Atherosclerosis : treatment of hyperlipidaemia.

London : University of London Audio-Visual Centre, 1975.

1 encoded moving image (33 min.) : sound, black and white.

00:32:34

University of London

Some restrictions

CC-BY-NC

In English

Presented by Dr Dennis Krikler, Cardio-Vascular Division, Royal Postgraduate Medical School, with Dr Barry Lewis, Department of Chemical Pathology, Royal Postgraduate Medical School, and Dr Gilbert Thompson, MRC Lipid Metabolism Unit, Hammersmith Hospital. Made by University of London Audio-Visual Centre for British Postgraduate Medical Federation.

This video is one of around 310 titles, originally broadcast on Channel 7 of the ILEA closed-circuit television network, given to Wellcome Trust from the University of London Audio-Visual Centre shortly after it closed in the late 1980s. Although some of these programmes might now seem rather out-dated, they probably represent the largest and most diversified body of medical video produced in any British university at this time, and give a comprehensive and fascinating view of the state of medical and surgical research and practice in the 1970s and 1980s, thus constituting a contemporary medical-historical archive of great interest. The lectures mostly take place in a small and intimate studio setting and are often face-to-face. The lecturers use a wide variety of resources to illustrate their points, including film clips, slides, graphs, animated diagrams, charts and tables as well as 3-dimensional models and display boards with movable pieces. Some of the lecturers are telegenic while some are clearly less comfortable about being recorded; all are experts in their field and show great enthusiasm to share both the latest research and the historical context of their specialist areas.

Segment 1 Footage of unhealthy activities is seen (e.g. walking next to heavy traffic, smoking, fatty foods), as well as related medical footage (taking blood pressure, measuring body fat). Dr Krikler introduces the lecture and explains that it will be about the treatment of hyperlipidaemias (raised or abnormal lipids in the blood). He explains why hyperlipidaemias must be treated, who is treated, how they are treated and when patients should be treated. He introduces Dr Barry Lewis, who outlines therapeutic classifications and schemas. Lewis explains how to sort patients into therapeutic categories, involving identifying patients with secondary hyperlipidaemias. He also explains about the treatment of secondary hyperlipidaemias. Time start: 00:00:00:00 Time end: 00:05:01:00 Length: 00:05:01:00

Segment 2 Lewis goes on to explain how to treat primary hyperlipidaemias. Both primary and secondary are treated with a reduced diet in the first instance. Graphs show the cholesterol and triglyceride response to a changed diet in a patient with type 2b hyperlipoproteinaemia; the patient responded well. A graph of a patient who did not respond well is also seen. Another graph of a patient with the rare disease chylomicronaemia of type 1 hyperlipoproteinaemia is also seen. Dr Krikler then describes and shows the kinds of foods that patients should eat. Both unsatisfactory and healthy food are seen. Time start: 00:05:01:00 Time end: 00:10:22:11 Length: 00:05:21:11

Segment 3 Photographs of unsuitable and suitable meals are seen, including a roast dinner (bad) and chicken a l'orange (good). Krikler then says that a change in diet may sometimes not be enough, so asks Dr Lewis to discuss medication. A list of common drugs in treating hyperbetalipoproteinaemia is seen. He also mentions clofibrate, used to treat patients with endogenous hypertriglyceridaemia. He next introduces Dr Gilbert Thompson, who speaks about drugs that act at an intestinal level. He explains that these drugs are used to treat patients with increased levels of low-density lipoprotein in their plasma. He first explains bile-acid-binding resins (Questran and Secholex). Time start: 00:10:22:11 Time end: 00:14:38:11 Length: 00:04:16:00

Segment 4 Thompson explains the enterohepatic circulation of bile acids using diagrams. He next explains another group of drugs, compounds that lower the level of serum cholesterol by blocking its absorption. He describes the physicochemical processes involved in fat absorption as well as a case study of a patient with familial hypercholesterolaemia. He hands back to Barry Lewis, who discusses the drug clofibrate. Time start: 00:14:38:11 Time end: 00:20:04:22 Length: 00:05:26:11

Segment 5 Lewis describes clofibrate's side effects, as well as an alternative drug, nicotinic acid. He passes back to Dr Krikler, who discusses another agent that may have an effect on the heart: dextrothyroxine. He shows charts that detail three patients' cholesterol levels after administration of dextrothyroxine. He passes over to Dr Thompson, who talks about developments in managing patients who may require more radical therapy, usually patients with familial hypercholesterolaemia. He describes the surgical procedure ileal by-pass. Time start: 00:20:04:22 Time end: 00:25:05:00 Length: 00:05:00:03

Segment 6 Thompson continues to discuss surgical treatments, including a portacaval shunt. He also describes plasma exchange - exchanging the plasma of two homozygous patients with a cholesterol-free fraction of human plasma. Footage of a female patient receiving plasma exchange is shown, and Thompson describes the process. The results of the process are seen in a chart. Dr Krikler asks Dr Lewis to talk about what levels doctors should consider instituting treatment at, and what targets they should aim for. Dr Lewis provides some figures for cholesterol levels. Krikler asks Thompson to provide evidence that all these procedures work. Time start: 00:25:05:00 Time end: 00:29:57:00 Length: 00:04:52:00

Segment 7 Dr Thompson provides some data but also says that more evidence is probably forthcoming and more research is needed. Krikler concludes the lecture. Time start: 00:29:57:00 Time end: 00:32:34:16 Length: 00:02:37:16