Thromboembolic complications occur frequently after the Fontan operation and its modifications and are a cause of significant morbidity. The time of presentation varies greatly. The rate of thrombosis appears to be similar in all modifications of the Fontan operation.

This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.

Patients with CS and ICDs are at high risk for ventricular arrhythmias. This population also has high rates of inappropriate shocks and device complications.

As the use of ICDs increases, more young patients will be eligible to receive these devices. Such patients may have different concerns than older patients who more commonly receive ICDs. We investigated quality-of-life issues in patients followed by the Yale electrophysiology service who were < or = 40 years old (mean = 28) at the time of ICD implant. Mean time since ICD placement was 3.3 years. Each patient received a modified SF-36 health questionnaire; 16 (88%) of 18 responded. Nine were women; ten were married. The highest education level attained was high school for 6 (37%), and college or beyond for 10 (63%). Ten patients were employed; eight held the same job before and after ICD placement. Four women conceived after ICD implantation; one experienced ICD discharge during pregnancy. All delivered healthy infants. All patients felt their health was good to excellent, with 6 (38%) reporting an improvement in health since ICD placement. All felt capable of performing the activities of daily living, while 68% engaged freely in moderate physical activities. All patients felt they were average to very attractive. However, 63% worried about how their clothes fit with the ICD. Three quarters of the patients felt the ICD interfered with social interactions, while 50% were concerned about sexual encounters. Thus, even though these young patients have body image concerns and may limit their activities to some degree, they are productive, active members of society who have benefitted from ICD placement.

This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of North American (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, This guideline was jointly developed by the Infectious Diseases Society of America, the American Academy of Neurology Institute, and the American College of Rheumatology. The article was peer reviewed by Arthritis & Rheumatology and simultaneously published by Clinical Infectious Diseases, Neurology, Arthritis Care & Research, and Arthritis & Rheumatology. Each editor of the 4 journals appointed 1 reviewer for peer review. The articles