[Importance of primary indications for fetal echocardiography proposed by the Portuguese Health Department]

BACKGROUND

Congenital heart disease is the most frequent congenital malformation, affecting about 5-8 newborn per thousand live births. Nowadays it is possible to do prenatal diagnosis of these conditions with fetal echocardiography (EcoF) but because health resources are limited this exam must be ordered according to the criteria established by the Portuguese Health Department.

AIMS

Evaluate the importance of the referral criteria for fetal echocardiography attending to the cardiac anomalies identified. To determine prevalence and mortality rates in fetus with cardiac anomalies.

METHODS

Retrospective analysis of the clinical records of 733 fetus to which was performed EcoF in the Prenatal Cardiology consultation of a tertiary center of Pediatric Cardiology, between 2006 and 2008. Were registered demographic data, referral motif, EcoF results and follow-up data. The referral motif was classified in two groups: (I) The "Risk Group"--which referral was consistent with the Health department indications and this included major causes (family, maternal, fetal) and minor causes (other situations), and the "No risk Group" (II)--which referral wasn't consistent with those indications.

RESULTS

During this period were performed 871 fetal echocardiograms to 705 pregnant women. The median maternal age was 32 years (15-45 years) and mean gestational age was 26 weeks (± 4 wk). The "Risk group" included 89.5% of the sample. Were identified 52 cases (7%) with cardiac anomalies in fetal echocardiography: 42 structural anomalies, 8 rhythm anomalies and 2 pericardial effusions. These abnormalities were distributed as follows: "Risk Group"--family cause (3), maternal cause (3), fetal cause (39), minor cause (5) and "No Risk Group" (2). The "Risk Group" had more cardiac abnormalities (6.8% vs 0.3%) (p>0.05), specially the "fetal cause subgroup" (p<0.05). Were missed on follow up 10 positive cases, there was 3 medical pregnancy interruptions and 3 children died. Eleven positive cases maintain follow-up on Pediatric Cardiology consultation.

CONCLUSIONS

Most of the cases fulfilled the referral criteria established by the Health Department, but there was no statistically significant difference in the prevalence of fetal cardiac anomalies in pregnant women with and without risk factors. The fetal cause was the best related to the presence of cardiac disease. The prevalence of cardiac anomalies and the mortality rate may be underestimated in this sample due to the loss of positive cases in the follow-up.

Decreased apoptosis in fatty livers submitted to subnormothermic machine-perfusion respect to cold storage

Machine perfusion at subnormothermic temperature (20°C), MP20, was developed by Vairetti et al. and showed to afford a better preservation of fatty livers respect to traditional cold storage (CS) in terms of enzyme release into the perfusate and bile, glycogen stores, energy charge and oxidative stress. Here we investigated whether it also caused decreased cell death by apoptosis. Fatty and lean Zucker rats were submitted to MP20 or CS for 6 h and reperfused normothermically for 2 h. Apoptotic cells were revealed by immunohistochemistry of activated caspase-3 and M30 (new epitope on CK18 degraded by caspase-3) and by the TUNEL assay. Portal pressure was also determined. A statistically significant reduction of hepatocyte apoptosis, but especially of sinusoidal cells was determined for fatty livers submitted to MP20 respect to CS. Portal pressure was significantly lower after MP20 respect to CS. The reduction of sinusoidal cell death by apoptosis without need for anti-apoptotic therapies appears particularly positive since apoptotic sinusoidal cells hinder microcirculation in the sinusoids and are thrombogenic. These results further confirm the potential of MP20 for preserving fatty livers that would be otherwise discarded as grafts, and thus for increasing the donor pool for liver transplantation.

Melatonin protects steatotic and nonsteatotic liver grafts against cold ischemia and reperfusion injury

