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HEPATIC FAILURE and Dopamine

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HEPATIC FAILURE Symptoms and Causes

What is fatty liver disease?

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Fatty liver disease is a condition in which fat builds up in your liver. There are two main types:

  • Nonalcoholic fatty liver disease (NAFLD)
  • Alcoholic fatty liver disease, also called alcoholic steatohepatitis
What is nonalcoholic fatty liver disease (NAFLD)?

NAFLD is a type of fatty liver disease that is not related to heavy alcohol use. There are two kinds:

  • Simple fatty liver, in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not get bad enough to cause liver damage or complications.
  • Nonalcoholic steatohepatitis (NASH), in which you have inflammation and liver cell damage, as well as fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer.
What is alcoholic fatty liver disease?

Alcoholic fatty liver disease is due to heavy alcohol use. Your liver breaks down most of the alcohol you drink, so it can be removed from your body. But the process of breaking it down can generate harmful substances. These substances can damage liver cells, promote inflammation, and weaken your body's natural defenses. The more alcohol that you drink, the more you damage your liver. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis.

Who gets fatty liver disease?

Researchers do not know the cause of nonalcoholic fatty liver (NAFLD). They do know that it is more common in people who

  • Have type 2 diabetes and prediabetes
  • Have obesity
  • Are middle aged or older (although children can also get it)
  • Are Hispanic, followed by non-Hispanic whites. It is less common in African Americans.
  • Have high levels of fats in the blood, such as cholesterol and triglycerides
  • Have high blood pressure
  • Take certain drugs, such as corticosteroids and some cancer drugs
  • Have certain metabolic disorders, including metabolic syndrome
  • Have rapid weight loss
  • Have certain infections, such as hepatitis C
  • Have been exposed to some toxins

NAFLD affects about 25 percent of people in the world. As the rates of obesity, type 2 diabetes, and high cholesterol are rising in the United States, so is the rate of NAFLD. NAFLD is the most common chronic liver disorder in the United States.

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time. The risk is higher for heavy drinkers who are women, have obesity, or have certain genetic mutations.

What are the symptoms of fatty liver disease?

Both NAFLD and alcoholic fatty liver disease are usually silent diseases with few or no symptoms. If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen.

How do I know if I have fatty liver disease?

Because there are often no symptoms, it is not easy to find fatty liver disease. Your doctor may suspect that you have it if you get abnormal results on liver tests that you had for other reasons. To make a diagnosis, your doctor will use

  • Your medical history
  • A physical exam
  • Various tests, including blood and imaging tests, and sometimes a biopsy

As part of the medical history, your doctor will ask about your alcohol use, to find out whether fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver (NAFLD). He or she will also ask which medicines you take, to try to determine whether a medicine is causing your NAFLD.

During the physical exam, your doctor will examine your body and check your weight and height. Your doctor will look for signs of fatty liver disease, such as

  • An enlarged liver
  • Signs of cirrhosis, such as jaundice, a condition that causes your skin and whites of your eyes to turn yellow

You will likely have blood tests, including liver function tests and blood count tests. In some cases you may also have imaging tests, like those that check for fat in the liver and the stiffness of your liver. Liver stiffness can mean fibrosis, which is scarring of the liver. In some cases you may also need a liver biopsy to confirm the diagnosis, and to check how bad the liver damage is.

What are the treatments for fatty liver disease?

Doctors recommend weight loss for nonalcoholic fatty liver. Weight loss can reduce fat in the liver, inflammation, and fibrosis. If your doctor thinks that a certain medicine is the cause of your NAFLD, you should stop taking that medicine. But check with your doctor before stopping the medicine. You may need to get off the medicine gradually, and you might need to switch to another medicine instead.

There are no medicines that have been approved to treat NAFLD. Studies are investigating whether a certain diabetes medicine or Vitamin E can help, but more studies are needed.

The most important part of treating alcohol-related fatty liver disease is to stop drinking alcohol. If you need help doing that, you may want to see a therapist or participate in an alcohol recovery program. There are also medicines that can help, either by reducing your cravings or making you feel sick if you drink alcohol.

Both alcoholic fatty liver disease and one type of nonalcoholic fatty liver disease (nonalcoholic steatohepatitis) can lead to cirrhosis. Doctors can treat the health problems caused by cirrhosis with medicines, operations, and other medical procedures. If the cirrhosis leads to liver failure, you may need a liver transplant.

What are some lifestyle changes that can help with fatty liver disease?

If you have any of the types of fatty liver disease, there are some lifestyle changes that can help:

  • Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains
  • Get vaccinations for hepatitis A and B, the flu and pneumococcal disease. If you get hepatitis A or B along with fatty liver, it is more likely to lead to liver failure. People with chronic liver disease are more likely to get infections, so the other two vaccinations are also important.
  • Get regular exercise, which can help you lose weight and reduce fat in the liver
  • Talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some herbal remedies can damage your liver.

