[What is an accident anyway and what is injury? : Considerations on causality in various legal fields]. / Was ist überhaupt Unfall und was Verletzung? : Kausalitätsüberlegungen in verschiedenen Rechtsgebieten.

It is not infrequent for physicians or lawyers who only occasionally deal with medical expert opinions to have difficulty understanding terms used in a legal context. A question of proof relating to consequences of an accidental injury can refer to the accidental injury itself and it seems relatively unknown that the term accident can apply to both the event and the damage/harm to health. The special situations with mental injuries (psychotrauma) are not dealt with in this article.This article explains the concepts and terms that are frequently used in relation to questions of causality and explains the fundamentals of medical causality assessment, from the viewpoint of both medical expertise and law. The focus is on private and public accident insurance, but the law relating to accidents at work of public officials and liability are also considered.

[Urinary bladder cancer as a late sequela of spinal cord injury : Decision-making aids for assessment of this causal association]. / Harnblasenkarzinom als Spätfolge einer Querschnittlähmung : Entscheidungshilfe für eine Zusammenhangsbegutachtung.

BACKGROUND: There is to date no convincing literature that has assessed the association between traumatic spinal cord injury (SCI) and the later development of urinary bladder cancer. The aim of this work is to present medical experts as well as the national accident insurance and the social courts decision-making aids based on the latest medical scientific knowledge, for assessment of this causal association. MATERIALS AND METHODS: A study conducted between April 1998 and March 2017 in the BG Trauma Hospital Hamburg forms the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 32 out of 6432 treated outpatient and inpatient SCI patients. Furthermore, relevant published literature was taken into consideration for the decision-making aids. RESULTS: It was found that urinary bladder cancer in SCI patients occurs at a considerably younger age as compared to the general population, more frequently shows muscle invasive carcinoma with a higher grade at first diagnosis and a higher proportion of the more aggressive squamous cell carcinoma than that of the general population. Correspondingly, the survival time is extremely unfavorable. For medical experts a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance. CONCLUSION: The results showed that urinary bladder cancer in SCI patients differs considerably from that of able-bodied patients. These differences drastically shorten the survival time. A study on patients with spina bifida, i.e., a congenital spinal cord disorder, corroborates these observations. They indicate histopathological differences that have so far been intangible.