Chronic organ-donor shortage has required the acceptance of steatotic livers for transplantation purposes despite the higher risk of graft dysfunction or nonfunction associated with the cold ischemia-reperfusion injury. This study evaluated the use of melatonin as an additive to Institute Georges Lopez (IGL-1) solution for protecting nonsteatotic and steatotic liver grafts against cold ischemia-reperfusion injury. In the current investigation, we used an ex vivo isolated perfused rat liver model. Steatotic and nonsteatotic livers were preserved for 24 hr (4°C) in University of Wisconsin or IGL-1 solutions with or without melatonin, as well as in University of Wisconsin solution alone. Thereafter, livers were subjected to 2-hr reperfusion (37°C). We assessed hepatic injury (transaminases) and function [bile production and sulfobromophthalein (BSP) clearance, vascular resistance], as well as other factors potentially implicated in the high vulnerability of steatotic livers against ischemia-reperfusion injury (oxidative stress and related inflammatory mediators including nitric oxide and cytokines). We also evaluated well-known cytoprotective factors as hemeoxygenase 1 (HO-1). Fatty livers preserved in IGL-1 solution enriched with melatonin showed lower transaminase levels and higher bile production and BSP clearance when compared to those obtained for livers maintained in IGL-1 solution alone. A significant diminution of vascular resistance was also observed when melatonin was added to the IGL-1 solution. The melatonin benefits correlated with the generation of nitric oxide (through constitutive e-NOS activation) and the prevention of oxidative stress and inflammatory cytokine release including tumor necrosis factor and adiponectin, respectively. The addition of melatonin to IGL-1 solution improved nonsteatotic and steatotic liver graft preservation, limiting their risk against cold ischemia-reperfusion injury.

Altered alkaline phosphatase activity in obese Zucker rats liver respect to lean Zucker and Wistar rats discussed in terms of all putative roles ascribed to the enzyme

Biliary complications often lead to acute and chronic liver injury after orthotopic liver transplantation (OLT). Bile composition and secretion depend on the integrated action of all the components of the biliary tree, starting from hepatocytes. Fatty livers are often discarded as grafts for OLT, since they are extremely vulnerable to conventional cold storage (CS). However, the insufficiency of donors has stimulated research to improve the usage of such marginal organs as well as grafts. Our group has recently developed a machine perfusion system at subnormothermic temperature (20°C; MP20) that allows a marked improvement in preservation of fatty and even of normal rat livers as compared with CS. We sought to evaluate the response of the biliary tree of fatty liver to MP20, and a suitable marker was essential to this purpose. Alkaline phosphatase (AlkP, EC 3.1.3.1), frequently used as marker of membrane transport in hepatocytes and bile ducts, was our first choice. Since no histochemical data were available on AlkP distribution and activity in fatty liver, we have first settled to investigate AlkP activity in the steatotic liver of fatty Zucker rats (fa/fa), using as controls lean Zucker (fa/+) and normal Wistar rats. The AlkP reaction in Wistar rats was in accordance with the existing data and, in particular, was present in bile canaliculi of hepatocytes in the periportal region and midzone, in the canals of Hering and in small bile ducts but not in large bile ducts. In lean ZR liver the AlkP reaction in Hering canals and small bile ducts was similar to Wistar rat liver but hepatocytes had lower canalicular activity and besides presented moderate basolateral reaction. The difference between lean Zucker and Wistar rats, both phenotypically normal animals, could be related to the fact that lean Zucker rats are genotypically heterozygous for a recessive mutated allele. In fatty liver, the activity in ductules and small bile ducts was unchanged, but most hepatocytes were devoid of AlkP activity with the exception of clusters of macrosteatotic hepatocytes in the mid-zone, where the reaction was intense in basolateral domains and in distorted canaliculi, a typical pattern of cholestasis. The interpretation of these data was hindered by the fact that the physiological role of AlkP is still under debate. In the present study, the various functions proposed for the role of the enzyme in bile canaliculi and in cholangiocytes are reviewed. Independently of the AlkP role, our data suggest that AlkP does not seem to be a reliable marker to study the initial step of bile production during OLT of fatty livers, but may still be used to investigate the behaviour of bile ductules and small bile ducts.

Percutaneous pulmonary valve implantation: initial experience

INTRODUCTION

Patients with congenital heart disease who undergo surgical implantation of a conduit between the right ventricle and the pulmonary artery (RV-PA conduit) may develop stenosis and/or insufficiency over time. These cases, which are associated with arrhythmias, RV dysfunction and sudden death, remain a challenge for surgical re-intervention, due to its complexity and associated morbidity and mortality. Percutaneous pulmonary valve implantation (PPVI) is therefore a valid alternative.

OBJECTIVE

To report our center's initial experience with PPVI.

METHODS

Prospective assessment of clinical, echocardiographic, magnetic resonance, hemodynamic and angiographic data from our series of PPVI.