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HEPATIC FAILURE Clinical Trials and Studies

Treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Clinical trials can also look at other aspects of care, such as improving the quality of life for people with chronic illnesses. People participate in clinical trials for a variety of reasons. Healthy volunteers say they participate to help others and to contribute to moving science forward. Participants with an illness or disease also participate to help others, but also to possibly receive the newest treatment and to have the additional care and attention from the clinical trial staff.
Rank Status Study
1 Recruiting Diuretics and Dopamine in Heart Failure With Preserved Ejection Fraction
Condition: Heart Failure, Diastolic
Interventions: Drug: Furosemide;   Drug: Dopamine
Outcome Measures: Change in glomerular filtration rate at 72 hours;   Change in incidence of acute kidney injury;   Volume of diuresis measured in liters;   Six minute walk distance;   Global well-being assessment score;   Heart failure readmissions;   Frailty index;   Subjective dyspnea score;   Length of stay
2 Not yet recruiting Dopamine Receptor Imaging to Predict Response to Stimulant Therapy in Chronic TBI
Condition: Traumatic Brain Injury
Interventions: Drug: methylphenidate;   Drug: Placebo
Outcome Measures: Relationship between tonic Dopamine release (measured by displacement of [11C]-raclopride by oral methylphenidate) and change in processing speed between baseline and after methylphenidate treatment.;   Relationship between D2/D3 receptor availability in ventral striatum and prefrontal cortex and neuropsychologic deficits.;   Relationship between tonic Dopamine release in the ventral striatum and prefrontal cortex with neuropsychologic deficits after TBI.;   Relationship between D2/D3 receptor availability and functional connectivity of the prefrontal cortex with nodes of the default mode network.;   Relationship between TMS-induced short-interval cortical inhibition of M1 and tonic Dopamine release.;   Test motivation and reward on and off methylphenidate in TBI patients.
3 Unknown  Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial
Condition: Acute Heart Failure
Interventions: Drug: Furosemide;   Drug: low-dose Dopamine + low-dose furosemide
Outcome Measures: 1-year mortality or rehospitalization (all-cause, cardiovascular, non-cardiovascular, and due to worsening heart failure).;   60-day mortality or rehospitalization (all-cause, cardiovascular, non-cardiovascular, and due to worsening heart failure).
4 Unknown  A Brain Imaging Study Into Nicotine Induced Dopamine Release in Cigarette Smokers.
Condition: Tobacco Use Disorder
Intervention: Drug: Bupropion
Outcome Measures: Dopamine D2 receptor occupancy before and after smoking a cigarette with nicotine;   Subjective measures of craving, anxiety and depression.
5 Recruiting Dopamine Versus Dobutamine for Treatment of Arterial Hypotension in Term and Preterm Neonates
Condition: Arterial Hypotension
Interventions: Drug: Dobutamine;   Drug: Dopamine
Outcome Measures: Cerebral tissue oxygen saturation;   Cardiac output
6 Recruiting Impact of Dopamine Infusion on Insulin Secretion in Healthy Subjects
Conditions: Hyperglycemia;   Sepsis
Intervention: Drug: Dopamine
Outcome Measures: insulin secretion;   counter-regulatory hormones
7 Not yet recruiting Role of Dopamine on Loss Aversion Behaviour: Study on Parkinsonian Patients
Condition: Parkinson's Disease
Intervention: Behavioral: Role of Dopamine
Outcome Measures: percentage of signal modification;   Cluster activation size;   Brain activity indicators
8 Recruiting Vasopressors for Cerebral Oxygenation
Conditions: Hypoxia;   Hypotension
Interventions: Drug: Dopamine;   Drug: phenylephrine
Outcome Measures: Cerebral oximeter reading;   cardiac output;   incidence of delirium;   incidence of acute renal injury
9 Recruiting Dietary Sodium's Effect on Urinary Sodium and Dopamine Excretion in Patients With Postural Tachycardia Syndrome
Condition: Postural Orthostatic Tachycardia Syndrome
Interventions: Radiation: Total Blood Volume;   Procedure: Exercise Capacity Test - Bicycle;   Procedure: Posture Study
Outcome Measures: Urinary sodium;   Urinary Dopamine;   Blood Volume;   Change in Heart Rate with Standing;   Orthostatic Symptoms;   Change in Urinary Sodium following Change in Dietary Sodium;   Change in Urinary Dopamine following Change in Dietary Sodium
10 Not yet recruiting Switching From Oral Dopamine Agonists to Rotigotine
Conditions: Restless Legs Syndrome;   Ekbom Syndrome;   Willis-Ekbom Disease
Intervention: Drug: Rotigotine
