
 
visayanbraindoctor: Taklong raised his hands. ‘Feast and be merry!’ he yelled. The darklings among the audience jumped into the arena and savagely commenced devouring the human bodies. Pana began a narrative amidst the gory feast. ‘There used to be many human races in this world. 500 years ...
 
   Mar-17-17 twinlark chessforum (replies)
 
visayanbraindoctor: There are industrial processes that emit CO2 from sources not directly to fossil fuel burning. 1. The manufacture of cement and concrete. Essentially, limestone CaCO3 is converted to lime CaO and CO2. The process releases CO2 from carbonate rocks. 2. The smelting of iron ...
 
   Mar-11-17 Alekhine vs Rubinstein, 1921 (replies)
 
visayanbraindoctor: This game is a classic on the the principles of tempo, initiative, and attack. The reason why White's funny looking moves worked is that they exploited Black's errors with threats, always maintaining the initiative. Why is h4, h5, h6 possible? It's because Black made the ...
 
   Mar-07-17 Women's World Championship (2017) (replies)
 
visayanbraindoctor: <Sally Simpson: Finally I've twigged it. This unfancied girl turns up to play chess in the championship. She hacks her way through all kinds of time controls and wins it.> I don't mean any offense to anyone. I would congratulate Tan for winning the tournament. (Even
 
   Feb-16-17 Carlsen - Karjakin World Championship (2016) (replies)
 
visayanbraindoctor: <perfidious> I'm not sure if you read my posts above correctly. If you have inadvertently misinterpreted them, let me point out that it is not a case in point because the extra classical tiebreak games (or game) are limited; not an indefinite format. As you ...
 
(replies) indicates a reply to the comment.

Kibitzer's Corner
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Feb-03-17
Premium Chessgames Member
  visayanbraindoctor: 9 January 2017.

Most gunshot cases I receive that are still alive in the ER consists of single shots fired into the head. 52M was unusual because he had one to the head (through the right mastoid), and one in the right chest.

He died in the ER.

I wondered if whoever did this employed the double tap method of professional assassins- one shot to the head and another to the chest.

Feb-04-17
Premium Chessgames Member
  visayanbraindoctor: 12 January 2017.

An unusual case. 57M was admitted more than two weeks ago in the public CiH after he got mauled. The CT scan then showed a left frontal lobe contusion and linear frontal bone fracture. No need to operate.

The patient remained stuporous and then began to deteriorate after two weeks. A repeat CT scan showed infarcts on both frontal lobes.

OR 1: Bifrontal craniectomies, partial bi frontal lobectomies, bone transplant to left hemiabdomen SQ layer. 1-12-17 10:25 am to 12:07 pm. No BT.

OR 2: Tracheostomy. 1-12-17 12:24 to 12:39 pm.

Since he had also developed pneumonia and had embarked on the sepsis roller coaster ride, I wasn't optimistic about his survival. Yet survive he did. I removed his tracheostomy two weeks post-op. I discharged him nearly three weeks post-op.

Feb-04-17
Premium Chessgames Member
  visayanbraindoctor: 18 January 2017.

16M, motorcycle fall, driver, hit another motorcycle.

He had a huge 70 cc epidural hematoma, but was still GCS 14 preo-op. I removed the hematoma. When these EDH cases deteriorate, they do so fast.

OR: Right parieto- temporal craniectomy, evacuation of epidural hematoma, bone transplant to left hemiabdomen SQ layer. 1-18-17 10:28 to 11:16 am. No BT.

Feb-04-17
Premium Chessgames Member
  visayanbraindoctor: 19 January 2017.

44M, whom I previously operated on 9-27-16 for subacute subdural hematoma.

OR: Replacement of bone flap right fronto- parietal. 1-19-17; 9:23 to 10:34 am. No BT.

Feb-04-17
Premium Chessgames Member
  visayanbraindoctor: 27 January 2017.

14M, whom I previously operated May 2016 for epidural hematoma.