RESULTS

Six patients in NYHA functional class +/- II underwent PPVI. All had significant conduit dysfunction and five had stenosis. The procedure consisted of implanting a bare metal stent to reduce the risk of fracture of the Melody valved stents (Medtronic) that were then successfully deployed in all. The immediate hemodynamic results showed a reduction in RV pressure (94 +/-27 to 44 +/- 7 mmHg), RV/LV pressure ratio (94 +/-27 to 44 +/- 7%) and conduit gradient (65 +/- 28 to 11 +/- 4 mmHg), and no insufficiency. The median duration of the procedure was 180 minutes, with no major complications. Patients were discharged a median of two days after the procedure. After a median follow-up of 7.8 months, patients are in functional class I (5) or II (1), with no evidence of conduit dysfunction on non-invasive assessment.

CONCLUSIONS

Our results are similar to the excellent results reported in larger series. PPVI is a valid therapeutic option in patients with conduit dysfunction.

Human liver autofluorescence: an intrinsic tissue parameter discriminating normal and diseased conditions

BACKGROUND AND OBJECTIVE

Autofluorescence (AF) emission is an intrinsic parameter that can provide real-time information on morpho-functional properties of biological tissue, being strictly related with their biochemical composition and structural organization. The diagnostic potentials of AF-based techniques have been investigated on normal, fibrotic, and steatotic liver tissues, in reference to histological features as evidenced by specific histochemical stainings.

MATERIALS AND METHODS

AF emission under excitation at 366 nm has been examined on cryostatic tissue sections obtained from biopsies collected during surgical operation, by means of fluorescence imaging and microspectrofluorometric techniques.

RESULTS

NAD(P)H, collagen, and vitamin A were found to be the endogenous fluorophores characterizing normal, fibrotic, and steatotic liver tissue AF, respectively. The differences of their photo-physical properties, in terms of emission amplitude, spectral shape, and response to irradiation, give rise to modifications of overall AF signal collected from tissues that allow the liver conditions to be distinguished.

CONCLUSION

The study provides a valid premise for a development of AF-based optical biopsy techniques for a real-time discrimination of liver anatomo-pathological patterns.

Hypoxia inducible factor-1α accumulation in steatotic liver preservation: Role of nitric oxide

AIM: To examine the relevance of hypoxia inducible factor (HIF-1) and nitric oxide (NO) on the preservation of fatty liver against cold ischemia-reperfusion injury (IRI).

METHODS: We used an isolated perfused rat liver model and we evaluated HIF-1α in steatotic and non-steatotic livers preserved for 24 h at 4°C in University of Wisconsin and IGL-1 solutions, and then subjected to 2 h of normothermic reperfusion. After normoxic reperfusion, liver enzymes, bile production, bromosulfophthalein clearance, as well as HIF-1α and NO [endothelial NO synthase (eNOS) activity and nitrites/nitrates] were also measured. Other factors associated with the higher susceptibility of steatotic livers to IRI, such as mitochondrial damage and vascular resistance were evaluated.

RESULTS: A significant increase in HIF-1α was found in steatotic and non-steatotic livers preserved in IGL-1 after cold storage. Livers preserved in IGL-1 showed a significant attenuation of liver injury and improvement in liver function parameters. These benefits were enhanced by the addition of trimetazidine (an anti-ischemic drug), which induces NO and eNOS activation, to IGL-1 solution. In normoxic reperfusion, the presence of NO favors HIF-1α accumulation, promoting also the activation of other cytoprotective genes, such as heme-oxygenase-1.

CONCLUSION: We found evidence for the role of the HIF-1α/NO system in fatty liver preservation, especially when IGL-1 solution is used.

Pulmonary asymmetry on chest X-ray

The unilateral absence of one pulmonary artery is a rare congenital abnormality. The authors report a clinical case of a two-year-old boy with no previous medical history who was referred for evaluation after the detection of pulmonary asymmetry on the chest X-ray with a right mediastinal shift. The CT scan and pulmonary perfusion scintigraphy pointed to an absent right pulmonary artery, which was confirmed by right heart catheterization and cardiac magnetic resonance imaging. This is an important pathology because early diagnosis and timely correction can prevent future complications. Since at this time the patient is asymptomatic, the authors opted for careful clinical vigilance.

Percutaneous closure of atrial septal defects: a decade of experience at a reference center

INTRODUCTION

Atrial septal defects (ASD) are among the most common congenital anomalies and account for 10% of congenital heart disease in the pediatric age-group and 30% in adults. Closure is indicated when there is evidence of hemodynamic significance or after a paradoxical embolic event. Ten years ago, percutaneous closure became the treatment of choice in our center for all patients with a clear indication and favorable anatomy. In this paper we report the experience of this first decade.

OBJECTIVE

To assess the short- and long-term results of our ten-year experience with percutaneous closure of atrial septal defects.

