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The left kidney gave the impression of being cystic and abnormal on direct palpation. However, a subsequent aortogram did not show any abnormalities. Postoperatively the patient was treated with vincristine and actinomycin D. However, a year later an abdominal mass growing in the right flank became evident and the patient was operated on again; a Wilms tumor recurring in the original tumor bed was removed. The operation was followed by radiation during which a total of 3,480 rads were administered, and by a second course of vincristine and actinomycin D. At 6�C6/12 years pulmonary metastases were discovered on chest films, one appearing in the right second intercostal space and one adjacent to the left hilum. Chemotherapy was changed to adriamycin, which caused partial regression of the metastases. A year later a lung CT scan showed persistence of these nodules, which were removed surgically. The left perihilar mass was a Wilms tumor metastasis, while that in the right lung was a benign hamartomatous lesion. Since then the patient has not had other recurrences. However, she developed a left peroneal paralysis (probably due to treatment with vincristine), which has caused problems with walking and a marked secondary lumbar lordosis. Overall, the patient always showed some delay in psychomotor development, which has never been estimated quantitatively. Nor is it clear whether it may be partly attributed to the severe physical and emotional stress imposed on her early in life and to loss of school time. When we examined the patient at 12 years she appeared frail with moderate psychomotor retardation. Her weight was 27?kg (