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There are multiple syndromes associated with tumors of the central nervous system (CNS). The most common CNS tumor syndrome is neurofibromatosis-1, with well-defined major and minor criteria needed for diagnosis. Other syndromes with variable degree of CNS and extra-CNS involvement that the neurosurgeon should be aware of include neurofibromatosis-2; Turcot syndrome; Cowden syndrome; Gorlin syndrome; Li-Fraumeni syndrome; ataxia-telangiectasia; multiple endocrine neoplasia type 1; von Hippel-Lindau syndrome; and tuberous sclerosis complex. Although most CNS tumor syndromes follow an autosomal dominant pattern of inheritance, the genetic underpinnings of each disease are complex and increasingly better understood.

Background: Cephalohematomas (CH) are benign neonatal fluid collections that arise between the periosteum and skull due to birth trauma, and usually resolve spontaneously without intervention. CH may rarely become infected. Case Description: The authors report a case of sterile CH requiring surgical evacuation in a persistently febrile neonate treated with intravenous (IV) antibiotics for Escherichia coli urosepsis. Diagnostic tap of the CH yielded no pathogens, but given the persistence of fevers, surgical evacuation was performed. The patient demonstrated clinical improvement postoperatively. Conclusion: A systematic review of literature was conducted through a MEDLINE search using the keyword “cephalohematoma.” Articles were screened for cases of infected CH and their subsequent management. Clinicopathological characteristics and outcomes of the present case were reviewed and compared to those in the literature. Infected CH were reported in 25 articles describing 58 patients. Common pathogens included E. coli and Staphylococcal species. Treatment included a course of IV antibiotics (10 days–6 weeks) and often included percutaneous aspiration (n = 47) for diagnostic and therapeutic purposes. Surgical evacuation was performed in 23 cases. To the authors’ knowledge, the present case is the first documented report in which evacuation of a culture-negative CH resulted in resolution of the patient’s clinical symptoms of sepsis that persisted despite appropriate antibiotic treatment. This suggests that patients with CH should be evaluated through diagnostic tap of the collection if there are signs of local or persistent systemic infection. Surgical evacuation may be indicated if percutaneous aspiration does not result in clinical improvement.

There are multiple syndromes associated with tumors of the central nervous system (CNS). The most common CNS tumor syndrome is neurofibromatosis-1, with well-defined major and minor criteria needed for diagnosis. Other syndromes with variable degree of CNS and extra-CNS involvement that the neurosurgeon should be aware of include neurofibromatosis-2; Turcot syndrome; Cowden syndrome; Gorlin syndrome; Li-Fraumeni syndrome; ataxia-telangiectasia; multiple endocrine neoplasia type 1; von Hippel-Lindau syndrome; and tuberous sclerosis complex. Although most CNS tumor syndromes follow an autosomal dominant pattern of inheritance, the genetic underpinnings of each disease are complex and increasingly better understood.

Introduction Pediatric pilocytic astrocytomas (PA) are the most common pediatric central nervous system tumor. Surgical resection is the primary treatment for PA with five-year survival rates up to 95%. Despite a favorable prognosis, our understanding about the prognostic value of histopathological findings, such as histopathologic qualifier* or BRAF alterations is evolving. Methods Patients treated for a WHO grade 1 PA at Washington University in St. Louis/St. Louis Children’s Hospital were analyzed for clinical details, including pathology diagnosis (*histopathologic qualifier refers to designations in the diagnosis such as “WHO Grade I pilocytic astrocytoma with increased proliferative index”). BRAF alterations include gene fusions and point mutations. Results 224 patients were analyzed (51% female, mean age 9.6 years). Tumors were located in the cerebellum/fourth ventricle (50%), optic pathway/hypothalamus (15%), brainstem (12%), and cerebral cortex (11%). BRAF alterations were identified in 55/77 patients (71.4%) and additional histopathologic qualifiers were present in 27/220 patients (12.3%). 196 patients (87.5%) underwent surgical treatment and 22 (9.8%) had biopsy alone. 45 patients (22%) displayed tumor progression or recurrence after resection. The presence of a histopathologic ‘qualifier’ in the topline or BRAF alteration was not associated with tumor progression or recurrence (p=0.36, p=0.77). Ki-67 proliferative indices were not predictive of progression or recurrence (p=0.94), including when controlling for extent of resection and adjuvant therapy. BRAF alterations, specifically KIAA1549 fusions, were associated with cerebellar/fourth ventricular tumor location (p Conclusion BRAF alterations and histopathologic qualifiers were not associated with tumor progression or recurrence in pediatric PA, although BRAF fusions were more common in tumors located in the cerebellum/fourth ventricle and in younger patients.