Outcome Measures: Proportion of patients completing the switch and their adverse events;   International Restless Legs Scale (IRLS);   RLS-6 Scales;   Preference of Medication Scale (POM);   The Patient Global Impression of Change scale;   The Clinician Global Impression of Change Scale
11 Recruiting Effects of Corticorelin Administration on Dopamine Transmission, Craving, and Mood in Cocaine Dependence
Conditions: Cocaine-Related Disorders;   Cocaine Addiction;   Substance-Related Disorders
Intervention: Drug: Corticotropin-Releasing Hormone
Outcome Measures: PET measure: [11C]-(+)-PHNO binding;   stress hormone levels;   subjective measures;   vital signs;   neuropsychological battery
12 Recruiting Study of Dopamine and Serotonin Transporters in Patients With Amyotrophic Lateral Sclerosis and Controls
Condition: Amyotrophic Lateral Sclerosis
Intervention: Drug: SPECT : 123 I-FP-CIT (DATSCAN) and 123I-ADAM
Outcome Measures: Dopamine transporter binding potential;   Serotonin transporter binding potential;   Relationships between transporter binding potential and the clinical scores
13 Recruiting Blinking and Yawning in Epilepsy: The Role of Dopamine
Condition: Idiopathic Generalized Epilepsy
Intervention: Other: Apomorphine (Experimental product)
Outcome Measures: Number of yawn;   Number of eyelid blinking;   Number of eyelid blinking in both groups after apomorphin or placebo injection;   Neurophysiological assessment of the Dopaminergic reactivity;   To test the correlation between the behavioral and neurophysiological markers of Dopaminergic reactivity in patients with epilepsy;   To assess Dopaminergic reactivity with biological markers;   Number of Adverse Events as a Measure of Safety and Tolerability;   Check the absence of spike-wave discharges in healthy volunteers
14 Not yet recruiting The Relationship Between Traumatic Brain Injury and Dopamine (a Chemical in the Brain)
Condition: Traumatic Brain Injury
Interventions: Drug: Methylphenidate;   Drug: Placebo
Outcome Measure: Choice reaction time (CRT) task with methylphenidate in patients with low volume of distribution (VT) of the Dopamine transporter (DAT) in the striatum.
15 Recruiting Dopamine D2 and D3 Receptor Occupancy and Clinical Response in Older Patients With Schizophrenia
Conditions: Schizophrenia;   Schizoaffective Disorder;   Schizophreniform Disorder
Intervention: Drug: risperidone
Outcome Measures: The occupancy of risperidone at the D2 and D3 receptor, using [11C]-raclopride and [11C]-(+)-PHNO, respectively.;   Plasma levels of risperidone and 9-hydroxyrisperidone
16 Recruiting Behavioural Addictions Occurring During a Dopaminergic Treatment Prescribe Under Parkinson's Disease: Study of the Psychopathological, Neurological and Pharmacokinetic Profiles
Conditions: Parkinson's Disease;   Secondary Behavioural Addiction
Intervention: Other: questionnaires
Outcome Measures: Psychopathological axis : score of sensation seeking (S Score) of the impulsivity questionnaire "UPPS";   Pharmacological axis : Area under the curve of the pramipexole concentration;   Neurological axis : Unified Parkinson's Disease Rating Scale (UPDRS) III score;   Treatments except the anti-parkinsonism ones;   drug misuse;   addiction and punding antecedents;   ADHD antecedents;   impulsivity profile;   Age of onset of the Parkinson's disease;   stage and form of the Parkinson's disease;   time course of Parkinson's disease;   family history of Parkinson's disease;   anti-parkinsonism treatments;   Residual plasmatic concentration of the pramipexole;   median pharmacokinetic parameters of pramipexole;   study of the hepatic and renal functions;   Physiopathological covariates
17 Recruiting Imaging of Vesicular Acetylcholine and Dopamine Transporters in Dementia With Lewy Bodies
Condition: Dementia With Lewy Bodies
Interventions: Other: Imaging with IBVM;   Other: Imaging with DATSCAN;   Behavioral: neuropsychological evaluation
Outcome Measures: Binding Potential (BP) quantification of each radioligand;   Ratio Dopaminergic system/cholinergic system Binding Potential
18 Unknown  Expression Profile of Somatostatin Receptors and Dopamine Receptor 2 in Non-functioning Pituitary Adenomas and Resistant Prolactinomas: Correlation With in Vivo Response to Pasireotide and Cabergoline
Conditions: Non-functioning Pituitary Adenomas;   Prolactinomas
Interventions: Drug: Pasireotide;   Drug: cabergoline
Outcome Measures: Tumor volume reduction;   Prolactin levels normalization
19 Unknown  Multicenter Study on Fibrotic Valvular Heart Disease in Patients With Parkinson's Disease Treated With Dopamine Agonists
Conditions: Heart Valve Diseases;   Parkinson's Disease
Intervention:
Outcome Measure:
20 Recruiting The Effects of Prazosin on Dopamine in Healthy Humans: A PET Pilot Study
Condition: Healthy
Intervention: Drug: Prazosin Hydrochloride
Outcome Measure: Changes in [11C]-(+)-PHNO binding