OR: Replacement of bone flap left temporo- parietal. 1-27-17; 4:19 to 5:14 pm. No BT.

Feb-04-17
Premium Chessgames Member
  visayanbraindoctor: 4 February 2017.

49M, motorcycle fall, driver, hit a dog.

OR: Right fronto- parietal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemiabdomen SQ layer. 2-4-17; 4:04 to 4:50 pm. No BT.

A nightmare case.

Four hours post-op, the the CiH nurse texted me that the patient was having BP spikes of 180 systolic. I thought it was because of pain, and I duly ordered IV Tramadol RTC. Past midnight nine hours post-op, the NOD again texted me that the patient had suddenly gone on CP arrest. He died after 30 minuts of CPR. I wasn't able to sleep well at all.

I think he was developing a massive infarct while I was operating, as I noticed his brain was not pulsating during the opertion itself.

Feb-09-17
Premium Chessgames Member
  visayanbraindoctor: 8 February 2017.

16M, whom I previously operated on June 2016 for epidural hematoma.

OR: Replacement of bone flap right temporo- parietal. 2-8-17; 9:40 to 10:30 am. No BT.

Feb-09-17
Premium Chessgames Member
  visayanbraindoctor: 9 February 2017.

63M, sudden decrease in sensorium and right hemiparesis, with history of HPN, CT scan showing a large 60 left basal ganglia hemorrhage.

It was dawn, and my cell phone's ringing woke me up. I was informed that the patient arrived in Prh1 GCS 11, and then deteriorated to GCS 3. So I grabbed my scrub suit, placed it in my duffle bag, dressed up, put on a jacket and boots. It was pouring a torrent of rain outside and the street below me was flooded. Fortunately there were still PUVs running.

The patient's pupils were 2mm EBRTL. The wife had decided strongly on an operation. Given he had just deteriorated and his pupils reactive, I operated on him stat, with no blood in reserve. (Fortunately I seldom have bleeding problems during my operations. I operate clean and fast, which is great in emergency situations when there is no time to get blood.)

OR: Left fronto- parieto- temporal craniectomy, cortisectomy, evacuation of basal ganglia hemorrhage, hemostasis, bone transplant to left hemiabdomen SQ layer. 2-9-17 8:56 to 10:10 am. No BT.

This hemorrhage was deeply located. I decided to approach it via a large frontal cortisectomy, trying to avoid the motor cortex on the pre-sulci gyrus which unfortuately was not entirely possible due to the location of the hemorrhage beneath it.

Not sure if the patient will survive. He had low sensorium pre-op, an indicator for bad prognosis.

Feb-13-17
Premium Chessgames Member
  visayanbraindoctor: 10 February 2017.

I woke up and had to get out of my apartment building near midnight building because of an earthquake. My old computer slid off its table and hit the floor hard.

Feb-13-17
Premium Chessgames Member
  visayanbraindoctor: 12 February 2017.

42M, motorcycle fall, driver, alone.

OR: Right fronto- parieto- temporal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 2/12/17 12:01 to 1:00 pm. No BT.

Awake post-op.

Feb-13-17
Premium Chessgames Member
  visayanbraindoctor: 12 February 2017.

26M, motorcycle fall, backrider.

Left temporo- parietal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 2/12/17 9:20 to 10:11 pm. No BT.

During the earthquake on February 10 (see above), the road cracked in front of the motorcycle the patient was riding on. The surface right in front of them slanted up. Thus the motorcycle flew up off the road and crashed.

Feb-13-17
Premium Chessgames Member
  visayanbraindoctor: 13 February 2017.

10M, hit by a van.

The child was GCS 3, anisocoric, and also suffered from a right pulmonary contusion. CT scan showed a left thalamus hemorrhage which leaked into the third ventricle, causing hydrocephalus.

I usually operate on such cases if they happen to be children, as they sometimes recover. Instead of the usual Burr hole, I decided to do a craniectomy on the side of the lesion in order to provide more space for the herniating brain.