METHODS

We studied retrospectively all patients with ASD treated with a percutaneous approach between November 1998 and December 2008. The pediatric age-group consisted of patients younger than 19 years old. Demographic data, clinical indications, minor and major complication rates, success rate and long-term outcome were assessed.

RESULTS

In the first ten years of experience 510 patients, of whom 166 were in the pediatric group, were treated in our center by a team of adult and pediatric cardiologists. The overall success rate of the procedure was 98% (97.5% in ASD and 99.5% in patent foramen ovale (PFO). The minor complication rate was 3% (3.4% in ASD and 2% in PFO). The most frequent complication was supraventricular tachycardia. The major complication rate was 1.2% (0.6% in ASD and 2% in PFO). Two patients developed cardiac tamponade due to hemopericardium that was resolved by pericardiocentesis, without need for surgery. One patient had an arterial pseudoaneurysm corrected by vascular surgery. There was no device embolization and no need for urgent surgery in this population. During follow-up two patients had recurrence of ischemic stroke, one had a transient ischemic attack and another had a hemorrhagic stroke. Mortality was 0.6% (0.6% in ASD and 0.5% in PFO). There were no in-hospital deaths. During follow-up there were two deaths, both in the adult group.

DISCUSSION AND CONCLUSION

In this population the success rate was high and most of the complications were minor. The results of this collaboration between adult and pediatric cardiologists in the first ten years of activity confirm the safety and efficacy of percutaneous closure of septal defects, when there is careful patient selection and a standardized technique.

[Painful scalp ulcers]

Temporal arteritis is a systemic vasculitis mainly affecting large and medium sized vessels, temporal artery in particular. The authors report the case of a male who presented with large painful scalp ulcers over the temporo-parietal area, ipsilateral headache, amaurosis fugax and jaw claudication. Temporal arteries were thickened, painful and pulseless. Laboratory work revealed erythrocyte sedimentation rate of 63 mm and normochromic and normocytic anaemia. On histopathology transmural acute and chronic inflammation and multiple giant cells were patent in temporal artery wall. Ophthalmologic observation revealed significant visual impairment, mainly on the right eye. Regarding temporal arthritis diagnosis, prednisolone 1 mg/Kg/day was introduced. Clinical improvement was outstanding, although visual impairment remained. This case emphasizes early diagnosis and treatment importance in the avoidance of definitive sequela.

Isolated aortic coarctation: experience in 100 consecutive patients

INTRODUCTION

Coarctation of the aorta (CoA) is a stenosis usually located in the descending aorta. Treatment consists of surgical or percutaneous removal of the obstruction and presents excellent immediate results but significant residual problems often persist.

OBJECTIVES

To describe the presentation, treatment and long-term evolution of a population of 100 unselected consecutive patients with isolated CoA in a single pediatric cardiology center.

METHODS

This was a retrospective study of all patients with isolated CoA treated during4 the last 21 years (1987-2008).

RESULTS

The patients (n=100, 68.3% male) were diagnosed at a median age of 94 days (1 day to 16 years). The clinical presentation differed between patients aged less or more than one year, the former presenting with heart failure and the latter being asymptomatic with evidence of hypertension (88 and 63%, respectively; p < 0.01). Treatment, a median of 8 days after diagnosis, was surgical in 79 cases (20 end-to-end anastomosis, 31 subclavian flap, 28 patch) and percutaneous in the remaining 21 (15 balloon angioplasty, 6 with stenting). The mean age of surgical patients was younger than in those treated percutaneously (3.4 vs. 7.5 years; p < 0.01). Immediate mortality was 2% and occurred in the surgical group. There was no late mortality, in a mean follow-up of 7.2 +/- 5.4 years. Recoarctation occurred in 8 patients (6 surgical, 2 percutaneous). There are 46 patients who currently have hypertension (19 at rest, 27 with effort), their median age at diagnosis being older than the others (23 vs. 995 days; p < 0.01).

CONCLUSIONS

Isolated CoA has an excellent short-term prognosis but a significant incidence of long-term complications, and should thus no longer be seen as a simple obstruction in the descending aorta, but rather as a complex pathology that requires careful follow-up after treatment. Its potentially insidious presentation requires a high level of clinical suspicion, femoral pulse palpation during physical examination of newborns and older children being particularly important. Delay in treatment has an impact on late morbidity and mortality. Taking into account the data currently available on late and immediate results, the final choice of therapeutic technique depends on the patient's age, associated lesions and the experience of the medical-surgical team. Hypertension should be closely monitored in the follow-up of these patients, as well as its risk factors and complications.

