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Patients with HPS due to Budd-Chiari syndrome were subsequently excluded because they were previously treated with cavoplasty and stent placement. The remaining HPS patients were divided into two groups based on a computer-generated randomized table: group 1 was comprised of patients receiving garlic and group 2 consisted of patients receiving placebo.

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Cyanosis, clubbing and spider angioma were present in 38 (79.16%), 42 (87.5%) and 11 (22.72%) patients with HPS, respectively, compared with only two (16.67%), two (16.67%) and one (8.33%) patient(s) with IS. Orthodeoxia was significantly higher in patients with HPS (31 of 48 patients [64.58%]) than in those with IS (three of 12 patients [25%]; P=0.01). Orthodeoxia was present in five of six patients with HPS due to Budd-Chiari syndrome. Twenty-six of the 42 patients with HPS who were randomly assigned to receive garlic or placebo had orthodeoxia.

Of the 48 patients in group A, six patients had HPS due to Budd-Chiari syndrome and were treated with cavoplasty and stent placement and were consequently excluded. The remaining 42 patients were divided into two groups by computer-generated randomized table, 21 patients in group 1 (patients receiving garlic) and 21 patients in group 2 (patients receiving placebo). One patient in group 2 did not return for follow-up. Therefore, 41 patients (21 patients in group 1 and 20 patients in group 2) were analyzed for the effects of garlic versus placebo. There were no significant differences in the baseline clinical, biochemical or blood gas profile of patients with HPS in group 1 or group 2 (Table 1). The mean dose of garlic taken by patients in group 1 was 1.550.29 g/day.

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Hepatopulmonary syndrome is a severe complication of liver disease, with greatly increased mortality. The syndrome is characterized by increased blood-flow, intrapulmonary vasodilatation and angiogenesis, leading to effects including the formation of shunts. This leads to a decrease in arterial oxygen pressure. Liver transplantation is the only effective treatment.

Early recognition of hepatopulmonary syndrome is important, because patients may be given priority for liver transplantation. Contrast echocardiography is indicated in patients with liver disease and suffering from hypoxaemia for which there is no other explanation, to reveal the presence of intrapulmonary shunt.

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