Left frontal craniectomy, tube ventriculostomy, evacuation of acute intra-ventricular hemorrhage and CSF. 2/13/17 6:00 to 6:30 pm. No BT.

Feb-28-17
Premium Chessgames Member
  visayanbraindoctor: 15 February 2017.

53M, whom I previously operated on 6-27-16 for acute subdural hematoma.

OR: Replacement of bone flap right temporo- parietal. 2-15-17; 4:25 to 4:40 pm. No BT.

Feb-28-17
Premium Chessgames Member
  visayanbraindoctor: 16 February 2017.

48M, mauled a week PTA.

Right fronto- parietal craniectomy, evacuation of sub-acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 2/16/17 10:31 to 11:25 am. No BT.

Feb-28-17
Premium Chessgames Member
  visayanbraindoctor: 27 February 2017.

31M, motorcycle fall, driver, hit another motorcycle.

Right temporo- parietal- frontal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 2/28/17 12:03 to 12:47 am. No BT.

The patient came in still able to communicate. In these cases one can opt to observe. I decided to observe. He deteriorated from GCS 14 to GCS 9 after 3 days. Repeat CT scan showed that the area around the original hemorrhagic contusion had become more hypodense following the middle cerebral artery territory. (This means that the part of the brain being perfused by the right MCA was ischemic and could convert to an infarct.) So I had to do an emergency operation.

I generally observe such borderline cases first because not all of them need to be operated upon; they just often improve in 5 days. If they deteriorate, they usually do so in 3 to 5 days.

If they do improve in 3 days, then there is no need to operate. If they deteriorate, then you have to operate ASAP. Before embarking on such management strategy, you have to explain it to the relatives, because if such a patient deteriorates, they often do so fast and may die before you can operate. If the relatives can't accept that risk, then you tell them that you will operate even on day 1.

Feb-28-17
Premium Chessgames Member
  visayanbraindoctor: Morbidity and mortality for post-op patients in February 2017.

1. <4 February 2017.

49M, motorcycle fall, driver, hit a dog.>

Died as mentioned above.

2. <9 February 2017.

63M, sudden decrease in sensorium and right hemiparesis, with history of HPN, CT scan showing a large 60 left basal ganglia hemorrhage.

It was dawn, and my cell phone's ringing woke me up. I was informed that the patient arrived in Prh1 GCS 11, and then deteriorated to GCS 3. So I grabbed my scrub suit, placed it in my duffle bag, dressed up, put on a jacket and boots. It was pouring a torrent of rain outside and the street below me was flooded. Fortunately there were still PUVs running.

The patient's pupils were 2mm EBRTL. The wife had decided strongly on an operation. Given he had just deteriorated and his pupils reactive, I operated on him stat, with no blood in reserve. (Fortunately I seldom have bleeding problems during my operations. I operate clean and fast, which is great in emergency situations when there is no time to get blood.)

OR: Left fronto- parieto- temporal craniectomy, cortisectomy, evacuation of basal ganglia hemorrhage, hemostasis, bone transplant to left hemiabdomen SQ layer. 2-9-17 8:56 to 10:10 am. No BT.>

Died after a week. The Neurologist signed it out as multiple organ failure. I never do so myself; as I think it's just a highfalutin term for the consequences or natural course of sepsis.

For what's it worth, a repeat CT scan post-op showed that I managed to successfully remove most of the intracerebral hemorrhage; so that he definitely did not die of brain herniation. I succeeded in my objective for the operation, but the patient still died of sepsis.

3. <13 February 2017.

10M, hit by a van.

The child was GCS 3, anisocoric, and also suffered from a right pulmonary contusion. CT scan showed a left thalamus hemorrhage which leaked into the third ventricle, causing hydrocephalus.

I usually operate on such cases if they happen to be children, as they sometimes recover. Instead of the usual Burr hole, I decided to do a craniectomy on the side of the lesion in order to provide more space for the herniating brain.

