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I won this card in an internet contest last April. So far I've been very satisfied with temps and performance. As others have pointed out, using MSI Afterburner and editing the cfg file opens this card to respectable OCing.
Mine has been relatively silent, even at full load. As to temps, never...
You mean the top fan next to the CPU cooler? Yes, its exhausting out the top, but I rarely turn it out (its controlled by a fan controller). There is another 120mm fan on top of the optical drive blowing air towards the CPU heatsink fan :)
I have the same PSU running my rig:
Pentium E5200 @ 3.5Ghz
2x2GB DDR2 800
HD5850 1GB
4x HDD
1x ODD
4x 120mm fan
It's stable but I do agree with the answers here that I should go for something better