An Italian doctor has had his life sentence in prison upheld for the murder of ten people, including some of his patients.
Leonardo Cazzaniga, 65, a former emergency physician at Saronno Hospital near Milan, was convicted of the intentional killing of eight people in his care by the Milan Court of Appeal.
The decision comes two months after Cazzaniga's mistress, nurse Laura Taroni, was jailed for two intentional homicides.
Cazzaniga was also convicted of the murder of Taroni's husband and father-in-law.
However, he was acquitted on appeal for three other murders by the Milan Assize Court.
The pair have been described as "diabolical lovers" by the Italian press and had administered the patients with lethal cocktails of analgesics and anaesthetics.
Defence attorneys had suggested the practices were consistent with standard palliative care, but the prosecution pointed out that one of the victims, a young woman, had died after only being admitted to Saronno Hospital with a dislocated shoulder.
Taroni, a 44-year-old mother-of-two, was convicted on appeal last February to 30 years in prison for murdering her husband, Massimo Guerra, and her mother, Maria Rita Clerici.
Guerra died in June 2013 after succumbing to an overdose of insulin, which Taroni had been giving him over a long period of time, after convincing him that he was diabetic.
"From time to time, I feel like killing someone, I need it," she said, according to police recordings.
Cazzaniga was also prosecuted for murdering Taroni's father-in-law Luciano Guerra.
During their investigations, the Italian carabinieri examined the records of around 40 deaths that had taken place on the emergency ward between 2011 and 2014 while Cazzaniga was on duty.
This "blacklist" also included the name of the practitioner's own father, who had died in October 2013, while hospitalised with a terminal illness.
Both Cazzaniga and Taroni have been incarcerated since 2016, and are expected to appeal to the Supreme Court.