Left frontal craniectomy, tube ventriculostomy, evacuation of acute intra-ventricular hemorrhage and CSF. 2/13/17 6:00 to 6:30 pm. No BT.>

Still alive, but GCS 5 (decorticate posturing), hooked to a ventilator. Really bad prognosis.

Mar-06-17
Premium Chessgames Member
  visayanbraindoctor: <3. <13 February 2017.

10M, hit by a van.

The child was GCS 3, anisocoric, and also suffered from a right pulmonary contusion. CT scan showed a left thalamus hemorrhage which leaked into the third ventricle, causing hydrocephalus.

I usually operate on such cases if they happen to be children, as they sometimes recover. Instead of the usual Burr hole, I decided to do a craniectomy on the side of the lesion in order to provide more space for the herniating brain.

Left frontal craniectomy, tube ventriculostomy, evacuation of acute intra-ventricular hemorrhage and CSF. 2/13/17 6:00 to 6:30 pm. No BT.>

Still alive, but GCS 5 (decorticate posturing), hooked to a ventilator. Really bad prognosis.>

Died of sepsis.

Mar-06-17
Premium Chessgames Member
  visayanbraindoctor: 3 March 2017.

Entry 1.

20M, whom I previously operated on 3-3-16 for epidural hematoma.

OR: Replacement of bone flap left parieto- temporal. 3-3-17; 9:59 to 10:38 am. No BT.

Entry 2.

58 M, accidentally fell down a riverbank. GCS 12 pre-op.

Right temporal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 3/3/17 12:21 to 12:57 pm. No BT

Mar-06-17
Premium Chessgames Member
  visayanbraindoctor: 6 March 2017.

There's a saying they come twice; but this one befoggles my mind.

25M shot last December in the head. previously admitted 12-26-16 to 1-5-17.

<27 December 2016.

24M, shot by unknown assailant.

This patient also exhibited left hemiparesis, the side contralateral to the injury on his right brain. The bullet had entered the right frontal bone and exited the right parietal, skimming through the cortex.

OR 1: (Right fronto - parietal craniectomy, evacuation of contused and infarcted brain and hematomas, repair of dura for CSF leak with temporalis muscle flap, bone transplant to left hemi-abdomen SQ layer. 12/27/16 8:57 to 10:40 pm. No BT.)>

He got shot again in the head. GCS 7 pre-op.

There was another gunshot wound on his right chest, but it did not cause any hemopneumothorax. (The assassin was obviously making sure he would die by using the double tap method, a bullet to the brain and another to the chest.) It did cause a huge lung contusion, which compounds his brain injury. He also has some respiratory distress.

In the first instance last December, his kid brother also took a bullet and died.

This time, it was a cousin that also got hit, and died.

Yet he was still alive and reached the hospital, so I operated on him again.

(Partial right frontal lobectomy, evacuation of intracerebral hemorrhage, repair of dura for CSF leak with temporalis muscle flap, bone transplant to left hemi-abdomen SQ layer. 3/6/17 10:44 am to 12:41 pm. 1 unit BT.)

This time it was a bigger and larger operation. It took me much longer than usual. The bullet's point of entry was at the right frontal lobe, point of exit at the left occiput. It plowed from the front of his brain to the back. It did not cross the midline, or he would be dead. I had to remove contused and dead brain. Then I had to divide his temporalis muscle on its planar section and extensively mobilize it, in order to effectively cover the dural defects.

Mar-17-17
Premium Chessgames Member
  visayanbraindoctor: 9 March 2017.

25M, GSW case above, actually woke up and improved, although he still had left hemiparesis. I guess he will survive.

Mar-17-17
Premium Chessgames Member
  visayanbraindoctor: 10 March 2017.

21M, motorcycle fall, driver.

(Bifrontal craniectomy, evacuation of contused brain, repair of dura for CSF leak with temporalis muscle flap and periosteum, bone transplant to left hemi-abdomen SQ layer. 3/10/17 4:41 to 6:41 pm. 1 unit BT.)

