H.Gu, M. Halper, J. Geller and Y. Perl,  Benefits of an Object-oriented Database representation for Controlled Medical Terminologies. Journal of the American Medical Informatics Association, 6(4), 283-303, July 1999.

Abstract: Objective: Controlled medical terminologies (CMTs) have been recognized as important tools in a variety of medical informatics applications ranging from patient-record systems to decision-support systems. CMTs are typically organized in semantic network structures consisting of tens to hundreds of thousands of concepts. This overwhelming size and complexity can be a serious barrier to their maintenance and wide-spread utilization. In this paper, we propose the use of object-oriented databases (OODBs) to address the problems posed by the extensive scope and high complexity of most CMTs for maintenance personnel and general user alike.