Cardiac tumors: the 17-year experience of pediatric cardiology department

INTRODUCTION

Primary cardiac tumork may be benign or malignant and may arise anywhere in the endocardium, myocardium or pericardium. They are rare in pediatric age-groups, with a prevalence in autopsy findings of 0.0017 to 0.28%; most are benign, malignant tumors accounting for only 10% of the total.

OBJECTIVE AND METHODS

The purpose of this paper is to report the 17-year (1989-2006) experience of primary cardiac tumors in a single center. The clinical data and histopathological diagnoses were collected from a retrospective chart review.

RESULTS

We identified 12 patients, with a mean age at diagnosis of 23 months, in two cases diagnosed in the fetal period. The frequent cause of referral was tuberous sclerosis, followed by a cardiac murmur. The diagnosis of primary cardiac tumor was based on echocardiography and/or magnetic resonance imaging. The patients all underwent 24-hour electrocardiographic Holter monitoring, and the most common finding was nonspecific repolarization abnormalities. The most frequent cardiac tumor was rhabdomyoma (67%), usually associated with tuberous sclerosis, followed by fibroma (17%) and fibroelastoma (8%) Although biopsy is the diagnostic gold standard, it was only performed in two patients. Surgical removal of the tumor was performed in a single patient (with fibroelastoma) due to the perceived risk of pulmonary embolization.

DISCUSSION AND CONCLUSIONS

In our population, the most frequent tumor was rhabdomyoma associated with tuberous sclerosis. Most patients were asymptomatic, and the diagnosis was made in routine observations on patients with tuberous sclerosis or with a cardiac murmur. A histopathological diagnosis is only warranted in the rarest forms of cardiac tumors.

Octreotide--additional conservative therapy for postoperative chylothorax in congenital heart disease

INTRODUCTION

Chylothorax is a rare but serious postoperative condition in children with congenital heart disease. Conventional medical treatment consists of specific long-term dietary modification, and surgical reintervention, such as lymphatic duct ligation, may be indicated in refractory cases. In recent years, an additional conservative treatment, octreotide, a synthetic analog of somatostatin, has been used in management of congenital and postoperative chylothorax.

METHODS

The objective of this work was to analyze the efficacy and safety of this treatment for chylothorax after congenital heart surgery. We reviewed the records of sixteen patients with chylothorax after surgery for congenital heart disease between January 1999 and December 2007, and collected the following data: demographic information; type of surgical procedure; onset, duration and management of chylothorax and treatment; and duration of hospital stay. To analyze efficacy we compared these parameters in children receiving conventional treatment only with those receiving octreotide. To analyze safety we compared the adverse effects of both treatments. Octreotide was administered at a dose of 4 to 10 microg/kg/hour, with monitoring of side effects.

RESULTS

The incidence of chylothorax in our population was 1.6%. It occurred more often after Glenn and Fontan procedures (8 patients). Octreotide was begun three days after diagnosis of chylothorax and continued for a median of seventeen days (ranging from 4 to 26 days), until complete resolution. Side effects were frequent (in 3 of the 8 patients) but of no clinical relevance. All patients responded to the therapy and there was no indication for further surgical intervention.

DISCUSSION AND CONCLUSIONS

Octreotide is safe and effective in the treatment of postoperative chylothorax in children with congenital heart disease. It is a useful adjunctive therapy to the conventional treatment of this complication.

Subnormothermic machine perfusion protects steatotic livers against preservation injury: a potential for donor pool increase?

We tested whether rat liver preservation performed by machine perfusion (MP) at 20 degrees C can enhance the functional integrity of steatotic livers versus simple cold storage. We also compared MP at 20 degrees C with hypothermic MP at 8 degrees C, and 4 degrees C. Obese and lean male Zucker rats were used as liver donors. MP was performed for 6 hours with a glucose and N-acetylcysteine-supplemented Krebs-Henseleit solution. Both MP and cold storage preserved livers were reperfused with Krebs-Henseleit solution (2 hours at 37 degrees C). MP at 4 degrees C and 8 degrees C reduced the fatty liver necrosis compared with cold storage but we further protected the organs using MP at 20 degrees C. Necrosis did not differ in livers from lean animals submitted to the different procedures; the enzymes released in steatotic livers preserved by MP at 20 degrees C were similar to those showed in nonsteatotic organs. The adenosine triphosphate/adenosine diphosphate ratio and bile production were higher and the oxidative stress and biliary enzymes were lower in steatotic livers preserved by MP at 20 degrees C as compared with cold storage. In livers from lean rats, the adenosine triphosphate/adenosine diphosphate ratio appears better conserved by MP at 20 degrees C as compared with cold storage. In steatotic livers preserved by cold storage, a 2-fold increase in tumor necrosis factor-alpha levels and caspase-3 activity was observed as compared with organs preserved by MP at 20 degrees C. These data are substantiated by better morphology, higher glycogen content, and lower reactive oxygen species production by sinusoidal cells in steatotic liver submitted to MP at 20 degrees C versus cold storage. MP at 20 degrees C improves cell survival and leads to a marked improvement in hepatic preservation of steatotic livers as compared with cold storage.