Patient was comatose at GCS 7 pre-op, but woke up after. With both of his frontal bones fractured in multiple places, it was a rather long operation. I had to emove them, control hte bleeding from the sagittal sinus, remove the contused fungating brain from both frontal lobes, and repair both frontal dura lacerations.

Mar-17-17
Premium Chessgames Member
  visayanbraindoctor: 12 March 2017.

35M had been suffering headache fro several months already, then one day PTA suddenly became unconscious. It turned out that he had a large left frontal cystic tumor, diagnosed by CT scan.

He was becoming anisocoric and decorticate, so I did stat craniectomy, even without blood.

(Left frontal craniectomy, partial excision of left frontal cystic tumor, bone transplant to left hemi-abdomen SQ layer. 3/12/17 10:00 to 11:15 pm.)

The tumor turned out to be ill-defined and very bloody. Three units of blood were transfused post-op.

Next day, the patient woke up and was communicative (to my surprise).

Mar-17-17
Premium Chessgames Member
  visayanbraindoctor: 17 March 2017.

25M, motorcycle fall, driver, hit a dog.

He was awake pre-op but with left hemiparesis. The CT scan showed no intracerebral hemorrhage, but with a piece of the fractured right parietal bone jutting inside the brain. There was huge 25cm long laceration on top of the fracture.

(Right parieto-occipital craniectomy, repair of dura for CSF leak with periosteum. 3/17/17 11:42 pm to 12:30 am. No BT.)

The patient is a policeman. Another policeman was back riding with him when their motorcycle hit a dog. His companion did not need an operation.

Most policemen and soldiers I have operated on don't actually get shot in the line of duty. They usually incur their head injuries from falling off motorcycles at night.

Mar-23-17
Premium Chessgames Member
  visayanbraindoctor: 22 March 2017.

Updates:

Entry 1.

<12 March 2017.

35M had been suffering headache fro several months already, then one day PTA suddenly became unconscious. It turned out that he had a large left frontal cystic tumor, diagnosed by CT scan.

He was becoming anisocoric and decorticate, so I did stat craniectomy, even without blood.

(Left frontal craniectomy, partial excision of left frontal cystic tumor, bone transplant to left hemi-abdomen SQ layer. 3/12/17 10:00 to 11:15 pm.)

The tumor turned out to be ill-defined and very bloody. Three units of blood were transfused post-op.

Next day, the patient woke up and was communicative (to my surprise).>

Histopath turned out to be astrocytoma grade 3 (Cancer).

Bad prognosis. The Neurologist in charge is planning to refer the patient to an Oncologist for possible radiotherapy.

Entry 2.

<17 March 2017.

25M, motorcycle fall, driver, hit a dog.

He was awake pre-op but with left hemiparesis. The CT scan showed no intracerebral hemorrhage, but with a piece of the fractured right parietal bone jutting inside the brain. There was huge 25cm long laceration on top of the fracture.

(Right parieto-occipital craniectomy, repair of dura for CSF leak with periosteum. 3/17/17 11:42 pm to 12:30 am. No BT.)>

Patient still has left hemiparesis. I'm afraid he is going to have a permanent disability. He was planning to apply and train for ranger training, but this likely won't push through.

Mar-23-17
Premium Chessgames Member
  visayanbraindoctor: 23 March 2017.

49F, sudden loss of consciousness, with right hemiparesis. GCS 6 peo-op. CT scan showed a 50 cc left basal ganglia hemorrhage. This patient probably has had a history of Hypertension.

(Left fronto- parieto- temporal craniectomy, cortisectomy, evacuation of intra-cerebral hemorrhage, bone transplant to left hemi-abdomen SQ layer. 3/23/17 10:34 to 11:32 am.)

(Tracheostomy. 3/23/17 11:35 to 11:52 am.)

Comatose hypertensive hemorrhage cases always carry bad prognosis, but this patient's family was aggressive. If they are not brain dead, I inform then of the bad prognosis and then proceed with the operation.

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