Background and Purpose. The number of older adults with cancer is growing, increasing the need for professionals who are able to meet these patients' special needs. In palliative care settings, physical therapists strive to promote quality of life. Minimal research exists, however, to guide therapists working with patients with terminal illness. The purpose of this study was to gain knowledge that can be used by physical therapists to more effectively assess and treat older people with cancer who are receiving hospice care. Subjects and Methods. A qualitative single-case study with replication was conducted with 3 older women with cancer who are receiving hospice care. Interview data were analyzed using grounded theory techniques. Results. Four themes emerged as central to the experience of the informants: social relationships, spirituality, outlook on mortality, and meaningful physical activity. Conclusion and Discussion. In addition to maintaining physical function, physical therapists, who attend to nonphysical as well as physical aspects of care, may foster social cohesion, help maximize life's meaning, and support stabilizing strategies of older women with cancer who receive hospice care.

147 Holmium-YAG LASER Lithotripsy in the Treatment of Biliary Calculi Using Intraductal Endoscopy (SPYGLASS®) in Adolescent Patients Douglas S. Fishman*, Kimberly a. Mackey, Dang Nguyen, Bethany J. Slater, David Wesson, Sheena Pimpalwar, Isaac Raijman Pediatric Gastroenterology, Texas Children’s Hospital, Houston, TX; Digestive Associates of Houston, Houston, TX; Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Pediatric Radiology, Texas Children’s Hospital, Houston, TX Background: Pediatric biliary disease has been increasing over the last decade with up to a 30% rate of complicated biliary obstruction reported. Adult ERCP data suggests up to 10% of biliary stones may need advanced removal techniques such as electrohydraulic or laser lithotripsy. We have previously described our experience using Holmium-YAG Laser in an adult population with excellent safety profiles. We now report our experience using Holmium-YAG laser with choledochoscopy in a series of adolescent patients. Methods: A single-center retrospective case series from November 2011 to November 2012. Four patients with large/complex biliary stones underwent intraductal endoscopy with Spyglass® (Boston Scientific, Natick, MA) guided Holmium-YAG laser (Dornier, Phoenix, AZ) lithotripsy using a Slimline® disposable 365 micron laser probe (Lumenis, Sunnyvale, CA). The laser fiber was placed close to the stone and repeat fragmentation was repeated as needed. Results: Median age was 17 years old (range 16-17) with two females. Standard ERCP was performed in 3 of 4 patients, with the additional case performed through previously established percutaneous biliary access in a patient with Roux-en-Y anatomy. 2 cases were planned electively, and all four were done with general anesthesia. Indications were for complex or large biliary lithiasis in all four patients, including 1 cystic duct stone (Figure 1) and 1 with a common hepatic duct stone in a patient with a choledochal cyst. All 3 ERCP had a sphincterotomy / biliary stent. Staged therapy due to access in the patient with a percutaneous drain was planned. Stone ablation was successful in all four cases, with complete stone destruction and removal in 50%, with partial stone fragmentation in the remaining. (Image 2). There were no procedural complications. Conclusions: Holmium-YAG laser usage in adolescent patients is safe and effective using both ERCP and PTC. Lithotripsy is feasible in the common bile duct, cystic duct and via PTC. As in the adult population, staged procedures may be necessary. Further studies are needed to assess the usage of this technology in pediatric patients. 188 Boston Bowel Preparation Scale Scores Provide a Standardized Definition of “Adequate” for Describing Bowel Cleanliness Audrey H. Calderwood*, David a. Lieberman, Judith R. Logan, Michael Zurfluh, Brian C. Jacobson Gastroenterology, Boston University Medical Center, Boston, MA; Gastroenterology, Oregon Health Sciences University, Portland, OR; Medical Informatics, Oregon Health Sciences University, Portland, OR Background: Establishing a threshold of bowel cleanliness below which colonoscopies should be repeated is important, yet there are no standardized definitions for “adequate” or “adequate to exclude polyps 5 mm in size.” We hypothesized that Boston Bowel Preparation Scale (BBPS) scores could provide a way to standardize the concept of “adequacy”. Methods: We performed a retrospective analysis of average-risk screening colonoscopy reports submitted to the Clinical Outcomes Research Initiative (CORI) data repository between 10/ 2009 and 8/2012. We included only reports documenting a BBPS score and a recommendation for timing of the next colonoscopy and excluded procedures with polyps. We evaluated recommended follow-up intervals stratified by total Figure 1. Total scores on part-task training box for each group of participants. Cystic duct stone.