Aortopulmonary window. Experience of eleven cases

Aortopulmonary (AP) window is a communication between the ascending aorta and the main pulmonary artery, in the presence of two separate arterial valves arising from separate subarterial ventricular outflow tracts. It is a rare anomaly that accounts for approximately 0.1% to 0.2% of all congenital heart disease. The purpose of this study was to assess clinical features, surgical treatment and outcome of patients with aortopulmonary window referred to a tertiary pediatric cardiac center over a 30-year period. Eleven patients were diagnosed with AP window, ten with the proximal type and one with the distal type defect. Age at first evaluation ranged from three days to 13 years (mean 44.5+/-63.3 months; median three months). Echocardiography enabled correct diagnosis in the four most recent cases. Seven patients underwent closure of the AP window through a transaortic approach and three patients underwent ligation. Simultaneously, significant associated cardiac anomalies were corrected in three patients: correction of interrupted aortic arch in two patients and closure of ventricular septal defect and Dacron patch enlargement of the right ventricular outflow tract in one patient. One patient was not operated because of fixed high pulmonary vascular resistance. Operative mortality was 10% (1/10) and there were no late deaths. Mean follow-up was 10+/-4.9 years. All nine surviving operated patients are asymptomatic, without medication, with no residual defects and without pulmonary hypertension. In conclusion, advances in diagnostic and surgical approaches to AP window in recent years have enabled earlier intervention with good outcome.

Further studies on long-term preservation of rat liver: Celsior versus UW solution

The effects of Celsior solution were compared with those of the University of Wisconsin solution (UW) after 18 or 48 hours of cold storage in a perfused rat liver model. Lactate dehydrogenase (LDH), hyaluronic acid (HA) uptake, thiobarbituric acid-reactive substances (TBARS), tissue reduced (GSH) and oxidized glutathione (GSSG) and ATP were evaluated. Histochemical in situ evaluation ofLDH and reactive oxygen species (ROS) were also performed. No significant difference in LDH release, HA uptake, TBARS, ATP levels and GSH/GSSG ratio were observed between UW and Celsior solution when the livers were preserved for 18 hours. By contrast, when preservation was performed for 48 hours, LDH release, TBARS and ROS formation were higher and the ATP levels, GSH/GSSG ratio and HA uptake were lower in the liver preserved by Celsior as compared with UW. Celsior solution was as effective as UW in liver preservation up to 18 hours but the superiority of UW over Celsior solution was obtained when liver was preserved for 48 hours.

Liver autofluorescence properties in animal model under altered nutritional conditions

Autofluorescence spectroscopy is a promising and powerful approach for an in vivo, real time characterization of liver functional properties. In this work, preliminary results on the dependence of liver autofluorescence parameters on the nutritional status are reported, with particular attention to vitamin A and lipid accumulation in liver tissue. Normally fed and 24 h starving rats were used as animal models. Histochemical and autofluorescence analysis showed that lipids and vitamin A colocalize in the liver parenchyma. Fasting condition results in a parallel increase in both lipids and vitamin A. Autofluorescence imaging and microspectrofluorometric analysis carried out on unfixed, unstained tissue sections under 366 nm excitation, evidenced differences in both spectral shape and response to continuous irradiation between liver biopsies from fed and starving rats. As to photobleaching, in particular, fitting analysis evidenced a reduction of about 85% of the signal attributable solely to vitamin A during the first 10 s of irradiation. The tissue whole emission measured in fed and starving rat livers exhibited reductions of about 35% and 52%, respectively, that are closely related to vitamin A contents. The findings open interesting perspectives for the set up of an in situ, real time diagnostic procedure for the assessment of liver lipid accumulation, exploiting the photophysical properties of vitamin A.