1 Huffman C.

Chillag S.

Paulman L.

McMahon C. It's not easy bein' green. 1 Huffman C.

Chillag S.

Paulman L.

McMahon C. It's not easy bein' green. 2 Jones R.N. A yellow-stained human femur from Tell esh-Shuqafiya, Egypt: evidence of ancient trauma. 1 Huffman C.

Chillag S.

Paulman L.

McMahon C. It's not easy bein' green. , 3 Larson E.A.

Evans G.T.

Watson C.J. A study of the serum biliverdin concentration in various types of jaundice. 3 Larson E.A.

Evans G.T.

Watson C.J. A study of the serum biliverdin concentration in various types of jaundice. A recent articledepicted greenish tissues of a patient who had died with obstructive jaundice and reviewed previous reports of “green jaundice.” The color was attributed to biliverdin formed by autoxidation of bilirubin.That explanation is chemically unlikely. Bilirubin is a rather stable pigment, particularly when deposited in tissues; witness the 2000-year-old bilirubin found in an Egyptian skeleton.In contrast, because of their reduced hydrogen bonding and greater conformational mobility, bilirubin conjugates are considerably more prone to free radical attack and autoxidation to the corresponding biliverdin conjugates. “Green jaundice” has invariably been associated with elevated direct bilirubin,and green skin and teeth associated with jaundice have followed periods of direct hyperbilirubinemia. Larson et alobserved “green jaundice” only in patients with high direct bilirubin levels and not in patients with, for example, hemolytic jaundice. Therefore, it is likely that the green color in the case presented, and in similar cases, was caused by esterified biliverdin derivatives rather than by biliverdin itself. The crude techniques used to identify “green jaundice” pigments wouldn't have distinguished biliverdin esters from the parent pigment.

4 Gåfvels M.

Holmström P.

Somell A.

et al. A novel mutation in the biliverdin reductase-A gene combined with liver cirrhosis results in hyperbiliverdinaemia (green jaundice). Defects in biliverdin reductase are unlikely to be involved in “green jaundice.” However, the first case of biliverdin reductase deficiency was reported recently.The patient had green serum with no elevation of bilirubin despite concomitant liver disease. Because biliverdin is readily excreted unchanged in bile, it is likely that, absent the liver disease, biliverdin would not have accumulated in serum of that patient.

The authors wondered whether there is clinical utility in measuring biliverdin. Probably not: not least because there are presently no good methods for doing so. For this reason, clinical “biliverdin” concentrations reported in the literature are unlikely to be accurate.

5 Lillie R.D.

Pizzalato P. The aldehyde reaction with bilirubin of bile and of bile pigment in the icteric liver. 6 Bedino J.H. Jaundice embalming: the superiority of glutaraldehyde versus formaldehyde. , 7 Fredrick J.F. Embalming with a poly(vinyl pyrrolidinone)-formaldehyde complex US Patent. It is unclear whether the green tissue discoloration depicted in the review was a consequence of embalming. Embalming of jaundiced corpses is problematic because formalin embalming solutions react rapidly with bilirubin conjugates to give a mixture of uncharacterized green pigments that can impart a Halloweenish hue to the deceased.This can be avoided by using proprietary embalming solutions containing glutaraldehyde or polymer-formaldehyde complexes(better things for better dying through chemistry). Apparently, in death, contrary to the review's title, “It's easy not bein' green.”

Article Info Footnotes Funding: None. Conflict of Interest: None. Authorship: The author is solely responsible for writing this manuscript. Identification DOI: https://doi.org/10.1016/j.amjmed.2010.01.030 Copyright © 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved. ScienceDirect Access this article on ScienceDirect

Linked Article It's Not Easy Bein' Green The American Journal of Medicine Vol. 122 Issue 9

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